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13-003 Agreement, 10139 Byrne Avenue, Cupertino APN: 357-11-009AGREEMENT 10139 Byrne Ave, Cupertino CA APN: 357 -11 -009 This AGREEMENT made and entered into this 13"" day of OeCe be-r-, 2012, by and between the CITY OF CUPERTINO, a municipal corporation of the State of California, hereinafter designated as CITY, and Roger C. Smith and Brenda Michelle Gaidies - Smith, husband and wife as community property with right of survivorship hereinafter designated as DEVELOPER. WITNESSETH WHEREAS, the DEVELOPER has made application to the CITY to secure a Building Permit to construct a single family dwelling at the above address hereinafter referred to as "PROJECT ". WHEREAS, CITY hereby approves the improvement plans and specifications prepared for the PROJECT by RI Engineering, Inc., a true copy of which improvement plans and specifications are on file in the office of the City Engineer of Cupertino; and WHEREAS, the same are incorporated herein by reference, the same as though set out in full; NOW, THEREFORE, said improvement plans and specifications shall be hereinafter called the "Plans ", and the work to be done under the Plans shall be called the "Work ". WHEREAS, pursuant to the provisions of this AGREEMENT, the CITY hereby established the amounts of Bonds, Fees, and Deposits as set forth in the following schedule: SCHEDULE OF BONDS, FEES, AND DEPOSITS Street Improvement Category: PART A. Faithful Performance Bond: $9,705.00 110 -2211 PART B. Labor and Material Bond: $9,705.00 110 -2211 PART C. Checking and Inspection Fee: $2,593.00 110 -4538 PART D. Development Maintenance Deposit: $1,000.00 110 -2211 PART E. Storm Drainage Fee — Basin 2 $1,546.58 215 -4072 PART F. Street Light — One -Year Power Cost: N/A 110 -4537 PART G. Map Checking Fee: N/A 110 -4539 PART H. Park Fee: N/A PART I. Reimbursement Fee N/A Page 2 of 10 NOW, THEREFORE, IT IS HEREBY MUTUALLY AGREED by and between the parties hereto as follows, TO WIT: 1. DEDICATION No dedication required. 2. INSTALLATION OF WORK It is further agreed that: A. The DEVELOPER shall install and complete the Work within one (1) year from the date of execution of this AGREEMENT, or such longer period as may be specifically authorized in writing by the City Engineer. In the event the DEVELOPER fails or refuses to complete the Work within the specified period of time, the CITY, at its sole option, shall be authorized to complete the Work in whatever manner the CITY shall decide. In the event the CITY completes the Work, the CITY may recover any and all costs incurred thereby from the DEVELOPER or the DEVELOPER'S surety or both. No final inspection shall be granted or street improvements shall not be accepted unless all the requirements for safety purposes are installed, such as sidewalks, handicap ramps, street lights, etc. B. The DEVELOPER shall install and complete the Work in a good and workmanlike manner in accordance with the plans as approved by the City Engineer of Cupertino. The Work shall be done in accordance with existing ordinances and resolutions of the CITY and in accordance with all plans, specifications, and standards approved by the City Engineer. The Work shall be done in accordance with all State and County Statutes applicable hereto. The decision of the City Engineer shall be final as to whether any material or workmanship meets the plans, specifications, and standards as set forth. C. It is further agreed that the Work shall be done in accordance with the most current Standard Specifications of the Department of Public Works, California Department of Transportation, State of California, and in accordance with the specifications of the Cupertino Sanitary District where applicable. D. Wherever the words "State" or "California Division of Highways" are mentioned in the State Specifications, it shall be consic'.ered as referring to the City of Cupertino; also wherever the "Director" or "Director of Public Works" is mentioned, it shall be considered as referring to the City Engineer. E. In case of conflict between the State Specifications and the specifications of the CITY, and /or the Cupertino Sanitary District, the specifications of the CITY and /or the Cupertino Sanitary District shall take precedence over and be used in lieu of such conflicting portions. Page 3 of 10 3. QUITCLAIM DEED It is further agreed that the DEVELOPER, when requested by the CITY, shall quitclaim all his/her rights and interests in, and shall grant to CITY authorization to extract water from the underground strata lying beneath said project. DEVELOPER agrees to execute a "Quitclaim Deed and Authorization" in J.avor of CITY, when presented to him/her for signature. 4. BONDS AND OTHER SECURITY A. Upon the execution of this AGREEMENT, the DEVELOPER shall file with the CITY a faithful performance bond to assure his/her full and faithful performance of this AGREEMENT. The penal sum of said faithful performance bond is as set forth in Part A of the SCHEDULE OF BONDS, FEES AND DEPOSITS. In the event that improvements are to be made under this AGREEMENT, the DEVELOPER shall, in addition to said faithful performance, file with the CITY, a labor and materials bond in a penal sum as set forth in Part B of the SCHEDULE OF BONDS, FEES AND DEPOSITS. Said bonds shall be executed by a surety company authorized to transact a surety business in the State of California and have been approved by the City Attorney as to form and by the City Engineer as to sufficiency. In the event that the DEVELOPER shall fail to faithfully perform the covenants and conditions of this AGREEMENT, or to make any payment, or any dedication of land, or any improvements herein required, the CITY shall call on the surety to perform this AGREEMENT or otherwise indemnify the CITY for the DEVELOPER'S failure to do SO. B. In lieu of a surety bond, the DEVELOPER may elect to secure this AGREEMENT by depositing with the CITY: i. Cash; or, ii. A cashier's check, or a certified check payable to the order of the City of Cupertino; or, iii. A certificate of deposit, or instrument of credit meeting the requirements of Govermnent Code Section 66499 (b) or (c). C. The amount of said cash, checks, certificate of deposit, or instrument of credit shall be as designated by the City Engineer, and shall be the equivalent to that which would have been required had the DEVELOPER furnished the CITY with a faithful performance surety bond. In the event that the DEVELOPER shall fail to faithfully perform the covenants and conditions of this AGREEMENT, or to make any payment, or any dedication of land, or any improvements herein required, the CITY may apply the proceeds of said security thereto. D. No release of surety bond, cash deposit, check or certificate of deposit shall be made except upon approval of the City Council. Schedule for bond and insurance release for paper bonds are as follows: Page 4 of 10 i. Release of 90 percent of the faithful performance bond upon acceptance by City Council. ii. Release of the remaining 10 percent of the performance bond at one year from acceptance after all deficiencies have been corrected and in the absence of any claim against such bond. iii. Release of the entire labor end material bond at six months from acceptance after all deficiencies have been corrected and in the absence of any claim against such bond. iv. Liability insurance, provided by the DEVELOPER to hold the CITY harmless in the event of liability arising from the project, to be retired at the end of one year if all deficiencies have been corrected and in the absence of any claim against such insurance. 5. CHECKING AND INSPECTION FEE It is further agreed that the DEVELOPER shall pay any and all necessary direct expenses for inspection, checking, etc. incurred by CITY in connection with said Project, and that DEVELOPER shall have deposited with CITY, prior to execution of this AGREEMENT, the amount as set forth herein at Page 2 (Part Q. Should construction cost vary materially from the estimate from which said sum is calculated, the City Engineer shall notify DEVELOPER of any additional sum due and owing as a result thereof. 6. DEVELOPMENT MAINTENANCE DEPOSIT It is further agreed that the DEVELOPER shall pay to the CITY, prior to execution of this AGREEMENT, the amount set forth herein at Page 2 (Part D) as a development maintenance deposit. The deposit may be used at the discretion of the City to correct deficiencies and conditions caused by the DEVELOPER or his/her contractor that may arise during or after the construction of the development. The deposit shall also be used for copies of approved plans for the CITY's files. If the cost exceeds the amount deposited the DEVELOPER is required to pay actual overage prior to return of original plans. Any unexpended amount will be returned to the DEVELOPER at the time all bonds are released in accordance with paragraph 4 of this agreement. 7. STORM DRAINAGE FEE It is further agreed that the DEVELOPER shall deposit with the CITY, prior to execution of this AGREEMENT, a storm drainage charge in connection with the said Project in accordance with the requirements established in Resolution 4422, March 21, 1977, in the amount as set forth herein at Page 2 (Part E). Page 5 of 10 8. STREET LIGHT - ONE YEAR POWER COST It is further agreed that the DEVELOPER shall pay to the CITY, prior to execution of this AGREEMENT, the amount as set forth herein at Page 2 (Part F), which amount represents the power cost for street lights for one year. 9. MAP CHECKING FEE It is further agreed that the DEVELOPER shall deposit with CITY, prior to execution of this AGREEMENT, for office checking of fina:[ map and field checking of street monuments, in compliance with Section 4:1 of Ordinance No. 47 (Revised 12/04/61) of CITY, the amount as set forth herein at Page 2 (Part G). 10. INSTALLATION OF STREET TREES It is further agreed that the DEVELOPER shall, at such time as deemed appropriate by the City Engineer, plant street trees in conformance with the standards of the City of Cupertino. Variety of tree shall be selected from the CITY approved list. 11. PARK FEES It is further agreed that the DEVELOPER shall pay such fees and /or dedicate such land to the CITY, prior to execution of this AGREEMENT, as is required within Section 18- 1.602, Park Land Dedication, Cupertino Municipal Code, and which is further stipulated herein at, Page 2 (Part H). Fees are also in accordance with action adopted by the City Council on March 19, 1991 and Chapter 14.05 or Section 18 -1.602 of the Cupertino Municipal Code. 12. REIMBURSEMENT FEE It is further agreed that the DEVELOPER shall deposit with the CITY, prior to execution of this AGREEMENT, a reimbursement fee for the street improvements that have been installed by the City, or by another property owner. Developer shall pay the City for the cost of the land at the cost to the City, or another property owner, and shall pay a street improvement reimbursement charge for the improvements which the City or another property owner, installed on the street abutting or included in the benefited property, in an amount equal to the total improvement costs for each particular benefited property as set forth in a reimbursement agreement, in the amount as set forth herein at Page 2 (Part I). Payments for both land and improvements shall include simple interest in the amount of seven percent per year, to be calculated in the following manner: A. Land Cost. Interest to accrue from the date the street improvements are accepted by the City to the date the street improvements reimbursement charge is paid, or if the land is purchased by the City for a City project, from the date of purchase to the date the charge is paid. Page 6 of 10 B. Improvement Cost. Interest to accrue from the date the street improvements are accepted by the City to the date the street improvement reimbursement charge is paid, or if installed by the City, from the date installation commenced to the date the charge is paid. C. Provided, however, that the interest shall be waived if the adjoining property owner dedicates or has dedicated to the City land necessary for the street improvements, or where no such dedication is necessary. 13. MAINTENANCE OF WORK It is further agreed that the DEVELOPER shall maintain the Work until all deficiencies in the Work are corrected to conform to the Plans and the City Standards and Specifications for the Work. The DEVELOPER shall, upon written notice thereof, immediately repair or replace, without cost or obligation to the City of Cupertino, and to the entire satisfaction of said CITY, all defects and imperfections arising out of or due to faulty workmanship and /or materials appearing in said Work. 14. SANITARY DISTRICT It is further agreed that the DEVELOPER shall file with the CITY, upon execution of this AGREEMENT, a letter from the Cupertino Sanitary District stating that the DEVELOPER has submitted plans for review by the District and that sanitary sewers are available to serve all lots within said Project. 15. GOVERNMENT COSTS It is further agreed that the DEVELOPER shall file with the CITY, upon execution of this AGREEMENT, substantial evidence that all provisions of Section 66493, Article 8, Chapter 4 of the Government Code, pertaining to special assessments or bonds, have been complied with. 16. PACIFIC GAS AND ELECTRIC/ AT &T It is further agreed that the DEVELOPER shall pay to Pacific Gas and Electric Company and /or to AT &T, any and all fees required for installation of overhead and/or underground wiring circuits to all electroliers within said property and any and all fees required for undergrounding as provided in Ordinance No. 331 of CITY when the DEVELOPER is notified by either the City Engineer or Pacific Gas and Electric Company and /or AT &T that said fees are due and payable. 17. EASEMENTS AND RIGHT -OF -WAY It is further agreed that any easement and right -of -way necessary for completion of the Project shall be acquired by the DEVELOPER at his/her own cost and expense. Page 7 of 10 It is provided, however, that in the event eminent domain proceedings are required, the CITY for the purpose of securing said easement and right -of -way, that the DEVELOPER shall deposit with CITY, a sum covering the reasonable market value of the land proposed to be taken and, to be included in said sum, shall be a reasonable allowance for severance damages, if any. It is further provided that in addition thereto, such sums as may be required for legal fees and costs, engineering, and other incidental costs in such reasonable amounts as the CITY may require, shall be deposited with the City of Cupertino. 18. HOLD HARMLESS It is further agreed that, commencing with the performance of the Work by the DEVELOPER or his/her contractor and continuing until the completion of the maintenance of the Work, the DEVELOPER shall indemnify, hold harmless and defend the CITY from and against any or all loss, cost, expense, damage or liability, or claim thereof, occasioned by or in any way arising out of the performance or nonperformance of the Work or the negligence or willful misconduct of the DEVELOPER or the DEVELOPER'S agents, employees and independent contractors, except to the extent any of the foregoing is caused by the negligence or willful misconduct of the CITY or the CITY'S agents, employees and independent contractors. 19. INSURANCE It is further agreed that: the DEVELOPER shall take out, or shall require any contractor engaged to perform the Work to take out, and maintain at all times during the performance and maintenance of the Work called for or required to be done hereunder, a policy of insurance naming the CITY and members of the City Council of the City of Cupertino individually and collectively, and the officers, agents and employees of the CITY individually and collectively, as insured. Said separate policy shall provide bodily injury and property damage coverage to the foregoing named CITY and individuals covering all the Work performed by, for, or on behalf of said DEVELOPER. Both bodily injury and property damage insurance must be on an occurrence basis; and said policy or policies shall provide that the coverage afforded thereby shall be primary coverage to the full limit of liability stated in the declarations, and i.f the CITY, its members of the City Council individually and collectively, and the officers, agents and employees of the CITY, individually and collectively, have other insurance against the loss covered by said policy or policies, that other insurance shall not be called upon to cover a loss under said additional policy. The insurance carrier shall provide proof of their ratings. All ratings should be Best's Guide Rating of A, Class VII or better or that is acceptable to the CITY. A. Each of said policies of insurance shall provide coverage in the following minimum amounts: for general liability for bodily injury, personal injury and property damage $1,000,000 each occurrence, with an aggregate limit of not less than $2,000,000. Page 8 of 10 B. The DEVELOPER shall file with the City Engineer at or prior to the time of execution of this AGREEMENT by the DEVELOPER such evidence of said foregoing policy or policies of insurance as shall be satisfactory to said City Engineer. Each such policy or policies shall bear an endorsernent precluding the cancellation or reduction in coverage without giving the City Engineer at least ten (10) days advance notice thereof. The CITY shall be shown as additionally insured on a separate "Additional Insured Owners, Lessees or Contractors" (Form A) or (Form B) Endorsement provided along with the evidence of said foregoing policy of policies of Insurance. C. In the event that the Project covered herein should be mutually situated in or affect the area of jurisdiction of a separate municipality or political subdivision of the State of California, the policies of insurance required herein and above shall co -name such municipality or political subdivision and the provision set forth herein and above for the protection of the CITY shall equally apply to municipality and political subdivision. D. DEVELOPER to use City supplied Forms for proof of insurance and endorsements to policy as specified above. 20. MAPS AND /OR IMPROVEMENT PLANS It is further agreed that the CITY shall obtain the following map and /or plans at the DEVELOPER'S expense: A. A mylar blackline and five (5) print, of fully executed parcel map. B. A mylar blackline and twelve (12) prints of fully executed improvement plans. C. A scan in raster format of all executed improvement plans and map. D. One (1) % size prints of fully executed plans and map. The DEVELOPER agrees to pay the CITY from the development maintenance deposit the cost for all prints of plans and maps. If costs exceed the amount deposited the DEVELOPER is required to pay actual overage prior to return of original plans. Page 9 of 10 21. SUCCESSORS This AGREEMENT shall bind the heirs, administrators, executors, successor, assignee and transferees of the DEVELOPERS. The assignment of this AGREEMENT shall not be made without approval by the City Council of the City of Cupertino. IN WITNESS WHEREOF, CITY has caused its name to be hereunto affixed by its Mayor and City Clerk, thereunto duly authorized by resolution of the City Council and said DEVELOPER has hereunto caused their name to be affixed the day and year first above written. Approved as to form: C Yttorney Attach Notary acknowledgement Page 10 of 10 CITY OF CUPERTINO: Mayor City Clerk DEVELOPER: R ger C. Smith J Brenda ich le Gaidies -Smith CALIFORNIA ALL- PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California County of 540T A— CZIW -,A- On J C M&Z Z&t before me, personally appeared 2 O cP f g- C V L. (Here /a -i ,4 K� insert name and tilYe of the who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is /are subscribed to the within instrument and acknowledged to me that he /she /they executed the same in his/her /their authorized capacity(ies), and that by his/her /their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. W. L. PATAKY o .,�;: COW #1873347 z Ss td an ffiCial al. Z '�►' Notary Public - California o ' Santa Clara County ti 1 Of Notary PPOC (Notary Seal) ADDITIONAL OPTIONAL INFORMATION DESCRIPTION OF THE ATTACHED DOCUMENT Auast FN-- leaT a1,elif A-Vt_ (Title or description of attached document) C U e-f tL, itJ o CA- AeA3 ,3S-t - ii 4e9 (Title or description of attached document continued) Number of Pages / 0 Document Date U Alr— ZO 1Z (Additional information) CAPACITY CLAIMED BY THE SIGNER j Individual (s) ��p❑ Corporate Officer (Title) ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other 2008 Version CAPA A2.10.07 800 - 873 -9865 www.Nobu- yClasscs.com INSTRUCTIONS FOR COMPLETING THIS FORM riny acknowledgment completed in California must contain verbiage exactly as cppears above in the notmy section or a separate acknowledgment form must be properly completed and attached to that document. The only exception is if a document is to be recorded outside of California. In .such instances, any alternative ccknowledgment verbiage as may be printed on such a document so long as the verbiage does not require the notary to do something that is illegal for a notary in California (i.e. cern)54ng the authorized capacity of the signer). Please check the abcumenl carefully forproper notarial wording and attach this form if required. • State and County information must be the State and County where the document signer(s) personally appeared before the notary public for acknowledgment. • Date of notarization must be the date that the signer(s) personally appeared which must also be the same date the acknowledgment is completed. • The notary public must print his or her name as it appears within his or her commission followed by a comma and then your tide (notary public). • Print the name(s) of document signer(s) who personally appear at the time of notarization. • lndicale the correct singular or plural forms by crossing off incorrect forms (i.e. Wsheldwj , is /ere) or circling the correct forms. Failure to correctly indicate this information may lead to rejection of document recording. • The notary seal impression must be clear and photographically reproducible. impression mustnot cover text or lines. If seal impression smudges, re -seal if a sufficient area permits, otherwise complete a different acknowledgment form. • Signature of the notary public must match the signature on file with the office of the county clerk. 3 Additional information is not required but could help to ensure this acknowledgment is not misused or attached to a different document. Indicate title or type of attached document, number of pages and date. Indicate the capacity claimed by the signer. if the claimed capacity is a corporate officer, indicate the title (i.e. CEO, CFO, Secretary). • Securely attach this document to the signed document CALIFORNIA ALL - PURPOSE CERTIFICATE OF ACKNOWLEDGMENT State of California. County of 5�-►.s; A- C'c/1-,e,A- On _13 1XCIAM Zott before me, personally appeared J3 i? ("j-A4 %4 tasert tnlatd and title of the officer). Dt'r s -sm IT14 who proved to me on the basis of satisfactory evidence to be. the persons) whose name(s) is/are subscnW to the withia instrument and acknowledged to me that he/she/tey executed the same in hivher/their authorized capacty(ies), and that by hislher/their s' s on the instrument the erson s or file entity ���) P (), upon behalf of which the persons) acted; executed the i st rent. I certify under PENALTY OF PERJURY under the laws of the State of Califomia that the foregoing paragraph is true and correct. W. L. PATAKY F) 14 COMM. $1873347 z z �► - Notary Public - California p ' Santa Clara County 17 aQl3t (Nosy S-) ADDITIONAL DPTION,%_L INFORMATION DESCRE?noN OF THE ATTACHED DOCUMENT A6ftfh f— %c ABU£ ('Title of description of attachod'document) C_ MILDIJO CA XPM 35-1 -11 -coq Mde or csmpdo'n of ettedw doazuiem conduned) Number of Pages i U Document Date 13 P(C 1111 (Additional infomation) CAPASITY CLAIMED By THB SIGNER ��(1J Individual (s) Corporate Officer ❑ Partner(s) ❑ Attorney -in -Fact ❑ Trustee(s) ❑ Other INSTRi)MONS FOR COMPLETING -TfUS FORM �rrlarowTedg et cvorX&W .ia Cali. a must -nwh l� t ezat:rlY a: oppeard 40— in the notary section - a 3W.—le ock-4 l -W form nm& be P'nPe fy cawktsd and' attached to that docwwi. 77re only areptton is Ora dac WWO Js lo be recorded oumhte &fC 1 jofflfa 14 arch hWUMeK +any aiW7100 re oebiowledgmait as mso be prbded tiri such a hUela tw sD long ar the verbiage doge not regttir a ilia notary to do.i6werrbrg dud is XW, fc*- a. notary in i:'alifornia (te. aer7iwgg. the awhorized ?capac7o of the.sfper). Please cheek the docuaeni YJaa" Pry wnotorlcriwor ,6gondo9ochthisform1'mph rA • Stet a and. Cottmy mfotraUoa. naisf be the State and Cooney where• the document signefO)Pm"uklly blkfbre. theaotatypub licforaelinowledgment • Date of nasalization mast.be the date. that die si Jams ) Ply appeared which muMatso be the same date.theaclmovaiod at is completed. 7be' nobly public most ptikit his or hk,pama as it appem. within his or tier eonarriaeion followed by a ooh and tltpn:your iiUc {notary public). • Prict the name(s) of doeuasem signor a) who personally hppcar at the burn of notbiizattbu. • Indicate the singular or piural.'brms by crossing off incorrect forms (i.e. Tudshdg)ey=is:lase.) or circling.thaLcorregttxmL Failure to omedly indicate this information may lead to rejection ofdocamaut recording. • The notary seal impression mast be clear and photographically ralmduer'ble Lnpnxaion musR nrd cover text or lines If ' baprescion smtfges, re -seal if a suffi cieru M Permits, 9d=wif4 egtuplefea different admowlodgment form-. • Signature of the notary pubtic must match the signature on file witti situ office of the rotuity cledc. 4• Additional information is net requited but could help to emum this aeiumwledgment is uOt misnsod or anaclhe4to a different document. + Indicate title or type of attached document, number ofpegm and date. 6 Indicate Use capacity claimed by the sigtter. if the claimed capacity is s corporate officer; indicate the tide (i.e. CEO, CFO, secretary), • $rxurcly attach Htis docutnptt to the signed document 0 CALIFORNIA ALL - PURPOSE ACKNOWLEDGMENT State of California County of Soh 4-.1 C /et CIVIL CODE § 1189 On 4h . L 3 i--a /-? before me, Put) Date Here Insert Name and Title of the Off- ices personally appeared C.— -, -, ,�� 4 „ n ems, Na e(s) of Signer(s) who proved to me on the basis of satisfa s ory evidence to be the person(s) whose name( i are subscribed to th within instrument and acknowledged to me that ( hP he /they executed the same in fler /their authorized capacity(i and that by )er /their signatureW on tl5e instrument the person(), or the entity upon behalf of which the person(g) acted, executed the instrument. KIRSTEN RENEE SGUARCIA I certify under PENALTY OF PERJURY under the Commission 0 1906898 laws of the State of California that the foregoing -: Notary Public - California paragraph is true and correct. Santa Clara County My Comm. Expires Oct 4, 2014 WITNESS my hand and official seal. . yy,,22 Sigriatum��-t�=-•- Place Notary Seal Above Signature of Notary Puliric OPTION) L Though the information below is not required by law, it may prove valuable to persons relying on the document and could prevent fraudulent removal and reattachment of this form to another document. Description of Attached Document Title or Type of Document: 14ap« -A. /0/39 /q,-Al': 3S'7- 9 Document Date: 2,/ 2_ Number of Pages: / Signer(s) Other Than Named Above: Capacity(ies) Claimed by Signer(s) Signer's Name: ❑ Corporate Officer — Title(s): ❑ Individual ❑ Partner—[] Limited ❑ General Top of thumb here ❑ Attorney in Fact ❑ Trustee ❑ Guardian or Conservator ❑ Other: Signer Is Representing: Signer's Name: -1 Corporate Officer— Title(s): -1 Individual M. Partner — ❑ Limited ❑ General Top of thumb here -1 Attorney in Fact -1 Trustee -1 Guardian or Conservator -1 Other: Signer Is Representing: 0 2010 National Notary Association - NationalNotary.org - 1- 800 -US NOTARY (1 -800- 876 -6827) Item #5907 ZICOVI1 OP ID: JT ACORO" �, CERTIFICATE OF LIABILITY ILITY INSURANCE DATE (MM /DD/YYYY) 02/25/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED .REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the `fernis and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate.fiolder in lieu of such endorsement(s). PRODUCER`,•'.. 4,.L, ::Phone: 408-288-6262 CONTACT .. _ ,.. .. ... :'.•i.. "_.. , . , ' -.:. ,, - ' Leavitt Pacific, Ins. Brokers L_icense•#OD79674: ; : Fax: 408- 298 -7635 1330 S. Bascom Ave ? =� r -- �+, San Jose, CA 95128 Jeffrey N Aber _ _ _ " PHONE FAX, _(A /C,.No, E :t):- -- — - __ s- I, r_' _, _ (AIC; No): _ _ _ -- -.— E -MAIL ? ADDRESS: :.,, ., t. • INSURER(S) AFFORDING. RAGE' —,.; I NAIL #; -• _ INSURERA:Colony Insurance•Company 39993 "' INSURED Zicovich Builders, Inc. Compensation Ins'. Fund , 135076 17510 Farley Road W Los Gatos, CA 95030 _INSURERB:State INSURER C:Unigard insurance Company 125747 103GL000089200 09/13/2013 D: DAMAGE TO RENTED PREMISES (Ea .occurrence) _INSURER INSURER E: —�� CLAIMS -MADE OCCUR INSURER. F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION of ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE INSR SUBD POLICY NUMBER MM/ DY/YYYY I MM DDY/YYYY I LIMITS GENERAL LIABILITY _ EACH OCCURRENCE 1 $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY X 103GL000089200 09/13/2013 09/13/2014 DAMAGE TO RENTED PREMISES (Ea .occurrence) $' 100,00 —�� CLAIMS -MADE OCCUR MED'EXP (Anyoneperson) $ 5,00 PERSONAL 8& ADV INJURY _ $ `1,000ioo X Owner/Cont Prot. _ _ - _ X Blkt Addt'I Insd GENERAL.. AGGREGATE. 1 $ 2,000;00 _ - _ P- RODUCTS - .COMP /OP AGG $ _ 2,000,00 tEN L AGGREGATE LIMIT APPLIES PER: i� PRO- } .{ C,C AUTOMOBILE LIABILITY ? . 'ANY AUTO - - i - - t PX810680 . - - 09/10/2013 09/10/2014 [COMBINED SINGLE LIMIT (Ea acciden) $ 1 000,00 BODILY INJURY (Per person) 1 $ _ BODILY-INJURY (Per accident) $ —' t ALL "OWNED , SCHEDULED;. ' AUTO S' X' AUTOS rX 1 HIRED AUTOS XJ AUTOS ED - i (per accident ) AMAGE I $ A X UMBRELLA LIAB X OCCUR EXCESS.LIAB CLAIMS -MADE XS169712 09/13/2013 09/13/2014 1 EACH OCCURRENCE $ 1,000,00 I AGGREGATE $ 1,000,00 �I DED I RETENTION $ I 1 $ WORKERSCOMPENSATION _ WC STATU- I X LTORY 1 B AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE YIN N OFFICER /MEMBER EXCLUDED? (Mandatory NH) N/ A 90480372014 03/10/2014 I 03/10/2015 LIMITS _L R 1 E.L. EACH ACCIDENT 1 $ 1,000,00 I E.L. DISEASE - EA EMPLOYEE $ 1,000,00 ' =:L, DISEASE - POLICY LIMiT"] $ 1,000,00 - If yes, describe under DESCRIPTION.OF OPERATIONS below _! — -- - DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks - Schedule, if more space is required) Re: Smith Residence, 10139 Byrne Ave,, Cupertino, CA. The City of Cupertino, & its directors, officers, engineer, agents & employees, and all public agencies from whom permits will be obtained & their d:rectors, officers, engineers, agents & employees are named as additional insured per U156P -0310 when required by written contract. CFRTIFICATF HOLDER CANCELLATION CUPER10 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Cupertino THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Dept 10300 Torre Ave. AUTHORIZED REPRESENTATIVE Cupertino, CA 95014 © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 103 GL 0000892 -00 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) (Additional Insured): Location(s) of Covered Operations: _ All persons or organizations as required by written As designated in written contract with the Named contract with the Named Insured Insured A. SECTION II -*WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule for whom you are performing operations when you and such erson-- or- orga4a4z- ataon- have - agreed -in - writing- •in- .a-con ,tract or agreement that sucfh _person -or_ organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury "; "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. ---- B- .-- VVith- respect to- the-insurance- afforded to- those additional- . insureds; the "following - additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "Bodily injury" or 'property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations at Work "Bodily injury" or "property damage" occurring after: .._AII work,_ including _materials,_parts_or_equipment_ furnished in connection with_suCh_wo.rk,_o.n the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or U156P- 0310 Includes copyrighted material of ISO Properties; Inc., Page 1 of 2 with its permission. 103 GL 0000892 -00 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. Negligence of Additional Insured "Bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional insured(s). C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is amended and the following added: The insurance afforded by this Coverage Part for the additional insured shown in the Schedule is primary insurance and we will not seek contribution from any other insurance available to that additional insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U156P -0310 Includes copyrighted material of ISO Properties, Inc.. Page 2 of 2 with its permission.