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13-008 Gallaher Company for Concrete Removal at Hoover and Three Oaks Parks / OFFICE OF THE CITY CLERK �• CITY HALL 10300 TORRE AVENUE •CUPERTINO, CA 95014-3255 TELEPHONE: (408)777-3223• FAX: (408)777-3366 � WEBSITE:www.cupertino.org CUPERTINO February 7, 2013 Gallaher Company 927 Linda Vista Street San Jose, CA 95127 An original copy of your agreement with the City of Cupertino is enclosed. If you have any questions or need additional information, please contact the Public Works department at (408) 777-3354. Sincerely, 0 Brittany Care( ` Senior Office Assistant City of Cupertino Enclosure cc: Public Works AGREEMENT BETWEEN THE CITY OF CUPERTINO AND GALLAHER COMPANY FOR CONCRETE REMOVAL AT HOOVER AND THREE OAKS PARKS O pc71 - TH REEMENT, for reference dated January 7th, 2013 is by and between CITY OF CUPERTINO, a municipal corporation (hereinafter referred to as "City"), and Gallaher Company, a California corporation whose address is 92 n'rEida7Vigta Street San Jose Ca., 95127 hereinafter called the Contractor, and is made with reference to the following: RECITALS: A. City is a municipal corporation duly organized and validly existing under the laws of the State of California with the power to carry on its business as it is now being conducted under the Constitution and the statutes of the State of California and the Cupertino Municipal Code. B. City and Contractor desire to enter into an agreement for Concrete Removal at Hoover and Three Oaks Parks per Exhibit "A", in accordance with the proposal dated December 20th, 2012. NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as follows: 1. TERM: The Contractor shall begin work within ten(10) calendar days after receiving notice from the Grounds Supervisor to commence the work, and shall diligently prosecute the work to completion before the expiration of fifteen (15) consecutive working days from the date of receipt of notice to begin work. 2. SERVICES TO BE PERFORMED: Contractor agrees, at its own cost and expense, to furnish all labor, tools, equipment, materials, except as otherwise specified, and to do all work strictly in accordance with the proposal (exhibit "A") dated December 20th, 2012 hereby referred to and expressly made a part hereof with the same force and effect as if the same were fully incorporated herein. 3. COMPENSATION TO CONTRACTOR: Contractor shall be compensated for services performed pursuant to this Agreement in the amount and manner set forth in Contractor's proposal, which is attached hereto as Exhibit "A" and incorporated herein by this reference. Payment will be made in the same manner that claims of a like character are paid by the City,with checks drawn on the treasury of the City,to be taken from the general fund. 1 4. TIME IS OF THE ESSENCE: Contractor and City agree that time is of the essence regarding the performance of this Agreement. 5. STANDARD OF CARE: Contractor agrees to perform all services hereunder in a manner commensurate with the prevailing standards of like professionals in the San Francisco Bay Area and agrees that all services shall be performed by qualified and experienced personnel who are not employed by the City nor have any contractual relationship with City. 6. INDEPENDENT PARTIES: City and Contractor intend that the relationship between them created by this Agreement is that of employer-independent contractor. The manner and means of conducting the work are under the control of Contractor, except to the extent they are limited by statute, rule or regulation and the express terms of this Agreement. No civil service status or other right of employment will be acquired by virtue of Contractor's services. None of the benefits provided by City to its employees, including but not limited to unemployment insurance, workers' compensation plans, vacation and sick leave are available from City to Contractor, its employees or agents. Deductions shall not be made for any state or federal taxes, FICA payments, PERS payments, or other purposes normally associated with an employer-employee relationship from any fees due Contractor. Payments of the above items, if required, are the responsibility of Contractor. 7. IMMIGRATION REFORM AND CONTROL ACT (IRCA): Contractor assumes any and all responsibility for verifying the identity and employment authorization of all of its employees performing work hereunder, pursuant to all applicable IRCA or other federal, or state rules and regulations. Contractor shall indemnify and hold City harmless from and against any loss, damage, liability, costs or expenses arising from any noncompliance of this provision by Contractor. 8. NON-DISCRIMINATION:, Consistent with City's policy that harassment and discrimination are unacceptable employer/employee conduct, Contractor agrees that harassment or discrimination directed toward a job applicant, a City employee, or a citizen by Contractor or Contractor's employee on the basis of race, religious creed, color, national origin, ancestry, handicap, disability, marital status, pregnancy, sex, age, or sexual orientation will not be tolerated. Contractor agrees that any and all violations of this provision shall constitute a material breach of this Agreement. 9. HOLD HARMLESS: Contractor shall, to the fullest extent allowed by law, indemnify, defend, and hold harmless the City and its officers, officials, agents, employees and volunteers against any and all liability, claims, stop notices, actions, causes of action or demands whatsoever from and against any of them, including any injury to or death of any person or damage 2 to property or other liability of any nature, arising out of, pertaining to, or related to the performance of this Agreement by Contractor or Contractor's employees, officers, officials, agents or independent contractors. Contractor shall not be obligated under this Agreement to indemnify City to the extent that the damage is caused by the sole negligence or willful misconduct of City, its agents or employees. Such costs and expenses shall include reasonable attorneys' fees of counsel of City's choice, expert fees and all other costs and fees of litigation. Contractor agrees to obtain executed indemnity agreements with provisions identical to those set forth here in these sections from each and every subcontractor or any other person or entity involved by, for, with, or on behalf of Contractor in the performance of this agreement. If Contractor fails to obtain such indemnity obligations from others as required here, Contractor agrees to be frilly responsible according to the terms of this section. 10. INSURANCE: On or before the commencement of the terms of this Agreement, Contractor shall furnish City with certificates showing the type, amount, class of operations covered, effective dates and dates of expiration of insurance coverage in compliance with paragraphs 10A, B, C and D. Such certificates, which do not limit Contractor's indemnification, shall also contain substantially the following statement: "Should any of the above insurance covered by this certificate be canceled or coverage reduced before the expiration date thereof, the insurer affording coverage shall provide thirty (30) days' advance written notice to the City of Cupertino by certified mail, "Attention: City Manager." It is agreed that Contractor shall maintain in force at all times during the performance of this Agreement all appropriate coverage of insurance required by this Agreement with an insurance company that is acceptable to City and licensed to do insurance business in the State of California. Endorsements naming the City as additional insured shall be submitted with the insurance certificates. A. COVERAGE: Contractor shall maintain the following insurance coverage: (1) Workers' Compensation: Statutory coverage as required by the State of California. (2) Liability: Commercial general liability coverage in the following minimum limits: Bodily Injury: $1,000,000 each occurrence $2,000,000 aggregate - all other Property Damage: $500,000 each occurrence $1,000,000 aggregate If submitted, combined single limit policy with aggregate limits in the amounts of $2,000,000 will be considered equivalent to the required minimum limits shown above. (3) Automotive: Comprehensive automobile liability coverage in the following minimum limits: Bodily injury: $500,000 each occurrence Property Damage: $500,000 each occurrence or Combined Single Limit: $1,000,000 each occurrence B. SUBROGATION WAIVER: Contractor agrees that in the event of loss due to any of the perils for which it has agreed to provide comprehensive general and automotive liability insurance, Contractor shall look solely to its insurance for recovery. Contractor hereby grants to City, on behalf of any insurer providing comprehensive general and automotive liability insurance to either Contractor or City with respect to the services of Contractor herein, a waiver of any right to subrogation which any such insurer of said Contractor may acquire against City by virtue of the payment of any loss under such insurance. C. FAILURE TO SECURE: If Contractor at any time during the term hereof should fail to secure or maintain the foregoing insurance, City shall be permitted to obtain such insurance in the Contractor's name or as an agent of the Contractor and shall be compensated by the Contractor for the costs of the insurance premiums at the maximum rate permitted by law and computed from the date written notice is received that the premiums have not been paid. D. ADDITIONAL INSURED: City, its City Council, boards and commissions, officers, employees, and volunteers shall be named as an additional insured under all insurance coverages, except worker' s compensation insurance. The naming of an additional insured shall not affect any recovery to which such additional insured would be entitled under this policy if not named as such additional insured. An additional insured named herein shall not be held liable for any premium, deductible portion of any loss, or expense of any nature on this policy or any extension thereof. Any other insurance held by an additional insured shall not be required to contribute anything toward any loss or expense covered by the insurance provided by this policy. E. SUFFICIENCY OF INSURANCE: The insurance limits required by City are not represented as being sufficient to protect Contractor. Contractor is advised to consult Contractor's insurance broker to determine adequate coverage for Contractor. 11. BONDS: Contractor is not required to provide bonds. 12. PROHIBITION AGAINST TRANSFERS: Contractor shall not assign, sublease, hypothecate, or transfer this Agreement, or any interest therein, directly or indirectly, by operation of law or otherwise, without prior written consent of City. Any attempt to do so without said consent shall be null and void, and any assignee, sublessee, hypothecate or transferee shall acquire no right or interest by reason of such 4 attempted assignment, hypothecation or transfer. However, claims for money by Contractor from City under this Agreement may be assigned to a bank, trust company or other financial institution without prior written consent. Written notice of such assignment shall be promptly furnished to City by Contractor. The sale, assignment, transfer or other disposition of any of the issued and outstanding capital stock of Contractor, or of the interest of any general partner or joint venturer or syndicate member or cotenant, if Contractor is a partnership or joint venture or syndicate or cotenancy, which shall result in changing the control of Contractor, shall be construed as an assignment of this Agreement. Control means fifty percent (50%) or more of the voting power of the corporation. 13. SUBCONTRACTOR APPROVAL: Unless prior written consent from City is obtained, only those people and subcontractors whose names are listed in Contractor's bid shall be used in the performance of this Agreement. Requests for additional subcontracting shall be submitted in writing, describing the scope of work to be subcontracted and the name of the proposed subcontractor. Such request shall set forth the total price or hourly rates used in preparing estimated costs for the subcontractor's services. Approval of the subcontractor may, at the option of City, be issued in the form of a Work Order. In the event that Contractor employs subcontractors, such subcontractors shall be required to furnish proof of workers' compensation insurance and shall also be required to carry general and automobile liability insurance in reasonable conformity to the insurance carried by Contractor. In addition, any work or services subcontracted hereunder shall be subject to each provision of this Agreement. 14. PERMITS AND LICENSES: Contractor, at its sole expense, shall obtain and maintain during the term of this Agreement, all appropriate permits, certificates and licenses, including a City Business License, that may be required in connection with the performance of services hereunder. 15. REPORTS: Each and every report, draft, work product, map, record and other document reproduced, prepared or caused to be prepared by Contractor pursuant to or in connection with this Agreement shall be the exclusive property of City. Consultant may retain a copy of any report furnished to the City pursuant to this Agreement. No report, information nor other data given to or prepared or assembled by Contractor pursuant to this Agreement shall be made available to any individual or organization by Contractor without prior approval by City. Contractor shall, at such time and in such form as City may require, furnish reports concerning the status of services required under this Agreement. 16. RECORDS: 5 Contractor shall maintain complete and accurate records with respect to sales, costs, expenses, receipts and other such information required by City that relate to the performance of services under this Agreement. Contractor shall maintain adequate records of services provided in sufficient detail to permit an evaluation of services. All such records shall be maintained in accordance with generally accepted accounting principles and shall be clearly identified and readily accessible. Contractor shall provide free access to such books and records to the representatives of City or its designees at all proper times, and gives City the right to examine and audit same, and to make transcripts there from as necessary, and to allow inspection of all work, data, documents, proceedings and activities related to this Agreement. Such records, together with supporting documents, shall be kept separate from other documents and records and shall be maintained for a period of three (3) years after receipt of final payment. If supplemental examination or audit of the records is necessary due to concerns raised by City's preliminary examination or audit of records, and the City's supplemental examination or audit of the records discloses a failure to adhere to appropriate internal financial controls, or other breach of contract or failure to act in good faith, then Contractor shall reimburse City for all reasonable costs and expenses associated with the supplemental examination or audit. 17. NOTICES: All notices, demands, requests or approvals to be given under this Agreement shall be given in writing and conclusively shall be deemed served when delivered personally or on the second business day after the deposit thereof in the United States Mail, postage prepaid, registered or certified, addressed as hereinafter provided. All notices, demands, requests, or approvals from Contractor to City shall be addressed to City at: City of Cupertino 10555 Mary Avenue Cupertino CA 95014 Attention: John Bisely All notices, demands, requests, or approvals from City to Contractor shall be addressed to Contractor at: Gallaher Company 927 Linda Vista Street San Jose, 95127 18. URBAN RUNOFF MANAGEMENT: The Contractor shall avoid creating excess dust when breaking asphalt or concrete and during excavation and grading. If water is used for dust control, contractor shall use as little as necessary. Contractor shall take all steps necessary to keep wash water out of the streets, gutters and storm drains. The Contractor shall develop and implement erosion and sediment control to prevent pollution of storm drains. Such control includes but is not limited to: A. Use storm drain inlet protection devices such as sand bag barriers, filter fabric fences, block and gravel filters. (Block storm drain inlets prior to the start of the rainy season (October 15), in site de-watering activities and saw-cutting activities; shovel or vacuum saw-cut slurry and remove from the site). B. Cover exposed piles of soil or construction material with plastic sheeting. All construction materials must be stored in containers. C. Sweep and remove all materials from paved surfaces that drain to streets, gutters and storm drains prior to rain as well as at the end of the each work day. At the completion of the project, the street shall be washed and the wash water shall be collected and disposed of offsite in an appropriate location. D. After breaking old pavement, Contractor shall remove all debris to avoid contact with rainfall or runoff. E. Contractor shall maintain a clean work area by removing trash, litter, and debris at the end of each work day. Contractor shall also clean up any leaks, drips, and other spills as they occur. The objective is to ensure that the City and County of Santa Clara County-Wide Clean Water Program is adequately enforced. These controls should be implemented prior to the start of construction, up-graded as required, maintained during construction phases to provide adequate protection, and removed at the end of construction. These recommendations are intended to be used in conjunction with the States Best Management Practices Municipal and Construction Handbooks, local program guidance materials from municipalities, Section 7.1.01 of the Standard Specifications and any other appropriate documents on storm water quality controls for construction. Failure to comply with this program will result in the issuance of noncompliance notices, citations, project stop orders or fines. The fine for noncompliance of the above program is two hundred and fifty dollars ($250.00) per occurrence per day. The State under the Federal Clean Water Act can also impose a fine on the contractor, pursuant to Cal. Water Code ' 13385. 19. TERMINATION: In the event Contractor fails or refuses to perform any of the provisions hereof at the time and in the manner required hereunder, Contractor shall be deemed in default in the performance of this Agreement. If such default is not cured within a period of two (2) days after receipt by Contractor from City of written notice of default. specifying the nature of such default and the steps necessary to cure such default, City may terminate the Agreement forthwith by giving to the Contractor written notice thereof. City shall have the option, at its sole discretion and without cause, of terminating this Agreement by giving seven (7) days' prior written notice to Contractor as provided herein. Upon termination of this Agreement, each party shall pay to the other party that portion of compensation specified in this Agreement that is earned and unpaid prior to the effective date of termination. 20. COMPLIANCES: Contractor shall comply with all laws, state or federal and all ordinances, rules and regulations enacted or issued by City. 21. CONFLICT OF LAW: 7 This Agreement shall be interpreted under, and enforced by the laws of the State of California excepting any choice of law rules which may direct the application of laws of another jurisdiction. The Agreement and obligations of the parties are subject to all valid laws, orders, rules, and regulations of the authorities having jurisdiction over this Agreement (or the successors of those authorities). Any suits brought pursuant to this Agreement shall be filed with the courts of the County of Santa Clara, State of California. 12. ADVERTISEMENT: Contractor shall not post, exhibit, display or allow to be posted, exhibited, displayed any signs, advertising, show bills, lithographs, posters or cards of any kind pertaining to the services performed under this Agreement unless prior written approval has been secured from City to do otherwise. 23. WAIVER: A waiver by City of any breach of any term, covenant, or condition contained herein, shall not be deemed to be a waiver of any subsequent breach of the same or any other term, covenant, or condition contained herein, whether of the same or a different character. 24. INTEGRATED CONTRACT: This Agreement represents the full and complete understanding of every kind or nature whatsoever between the parties hereto, and all preliminary negotiations and agreements of whatsoever kind or nature are merged herein. No verbal agreement or implied covenant shall be held to vary the provisions hereof. Any modification of this Agreement will be effective only by written execution signed by both City and Contractor. 25. SAFETY REQUIREMENT All work performed under this Agreement shall be performed in such a manner as to provide safety to the public and to meet or exceed the safety standards outlined by CAL-OSHA. City reserves the right to issue restraints or cease and desist orders to Contractor when unsafe or harmful acts or conditions are observed or reported relative to the performance of the work under this Agreement. Contractor shall maintain the work sites free of hazards to persons and/or property resulting from his or her operations. Any hazardous condition noted by Contractor, which is not a result of his or her operations, shall immediately be reported to City. 26. HOURS OF OPERATION Contractor shall be allowed to operate only for the hours of 7:00 a.m. to 3:30 p.m. unless prior written approval has been secured from City to do otherwise. 27. REQUIREMENT TO PAY PREVAILING WAGES 8 Consistent with the City's policy to pay prevailing wage rates, Contractor shall comply with the City's Labor Compliance Program and all other requirements set forth in Labor Code section 1770 et seq. The City shall require payment of the general rate of per diem wages or the general rate of per diem wages for holiday and overtime work. Contractor will submit (monthly or biweekly) certified payroll records to the City for all employees and subcontractors in a preapproved format or a City provided form. Any delay in remitting certified payroll reports to the City upon request from the City will result in either delay and/or forfeit of outstanding payment to Contractor. 28. INSERTED PROVISIONS: Each provision and clause required by law to be inserted into the Agreement shall be deemed to be enacted herein, and the Agreement shall be read and enforced as though each were included herein. If through mistake or otherwise, any such provision is not inserted or is not correctly inserted, the Agreement shall be amended to make such insertion on application by either party. 9 29. CAPTIONS: The captions in this Agreement are for convenience only, are not a part of the Agreement and in no way affect, limit or amplify the terms or provisions of this Agreement. IN WITNESS WHEREOF, the parties have caused the Agreement to be executed on the day and year first above written. CONTRACTOR CITY OF CUPERTINO "CONTRACTOR NAME" A Municipal'. Corporation By B y Title CT6 Title ► - : 62-5 Date (-Zr- 3 Date ` ( Soc. Sec. #or Tax I.D. Z--2 y cc -y BCOMMEND ORPROyL: //, Title S�srlo�/ <<Z/e„i df ri�iG APPROVED AS TO FORM: c/7 frYCity Attorney ATTEST: G4/94_C 'lam' City_Clerk ovt-Irrac.-t' 4vvio✓..- r No{• - ExCCCOQ sae,80o.90 Arto„.,‘4- : ( I o - 931'{- 9300 /rz)(41 10 Exhibit "A" Gallaher Company Estimate 927 Linda Vista St San Jose,CA 95127 Date Estimate# Bus. (866) 918-1199 Fax(408) 521-0101 12/20/2012 967 • robert @gallaherco.com www.GallaherCo.com License#946359 Name/Address Project Name City of Cupertino 1.)Hoover Park Leeds Ave near Primrose 2.) Three Trees Park Cupertino CA Concrete Work P.O.No. Terms Estimate Expires Net 30 1/19/2013 Description Total Price for labor and materials to perform the following at Hoover Park: 23,200.00 Demo concrete "shelf/step" going into play area. Step is approximately 12 inches deep. It will be core drilled with 4 inch holes every 5 inches to provide a breaking joint. Remaining concrete will be chipped off to leave a flat edge. Demo concrete sidewalk going around playground concrete ring. Includes demo and haul away of rocks. Includes demo of small slap extending step near rocks. Concrete pad where park bench is located will remain. Concrete and debris will be hauled off and dumped at the Cupertino City Maintenance yard. Excludes landscaping. Price for labor and materials to perform the following at Three Trees Park. 5,600.00 Saw cut and remove six foot section of concrete curb where rocks are poured into place. Haul away debris and concrete and dump at the Cupertino City Maintenance yard. Repour section of curb with rebar doweled. Excludes landscaping. This Proposal excludes everything not mentioned above. Total $28,800.00 Gallaher Company will provide labor and materials required as per the scope of work for the above mentioned project. This work will be performed in a professional manner according to industry standards. Signature ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 44q.""---, 09/27/12 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 WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Gary Seki NAME: ry 9ahama MKS Insurance Services fvco .No.Ext): (800)895-6915 FAx 101 Parkshore Dr.Ste 100#500 �ADDREsIL s, 9 ry�a mks insurance.com I ( No): (866)894-7354 Folsom,CA 95630 _ INSURER(S)AFFORDING COVERAGE NAIC# Phone (800)895-6915 Fax (866)894-7354 INSURER A: Liberty Surplus Insurance Company INSURED INSURER 8: Wesco Insurance Company Gallaher Company INSURER C: National Union Fire Company of Pittsburgh,PA 927 Linda Vista Way INSURER D: Everest Indemnity Insurance Company San Jose,CA 95127 INSURER E _ INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) UNITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000.00 GE TO 0 COMMERCIAL GENERAL LIABILITY PREMISES(Ea RENTED $ 50,000.00 0 ❑ CLAIMS-MADE Q OCCUR TCP000139-02123 MED EXP(Any one person $ 5,000.00 A ❑ PERSONAL&ADVINJURY $ 1,000,000.00 ❑ GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000.00 0 POLICY ❑ PRO- ❑ LOC $ JFCT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000.00 (Ea accident) $ 0 ANY AUTO BODILY INJURY(Per person) $ B ❑ AUTOS NED ❑ SCHEDULED N N WPA1031937-01 10/07/2012 10/07/2013 BODILY INJURY(Per accident) $ Q HIRED AUTOS © NON-OWNED PROPERTY DAMAGE $ (Per accident) ❑ LI $ O UMBRELLA LIAB 0 OCCUR EACH OCCURRENCE $ 1,000,000.00 EXCESS LIAB BE0346064671 C ❑ ❑CLAIMS-MADE Y Y 09/27/2012 09/27/2013 AGGREGATE $ 1,000,000.00 ❑ DED ❑ RETENTION$ $OTH WORKERS COMPENSATION 0 TORY L STATU- ❑ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE 7600007873121 E.L.EACH ACCIDENT $ 1,000,000.00 D OFFICER/MEMBER EXCLUDED? N I A Y 09/27/2012 09/27/2013 (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000.00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000.00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Service&Repair work CERTIFICATE HOLDER CANCELLATION 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. 10300 Torre Avenue Cupertino,CA 95014-3202 AUTHORIZED REPRESENTATIVE Attn:John Bisely /� [� de4U�~" ..2-- ijohnb@cupertino.org ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105)QF The ACORD name and logo are registered marks of ACORD AWRQ, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) ,- 08/09/12 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 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). _ CONTACT Jared Brown PRODUCER NAhIE: MKS Insurance Services tide No.Eati: (800)895-6915 1(FV,Noy. (866)8947354 101 Parkshore Dr.Ste 100#500 ADC RESS: jared@mks-insurance.com Folsom,CA 95630 -_ INSURER(S)AFFORDING COVERAGE NAIC k Phone (800)895-6915 Fax (866)894-7354 INSURER A: Liberty Surplus Insurance Company INSURED INSURER B: Wesco Insurance Company Gallaher Corporation INSURER C: National Union Fire Company of Pittsburgh.PA 927 Linda Vista Way INSURER D: Everest Indemnity Insurance Company INSURER E: San Jose,CA 95127 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE.POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER _ (MM/DD/YYYY) (MM/DDIYYYY) GENERAL UABIUTY EACH OCCURRENCE 5 2,000.000.00 DAMAGE TO RENTED 50,000.00 !v 9 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ VI , 1 CLAIMS-MADE I�Ji OCCUR TCP000139-0111 MED EXP(Any one person $ 5,000.00 A j 11 09/27 /2012 PERSONAL a ADV INJURY $ 1,000,000.00 --- GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG S 2,000,000.00 I I PRO- L S U POLICY .__ JET L.__ LOC COMBINED SINGLE UMIT AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000.00 v/l ANY AUTO BODILY INJURY(Per person) $ ALL OWNED --- SCHEDULED WP P1028297 00 BODILY INJURY(Per accident) 5 B AUTOS AUTOS N N 10/07/2011 10/07/2012 NON-OWNED PROPERTY DAMAGE $ L . HIRED AUTOS AUTOS (Per accident) [I I i _ $ —. UMBRELLA LIAB j■ OCCUR EACH OCCURRENCE $ 1,000,000.00 EBU02739105 C .J] EXCESS LIAB I__l CLAIMS-MADE Y Y 09/27/2011 09/27/2012 AGGREGATE $ 1,000,000.00 DED L RETENTION$ _. r- _ $ WORKERS COMPENSATION Ll TORY LIMITS .71 ERH AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE 7600007873111 E L EACH ACCIDENT $ 1,000,000.00 D OFFICER/MEMBER EXCLUDED? I N/A Y 09/27/2011 09/27/2012 (Mandatory in NH) E L.DISEASE-EA EMPLOYE s 1,000.000.00 If yes,describe under E.L.DISEASE-POLICY LIMIT S 1,000,000.00 DESCRIPTION OF OPERA-IONS below — _ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Sequoia Equities,Inc.Go Registry Monitoring Insurance Services,Inc.,and Mill Springs Park Apartment Homes,1809 Railroad Avenue,Livermore,CA,94550- Legal Entity:Sequoia Equities-Mill Springs,a California Limited Partnership are named as an additional insured's on the General Liability policy. Includes Primary&Non-Contributory wording and Waiver of Subrogation. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Sequoia Equities,Inc. THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PR c/o Registry Monitoring Insurance Services,Inc. 5703 Corsa Avenue,1st Floor AUTHORIZED REPRESENTATIVE Westlake Village,CA 91362 I 4,01/ ©1988-2010 ACO'• CORPORATION. All rights reserved. ACORD 25(2010/05)QF The ACORD name and logo are registered marks of ACORD n Ott , orpE ration Commercial General Liability LIBERTY SURPLUS INSURANCE CORPORATION (A New Hampshire Stock Insurance Company,hereinafter the"Insurer") Named Insured: Gallaher Corporation Policy Number: TCP000139-0212 Effective Date: 9/27/2012 THIS ENDORSEMENT CHANGES THE:POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS COMPLETED OPERATIONS SCHEDULE Name of Person or Organization: BLANKET BASIS WHERE REQUIRED BY WRITTEN CONTRACT-COMMERCIAL OPERATIONS ONLY. Location and Description of Completed Operations: (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". ALL OTHER TERMS&CONDITIONS OF THE POLICY REMAIN UNCHANGED. 1 1 CGL 1038 0111 Liberty pit Surplus rance Commercial General Liability Member of!Ahem Mutual Group LIBERTY SURPLUS INSURANCE CORPORATION (A New Hampshire Stock Insurance Company,hereinafter the"Insurer") Named Insured: Gallaher Corporation Policy Number. TCP000139-0212 Effective Date: 9/27/2012 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE CLAUSE ENDORSEMENT To the extent that this insurance is afforded to any additional insured under the policy,such insurance shall apply as primary and not contributing with any insurance carried by such additional insured,as required by written contract. Nothing herein contained shall be held to waive,vary,alter or extend any condition or provision of the policy other than as above stated. ALL OTHER TERMS&CONDITIONS OF THE POLICY REMAIN UNCHANGED. 1. ] CGL 1031 0403 • Form W.9 Request for Taxpayer Give Form to the v.December 2011) Identification Number and Certification requester.Do not Department Internal elnueSTreasury ry ce ry send to the IRS. Name(as shown on your income tax return) Gallaher Company N Business name/disregarded entity name,if different from above m rn W o Check appropriate box for federal tax classification: oo ❑Individual/sole proprietor ❑ C Corporation A S Corporation ❑ Partnership ❑Trust/estate o.0 ❑ Limited liability company.Enter the tax classification(C=C corporation,S.S corporation,Partnership))► Exempt payee c2 I o ❑ Other(see instructions)■ .€ Address(number,street,and apt.or suite no.) Requester's name and address(optional) $ 927 Linda Vista St m City,state,and ZIP code O San Jose,Ca 95127 List account number(s)here(optional) Part I Taxpayer Identification Number(TIN) Enter your TIN in the appropriate box.The TIN provided must match the name given on the"Name"line I Social security number to avoid backup withholding.For individuals,this is your social security number(SSN).However,for a resident alien,sole proprietor,or disregarded entity,see the Part I instructions.on page 3.For other - - entities,it is your employer identification number(EIN).If you do not have a number,see How to get a 17N on page 3. Note.If the account is in more than one name,see the chart on page 4 for guidelines on whose Employer identification number number to enter. - - 2 7 - 2 4 5 5 8 2 6 Part II Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me),and 2. I am not subject to backup withholding because:(a)I am exempt from backup withholding,or(b)I have not been notified by the Internal Revenue Service(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends,or(c)the IRS has notified me that I am no longer subject to backup withholding,and 3. I am a U.S.citizen or other U.S.person(defined below). Certification instructions.You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions,item 2 does not apply.For mortgage interest paid,acquisition or abandonment of secured property,cancellation of debt,contributions to an individual retirement arrangement(IRA),and generally,payments other than interest and dividends,y ou are not required to sign the certification,but you must provide your correct TIN.See the instructions on page 4. Sign si9rrawre of Here U.S.person► %� Date► General Instructions Note.If a requester gives you a form other than Form W-9 to request your TIN,you must use the requester's form if it is substantially similar Section references are to the Internal Revenue Code unless otherwise to this Form W-9. noted. Definition of a U.S.person.For federal tax purposes,you are Purpose of Form considered a U.S.person if you are: A person who is required to file an information return with the IRS must ▪ individual who is a U.S.citizen or U.S.resident alien, obtain your correct taxpayer identification number(TIN)to report,for •A partnership,corporation,company,or association created or example,income paid to you,real estate transactions,mortgage interest organized in the United States or under the laws of the United States, you paid,acquisition or abandonment of secured property,cancellation •An estate(other than a foreign estate),or of debt,or contributions you made to an IRA. •A domestic trust(as defined in Regulations section 301.7701-7). Use Form W-9 only if you are a U.S.person(including a resident Special rules for p alien),to provide your correct TIN to the person requesting it(the partnerships.Partnerships that conduct a trade or requester)and,when applicable,to: ousiness in the United States are generally required to pay a withholding 1.Certify that the TIN you are giving is correct(or you are waiting for a tax any foreign partners'share of income from such business. number to be issued), =urther,in certain cases where a Form W-9 has not been received,a ;partnership is required to presume that a partner is a foreign person, 2.Certify that you are not subject to backup withholding,or ,ind pay the withholding tax.Therefore,if you are a U.S.person that is a partner in a partnership conducting a trade or business in the United 3.Claim exemption from backup withholding if you are a U.S.exempt payee.If applicable,you are also certifying that as a U.S.person,your ,provide Form W-9 to the partnership to establish your U.S. allocable share of any partnership income from a U.S.trade or business ;status and avoid withholding on your share of partnership income. is not subject to the withholding tax on foreign partners'share of effectively connected income. Cat.No.102'31X Form W-9(Rev.12-2011) ow rr "% r, %I Sclz piw;i9s. rail: J u z r7:)(wat.i€m Commercial General Liability :,:. , 3 N; . LIBERTY SURPLUS INSURANCE CORPORATION (A New Hampshire Stock Insurance Company,hereinafter the"Insurer") Named Insured: Gallaher Corporation Policy Number: TCP000139-0212 Effective Date: 9/27/2012 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US It is hereby agreed that Section IV,item 8.Transfer of Rights of Recovery Against Others to Us,is modified as follows: SCHEDULE. Name of Person or Organization: BLANKET BASIS AS REQUIRED BY WRITTEN CONTRACT- COMMERCIAL OPERATIONS ONLY. (If no entry appears above,information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV—COMMERCIAL GENERAL LIABILITY CONDITION) is amended by the addition of the following. We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work"done under a contract with that person or organization. This waiver applies only to the person or organization shown in the Schedule above. ALL OTHER TERMS&CONDITIONS OF THE POLICY REMAIN UNCHANGED. 1 1 CGL 1025 0103 4 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 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 2%of the California workers' compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION FOR WHOM THE BLANKET WAIVER OF SUBROGATION NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective: 09/27/2012 Policy No.7600007873121 Endorsement No. 001 Insured: Gallaher Company Premium$INCL. Insurance Company:Everest National Insurance Company Countersigned By: -1998 by the Workers'Compensation Insurance Rating Bureau of California.All rights reserved. From the WCIRB's California Workers'Compensation Insurance Forms Manual-1999. ar Ott StIrphi4i artttt ;�� f orporatIon Commercial General Liability 701 t't, LIBERTY SURPLUS INSURANCE CORPORATION (A New Hampshire Stock Insurance Company,hereinafter the"Insurer") Named Insured: Gallaher Corporation Policy Number: TCP000139-0212 Effective Date: 9/27/2012 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS SCHEDULED PERSON OR ORGANIZATION SCHEDULE Name of Person or Organization: BLANKET BASIS WHERE REQUIRED BY WRITTEN CONTRACT-COMMERCIAL OPERATIONS ONLY. Location and Description of Covered Operations: (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 tc include as an insured the person(s)or organizations)shown in the Schedule,but 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. B. With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: 1 1 CGL 1338 0111 l :,try tt 1.t hams-ura lcc, sow Commercial General Liability (� 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 location of the,;overed 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. ALL OTHER TERMS&CONDITIONS OF THE I'C)LICY REMAIN UNCHANGED. 2 2 CGL 1338 0111