14-003 Breneman, Inc, for concrete accessibility improvementsOFFICE OF THE CITY CLERK
CITY HALL
1.0300 TORRE AVENUE • CUPERTINO, CA 95014 -3255
TELEPHONE: (408) 777.3223 • FAX: (408) 777 -3366
C U P S RT I N O WEBSITE: www.cupertiho.org
January 7, 2014
Brenemen, Inc.
Re: Agreement for Concrete Accessibility Improvements
Enclosed .are fully executed copies of the above stated agreements with the City of Cupertino.
If you have any questions or need additional information, please contact the Public Works
Department at (408) 777 -3354.
Sincerely,
Kirsten Squarcia
Deputy City Clerk
Enclosure
cc Public Works
0
REEMENT BE
T WEEN TFIE CITY OF CUPERTINO AND BRENEMAN, INC. FOR
CONCRETE ACCESSIBILITY IMPROVE1 1 MENTS
po zov
HIS AGREEMENT, for reference dated December 2, 2013; is by and between CITY
OF CUPER11Np, a municipal corporation (hereinafter referred to as "City "); and
Brenenlan, Inc, a California corporation whose address is
hereinafter called the Contractor, and is made
with reference to the following:
RECITALS:
A. City r5 a nllinlclpal corporation dUly organized and validly existing Linder the laws
of the State of California with the po\Ver 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 accessibility improvements, in accordance Nvith the most recent version of the City Of
Cupertino Standard Drawings and improvement drawings as prepared by CSG Consultants; Inc.
NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as
follows:
1. TERM:
The Contractor shall begin work within ten (10) working days after receiving notice from
the Engineer to commence the work, and shall diligently prosecute the work to completion
before the expiration of thirty (3'0) 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 CSG
Consultants, Inc. improvement plan labeled "Sheet I" for 22086 Homestead Road (dated
10/23/13) and "Sheet')" for Hoover Park (dated 10/25/13) and with the most recent version of the
City 01' Cupertino Standard Drawings are hereby referred to and cxpicssly made a part hereof
with the same force and effect as if the same were I' lily incorporated herein. Other locations of
work occur at Varian Park, Three Oaks Park arid Jollyman Park.
3. COMPENSATION TO CONTRACTOR:
Contractor shall be eonapensated for services performed pursuant to this Agreement in the
amount and manner set forth In Contractor's bld, Which Is attached hereto as Exhibit "A" dated
11/15/13 and incorporated herein by this reference. Payment will be illade In the same manner
that claims of a like character are paid by the City, vwith checks dra\vn on the treasUry of the City;
to be taken from the phase Ill park pith repair (544,250) and the pavement maintenance fund
(`23,250).
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,
VaCat101a and S1Ch leave are available from City to Contractor, Its employees or agents.
Deductions'shall not be made for any state or federal taxes, FICA payments, P; RS payments, or
other pLu_poses normally associated with an employer- employee relationship from any fees due
Contractor. Payments of the above items, i'f 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 1RCA
or other :federal, or state rules and regulations. Contractor shall indemnify and hold Cit}
harmless from and agaiaast any loss, damage; liability; costs or e\l?enses arising from ally
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 atrrees that any
and all violations of this provision Shall constitute a material breach of this Aoreenaent.
9. SAFETY REQUIREMENT
All wort: 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 wader
this Agreement.
Contractor shall maintain the work sites free of hazard's to persons and /or property
rest►lting from his or her operations. Any hazardous condition noted by Contractor; which is not
2
a result of his or her operations; Sha11 innmediatel�, be reported to City.
10. HOURS OF OI'ERATI.ON:
Contractor shall be allowed to operate only for the hours of 8 a.m. to 5p.m. unless prior
written approval has been secured from City to do otherwise.
11. REQUIREMENT TO PAY PRFNAI LING WAGES:
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 preahproved format or a City provided f orm. 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.
12. HOLD HARMLESS:
C'onstruct'ion agreements include public works, construction, renovation and
remodeling, welding, plumbing, painting electrical work and similar trades. Construction
agreements with provisions seeking to indemnify for sole negligence, willful misconduct; or the
City's own active negligence are void. (Civil Code section 2782(,
indemnification The standard
indemnification clause for construction agreements is as follows:]
Contractor shall, to the fullest extent allowed by law, indemnify, defend, and Bold 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 clamage to property or other liability of
any mature; arising out of; pertaining to,or rclate.d 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 ofd 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 fully responsible according to the terms of this section.
13. 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
3
certificates, which do not limit Contractor's inclenIn*r1cation, shall also contain substantially the
following statement: "Should any of the above insurance covered by this if be canceled
or coverage reduced before the expiration date thereof, the insurer affordi -ng covera-ge. shall
provide thirty (30)-days' advance written notice to the City of Cupertino by certifiecl 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. Endorseme�its naming the City Cl s 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 'coverabe in the l'olGowiny minimum limits:
Commercial
Bodily Injury: $l 000,000
each occurrence
$2,000,000
aggregate - all other
Property Damage: $500;000 each occurrence
$1 000;000 aggregate
I(� submitted, combined �,in��le limit policy with agpre�c,_ate 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: $500,0.00 each occurrence
or
Combined Single Limit: 9 >1.000,00.0 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 loot:
solely to its insurance for recovery. Contractor hereby ':rants 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 i�lsurer 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 tl7e Contractor for the costs of the
insurance premiums at the maximum ra e permitted by law and computed frorn the elate yvritten
notice is received that the premiums have not bren paid.
m
D. ADDITIONAL INSURED:
City, its City Council, boards and coiaamissions, 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 ibis 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 Contraetor's insurance broker to determine adequate
coverage for Contractor.
9. BONDS:
Contractor shall furnish the following bonds from a bonding company acceptable to the
City Attorney:
A. Faithful Performance:
A bond in the amount of 0 % of the total contract price guaranteeing the faithful
performance of this contract, and
B. Labor and Materials:
A bond for labor and materials in the amount of 0 % of the total contract price.
15. PROHIBrriON AGAINST TRANSFERS:
Contractor shall not assi,n, 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, h} pothecate or transferee shall acquire no right or interest by reason of such
attempted assignment, hypothecation or transfer. 1- lovvever, claims for money by Contractor
From City under this Agreement may be assigned. to a bank, trust company or other Financial
in "stituti'on 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 otrtStall
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 of cotenancy,
-vhich shall result in changing the control of Contractor, shall be con n construed as a assignment of
this Agreement. Control means fifty percent (50 %) or more of the voting power of the
corporation.
10. 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 subniitted 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.
5
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.
11. 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.
12. 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.
13. RECORDS:
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 aec.ounting 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 therefrom as necessary, and to allow inspection of all work, data, documents,
proceedings and activities related to this Agreement. Suc11 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.
14. 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
6
City at:
City of Cupertino
10300 Torre Avenue
Cupertino CA 95014
Attention: Roger Lee
All notices, demands, requests, or approvals from City to Contractor shall be addressed to
Contractor at:
Breneman, Inc.
2000 Norris Road,
Walnut Creek, CA 94596 -5447
15. 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 o municipalities, Section 7.1.01 of the Standard Specifications and any other
frm
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.
N
22. 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. I�f 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
Agreeinnent 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.
23. COMPLIANCES:
Contractor shall comply with all laws, state or federal and all ordinances, rules and
regulations enacted or- issued by City.
24. CONFLICT OF LAW:
This Agreement shall be interpreted older, 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 'Urtsdiction over this Agreement (or tine-
successors of those authorities.) Any suits brought pursuant to this Agreement shall be filed
with the courts of the CoLulty of Santa Clara, State of California.
25. ADVERTISEMENT:
Contractor shal`I 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. ,
26. 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 an,, subsequent breach of the same or any other term,
covenant, or condition contained herein, whether of the same or a different character.
17. 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 rrioditication of this Agreement will be effective only by
written execution signed by both City and Contractor.
'28. INSERTED PROVISIONS:
Each provision and clause regUired by law to be inserted into the Agreement shall be
8
deemed to be enacted herein, and the Agreement shall be react 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.
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
Breneman, Inc. A Municipal Corporation
By By_
Title TItle
Date Dates
RECOMMEN' .,L 1 -`OR APX IZOVAL:
By
APPROVED AS TO FORM:
B v r t'
City Attorney
ATTFC"T-
Cityclerk
C�) lb /I q1
BLIILDIAIG 1: ENGIAIEERIPIG
CENTRRCTOR
Project
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014
Various Locations
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Date
Estimate #
11/15/2013
490
Description
Qty
Rate
Total
Varian Park Improvements
4,200.00
4,200.00
Hoover Park Improvements- Site A
14,250.00
14,250.00
Hoover Park Improvements- Site B
8,200.00
8,200.00
Three Oaks Park Improvements
3,800.00
3,800.00
Jollyman Park Improvements- Site .A
9,100.00
9,100.00
Jollyman Park Improvements- Site B
4,700.00
4,700.00
22088 Homestead Road
23,250.00
23,250.00
Phone # Fax #
925- 457 -2026 925- 446 -6600
Total $67,500.00
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DATE (M YYY)
12/21/2012013
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 Flo licy (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).
PRODUCER
Automatic Data Processing Insurance Agency, Inc
1 ADP Boulevard
Roseland, NJ 07068
CONTACT
NAME:
PHONE FAX
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INSURER(S) AFFORDING COVERAGE I NAIC N
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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.
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DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach, ACORD 101, Additional Remarks Schedule, if more space is required)
Job Reference:- Concrete Accessibility Improvements
� rN 1 I r I I+M I
City of Cupertino
10300 Torre Avenue
Cupertino, CA 95014-
r•AnlrPI I ATIONI
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
/�l1nn r 00rl0ATlr)Al All rinhtc rPCPrVPrI
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
AC"na
CERTIFICATE OF LIABILITY INSURANCE F,2/2;20 DATElrnrn ;DOlvvvv)
13
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).
PRODUCER CONTACT
NAME:
Brown & Brown Insurance Brokers of Sacramento, Inc PHONE - Fax
P. O. Box 619043 Lic OH38004 rho „� :u_916_u30 -8613 __[L/_c, r.)_t300- 7333 =i�Q83
E -MAIL
Roseville CA 951J61-9043 ADDRESS:
INSURER(S) AFFORDING COVERAGE rt
ws uR: aA _ James _River_InsuranceCompany "1._2203___ -__
INSURED INsuRER a Financial Pacific 31453
-------- - - - - -- - - - - - - --
Breneman Inc INSURER C National_ Union Fire l_ns_C_o_(PA 194 a5
-
INSURER E
INSURER F
COVERAGES CERTIFICATE NUMBER': R54ni4R48 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 i - - . _. . . _.. - - - ' `AODL;SUBR` - POLIri EFF ` POLICY EXP
LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (Mf+liDDIYY fY) MPn ;DO " /Y'f Yt
._ _ _. _ -_ -- . _ _. -- - _ -- ---
LIMITS
GENERAL LIABILITY Y I 00057;'080 3130'2713 3130:2014
',Act-] OCCURREPICE 51.000.000
tX GOIvt PAERCIAL GENERAL LIABII_tT'l
PF.EialISES`. Ea ocaurenrcn 550,000
CLAIMS -MADE !'t occur I l
hIED E <R(Any one person]
_ _;SEXCLUDED
_
PERSONAL:: ACV INJUR]_? 5.1,000,000___ —
. —_- — --- --_ —_ -- l
GENERAL AGGREGATE --I S2.000,000 --- ---
' GEN'L A GGREGA FE LIiMIT APPLIES PER:
PRODUCTS - COMP!OP AGG 52.000000
t' POLICY I JEC:T I LOT: 1 I
S
B AUTOMOBILE LIABILITY 'Y
I�
_
$0 {2FJO19 3,'30:2013 30;20114
CO, •! Sir.,Lt L:!
Ealaccidem) 1 ;1.000.000
I—] ANY AUTO
3ODTY INJURY (Per;x son? I S
ALI O`NNED SCHEDULED
-
, AUTOS 4
ODIL INJUY(P•r:. rd ml 5
_
NON -OWNED
� j
HIRED AUTOS
PROPE rY DAMAGE I. — --
5
!
�5
C UMBRELLALIA13 �Y OCCUR IY
I IBEO"o8027263 '5!1'112013 3/30/201a
E:aCII000URRElCE 55.000,000
'x 1 EXCESS LIAB I I
CL.AINIS- KIADEi
!
— — - -_--
! AGGREGATE 55.000,000
DEC I RETENTION
WORKERS COMPENSATION i
'iVC 5 Oriel-
( AND EMPLOYERS' LIABILITY Y
ANY ?ROPRIETOPfP1R.tJER /�x�C'U -IVE t
OFFICE R;RI ErdBEff LXCLUU�J° !
) - _ `tc E . -) . N I A
E.L. EACH ACCIDENT S
- - - - - -- - -- •- -- - --- - -- - -
Mandator in NH J
( Y
ET. DISEASE - E.A EMPL O'(EE, S
I if ves. describe uncer
I - - - - -- '—
)ESCRIP LION OF OPERATIONS below
t E.L. DISEASE - POLICY ITIM - ' S
I�
_
t I '
_
DESCRIPTION OF OPERATIONS ! LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Certificate holder is included as an Additional Insured under Commercial General Liability policy per endorsements
CG 20 10 07 04 CG 20
37 07 04 and Commercial Auto Liability per endorsement FPICO200 (12 -11), subject to a written contract between the Named Insured and
the Additional Insured. Sample endorsements attached. "Subject to company approval.
City of Cupertino, its City Council, boards and commissions, officers, employees and VOlunleers.
1-r-N I I1-11-A I r-11U LI-JeK UANUELLA I IUN
City Of Cupertino
10300 Torre Avenue
Cupertino CA 950'14
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
-/
1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CARFEULLY.
WAIVER OF SUBROGATION AS REQUIRED BY
CONTRACT
This endorsement modifies insurance providecl under the following:.
ALL COVERAGE PARTS
The Cornpany agrees to waive any right of recovery against any person or organization, as
required by written contract, because of payments we make for injury or damage which is limited
to liability directly caused by "your work" which is imputed to such person or orcranizatio'n.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
AP5004US 11 -06 Page 1 of 1
Sample
F
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
PRIMARY - CONTRISUTORY
l D i R G.
This endorsement modifies insurance provided under the following
ALL COVERAGE PARTS
Narne Of Additional Insured Person(s)
Or Oraanization(s):
If no entry appears above, this endorsement applies to all Additional Insureds covered under
this policy.
Any coverage provided to an /additional Insured under this policy shall be excess over any other
valid and collectible insurance available to such Additional Insured whether primary, excess,
contingent or on any other basis unless a written contract or written agreement specifically
requires that this insurance apply on a primary and noncontributory basis
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
AP5031 US 04 -10 Page 1 of 1
Sample
60426619
1"PICO200 (12-11)
THIS I--,NI-)0RSEN1ENT (TIANGES THE P(MICY, PLF.ASE R'E'Af) IT CAR'EFULIA'
BUSINESS ALIT) ELITE COVERAGE ENDORSENIE!N-T
This WOO-MCM 1110difics iflsHr:!HCC provided LIHdCI- the following,: P R E M i U M 150
BUSINESS AUTO COVERAGE FORM
With resp-cCi to cc)% cnige pm% wed q I his Hie pro", 16 of Te Cmismye Fmm N, unless nowpd Q &is
cuiclommall.
SECTION H . LIABILITY COVERAGE - Amuldirilvub COVERAGE EXTENSfONS -- SUPPLEMENTARY
11 I-10 IS.-AxN'I:NStjRE,D PAYNIKINTS
ThC0110wingare added to WHO ]SAN INSURED:
I; LA NKE T ADDI'T'IONAL INS U'R E D S
All person or or allizatioll willil \010111 you agreed. pul"."llaill
10 it \%rillcn Colillact. to [)I-0\-wC ilISHFaIIQ-'C sucl ijs is t11`rord(:d
'Hider this CO era.c Part. but 0111) 10 Ile CxJeljj (gal Ille
Person Or C-)F-20hizatiOn is IWW WbQ fur voto ims vq
0"Ass"FIS "K Inspect (o your owtwi-skip. main numCe or
Use of it cmvNd -aino.- Thk PMOSK DIAh applies I Nine
wrilici) contract has been cxC(:l1k2d prior Ic) (lie '-bodik
ijjjur- or
This Cotcr,I c shall 1k: primal-, rjljcj ,,)I ck)lllribillor� \,Hit
respect Ho the person or org'alirz;ltioll Hl(:luc(!d as an --ilistInK
under Ohs senioll. Ally other insurance Illat person or
OF!"SnAl has shall be excess and not contributor "All
respect 10 this Hisurance- but NIiS Pro% iSiorl oult applies if it is
N(It""d in 1110 " rillcri c0l"MO. kkmificd in this section. and
is permitted b� law.
BROAD FOR-,N] NAMED UNSURED
A, q- business CHI i I � 1IC'A I :I CCJ H i red or j-,-) I I I I Cdl by yoll. C:q I
Mall a partnership. joint (clfflirc or limited liability c0mp;lll�
dlifill'." (1h: polio period pro,,ided you own jV% or MON of
[lie business crllil., and Ile hisitlem entire is Hol seqpir"ch
insured for 130hiess .Auld Coy Ni Cm,mge is evanjul
ill) to it 111axillmill "-)1- 180 cla ' %S follo\vill;, accluisilioll or
101-niahon of the business entity.
EMPLOYEES AS INSURED- HIRED AUTOS
Any -mnph)m- or yours is an -hismod' "IQC ON,K, an
"Wolo- liAnd or rented midei a contract or a,ruellicill in (11:11
elliployce's" Hitille. with yotlr permission. \\-title performing
dmbs related M dw cmidni orymir hishys.;
EMPLOYEES AS MSURED - NONOWNE D AUTOS
Ain -crilploycv, Of yous is an -hTmvd wtilu using N
C0%CI-Cd dLIHO �.Otl don't (p\Ij lure ol, bcrrou in rut
hswvs-
.- SU[)PICHICIWUr, PilyInClItS is alliClided as follows:
\\"e will jxo (11) to $3.000 for or Co.o of' bail bonds (illclltclin�
bonds Or rehaed HIM law violations) inquired become of
an cCidcul n cmer. We do Hot lwc to Om% ik.sc
hikes.
We wM Ply &I reasonable expenses incurred b� the
insured ill our IC(luco. includili'Lz' actual loss of carning:5 tip
M $As) a cop, Incense of time (AT from " ork-.
SECTION KI - PFfYSIl-'AJ- DAMAGE COVERAGE
Allicildilleats
AUDICI V I S UA L, - A N D DATA ELECTRONIC
E0U.I-PMENT COVERAGE EXTENSION
Any reference W equipment lbr dic FeWaTichon of sound
also indides %ideo Gild global "Aidoubly poems.
EXPANDED TOMANG COVERAGE
It, addilion to ilic o\\Hig ;Ind labor limit slim\ii in III,--
Dcclaraliwl,s for Q an pa.swngo- iypc autos \tc trill pal
lip to $75 for totlial and labor costs incurred Cacjj tinge Nie
cmvNd -auto" is disabled, 1-10\\cvor. the labor must be
perl'brilled a( Ile place, Of disablement
This co\vnige applies only to an -auto" cjy,ered oll Illis
poHq for wlwr On sid danagc vnerqc.
EXPANDED TRANSPORA'ATION' EXPENSE
Coverage Extensions - Trarispon;lHon Expol-scs K deleted
and replaced by 1110 followill."j:
We will pin tip to •S60 per dilt to a Illaxillitilli ol-S1.900 for
"UPOnlry lansPollauh, expense incurred by it besmse of
Ow IMA 11wh of a cmtwd �""- of dw pKak passenger
lypo "I "ill pq Only for low um` md \% Inch
y()tj ','am enlier Cculrllr icnsi e or SpeciFi,2d Causcs of Loss
CM eirage. We wh! poi for lempol-on- Inumpormhon
expenses iucurr--d didug Ik period bey"nig 48 Inis dFIn
lndtid�_ ':oll� ja,.dl[vd llmlo hqperik :. 111C. a ifil 11: perlijj�'i,li Page 1 00
the TS and ending, regardIcss of Me pwofs expiration.
;t hen the COVCred is returned to use or ", pay for its
EXTRA F X P E N&E — STO L EN A UTOS
We "of P" iq to Vow or Mc expense of returning n
stolen Covered ;lIIIo to you. W'e will pay only or those
c0\-Cf•d all[OS for NVI'i;:Il * \011 carry Conipt-chensko or
Specified Causes ofLoss Cover"e.
IARED CAR PHYSICAL DANIAGE COVERAGE
I-()[- purposes Of this SCCIi011. the ICI'Ill '_aLII0 is redCfIlled to
filet'] a land motor or swrint-nifer "Ali o
vehicle \\eigh( under 2t).00C, pounds dcsi.,;ncc1 for lra\�el
on plblinuld, but does iwi indWe"Inobile equilmnein.'
If (:0111prellell-Sil•-C. Specified Causes 6f Loss or Collision
c(MMV,c is proYidal 0 all 0-fied outos by this polio. you
stay extend that coveragc to apply ful Physical Damage "loss"
to hired aIllos.-, We Nvill provide coy era ge equal to the
linilijillullicovorage mAi hbk to Any covered 2 Auto- ShMN'll in
the Declarations. BUL Ac most mr "ill pay for lOS.S to A
hired oullo" in any one "accident" is the lesser of:
1. STWME or
1 The ad und cash x6ife of do damycd or moon properly
as of NW time of Hy -loss- or
The actual cost of impairing or replacili, the damaged or
stolen yots, NOT wha pmpm) of Ile And or qwdity
A port is of like kind and quality NN-hell it is Of c(Inal Or
beticr condition than Of pivanideru pan, We \vHI use
[Ile original equipment nun the
;I) The operational safety or the \ ell-icle lj)i,,ljj
odicnvisc be impaired:
b) Reasonable and ddQem efforts to locate the
UIPPI50pl-inte rebtfill- afterniarket or used pan We
been unsuccessful:
0 A IICNN. Original C(lLIipnICII1 Pon of" like kind and
(luality is mailable ond \\ill result ill tire lc\%.,Csl
Overall repair cosl:
d) For Nehicks hmwcd ruiner policies mine" on or
before December 31. 2003, NW Nvhicle has been
used no more than 1,5.000 Infles unless the pre-
Accident Condition Darr arils othcIlvise: of
e) For %chicks MY under polides "rhien on or
After Jamjan L 2004, Me \K&K has been used no
more (han 20.000 miles unless the pre -ace
condition \\arrants ojficn\.isc.
FTICO200 (12-11)
For each hired owo- our obliquion to pay -loss- "A! be
i-eliced h a deliclibl• eWml 10 Me hip kst dechwidble
applicable to any oNNued ";into" for that No
diccluclibIc tit ill be Applied to loss" caused by fire or
liglon&! Wt Nvill Also pad. tip Iii 5500 per ;)Ccid0fIt for
loss of use of the hired "'Aulo it' it f-CmIll-S from Ali
for which )oil are legally liable. The Issof mast vidir ail:
adil"ll financial loss" for this CON-Cro,'.,C to applN.
IMS Car Physical Damage Coverage provided by- this
emsdo-K cuss over mw other collectible hourmwc.
LOANTEASE CAP COVERAGE
For MiMons of Mis section. the Icrul aqjto is redefined to
mean a huld momr Nd6clu. ""trailer ' or sandmiler witb :I
gross MhOle wAQ under 2[1 000 pounds designed for mr ell
on public roads. but does no &An& ""mobile dyipitud."
If long-terin ]eased or financed o"K is a co omd owl'
for the Phyvicrfl Dannyc C!"ernge applicable to a total
"fosin- mid the KS5017 Or fill;1flCiol illSfiltAi011 is an additional
insured under His Coverage Pan, "t will pay up to it
lunxinnim of WAIN dr; difference boween amounts vou.
o%\c file lessor or Financial institution under the ]case or loan
Wivis 00 Me mirini"t of insurance paid die lessor or financial
hinadmiall or Me W ImV or Me smired auto- urines:
any p,inews omdue at the iinic or the loss: any financial
penalties imposed to to %mm And War high unlaye of-
Silffllf ChAf�.'Cs: Jll� S0,'tIritV deposits not refunded by the
lessor or 11mincial instill)(ioll: any costs for credit life. health
and XCiCICLII. or disabilit V insurance: an` costs of extended
i\arranties: Or arly earn -over balances front preY ions leases
or loons. You are responsible for Me deduct ble apoWnble to
Me -loss- for Me Covered onto". This co\ern�e is eons
instimucc our any imlar collectible insurance or lone
provision.
PERSONAL EFFECTS COVERAGE
We Nkill pay tip to 5400 for --loss'" to weal-irig apparel and
other personal effids. "Ifsh me:
I. 0\N tied by an "instired: and
2. In or on � our covered o
ill [Ile ON;ent of a [01,11 [[left •0 Q Our con Bred outs."
No deductibles apply to Personal Effccis Co\crn,_,c.
RENTA.L REUNI-BURSENFENT COVERAGE
We NY 01 pa) IN rental rcimblors(miciit Cxpell.Ss incurred
by, you for the rental of art nuto beaflsu of "loss- to a
CO'NUedoina " Pro merit applies in addition iothe
-)(I ha%e
On o CoVered aUto." No deductibles apply to Rental
Reimbursement CoNerage.
I Ili: ILI (Qrie I r IS0 III" rQT I I eS. Inc. I,:. wi( 11 it., p ern I i>si, -11 Ilige 2 of .+
2. We will pa\ 0111\ ho " 'hose expcn.ses incurred during Ills
police period be innin, ?-f hours after Iie "toss and
ending. rc ;lydlcss of the policy ",s ezpir,ltioil. \t ill) the
lesser of the folio\\ iue number of da\ s:
A) The nun ki— of dass reasonabt\" required to repair or
replace the covered "auto." If "loss" is caused bs
theft. this number of da\s is added to the number of
da\s it takes to locate the co\ered -aulo and rclurn
it to sou.
b) The nuuaber of (lass shovvil in the Schedule.
3. This c0\ crags applies 0111\- to d co\ crcd "dLUO for n iicla
there is ComprChensi\c. Spci ified Causes of Loss of
Collision Co \.cmge provided oil this Covered " "auto."
If there is no Col lision CON erase for a Covered
then Rentill R6mburscrrlcnt Co\ erl c \\ ill not apply• tci a
Collision loss in\ ol\:ia1" 11)11( co\ tired
4. Our pasnacnt is luuited to the lesser of the. follo\sino
dnaounrs:
a) Necess<in ;Ind ;Ictuat expenses incurred.
b) $75 foram one da\ Or for a masimum of 10 doss.
This co\ craze does not appl\ while (here ;oe spare or
resen"e "autos" in aiiable to sou for \our operations.
6. ff "- loss" results front the total theft of a co\ tired ' "auto.. of
the pri\ ate posscm, r tvpc. \se \\ ill pa\ under, this
co\ crage 0111\ that anlotllll of \-our rental reilllburselneut
cxpenscs which is not ,dread\ prorjdcd for t,nidcr tic
PHYSICAL. D.AJNLaGE COVERAGE Co\crlee
E\(ension.
7. Covera c does not ,ippIN" to an\ co\ tired " 111110 tior \, taich
co\'er,igc is provided bs cndorseniclii form CA T)23 oll
ill.ls Polley.
WAIVER OF' DEDUCTIBLE — GLASS
Deductible is mnended b\ addim, the fotlo\\iri_:
No deductible fqr a coy Bred `auto- will ,Ippl\ to gloss
iinur,nc� if the glass is repaired rather Ihan replaced.
SECTION IV — BUSINESS AUTO CONDITIONS —
Amendments
LOSS CONDITIONS
KNOWLEDGE OF A(`CTDENT, CLAIM, SUIT OR
.rPICO200 (12 -11)
subseducnl imestioarion of such claims or "suits.. under
C>UTIE:> IN THE EVENT OF AC [DENl. CL,AFIM. SHIT
OR LOSS. do not ,Ippl\ 1111111 the Iccidenl' or "li)ss s
1. You. if \•ota are an individual:
2. A ihirtiier. if \ ou are al partnership:
3. Au exmiti\c officer or insurance m,tmiger. if \ou �Irc a
corpor;I l icm:
4. Your members, Villagers or Illslinin c Illaim'-'er. if 1'011
area limited liabililN company:
Yotir elected or appointed officials. trustees. board
members. or sour insurance nt,urlrer. if \oil are an
( rganizarionother than it parataership. Joint \cn[tirc, or
limil'ed Iiabitii\ comp ;111\.
13111. Ihis section does not aniclld Ilse p•rosisious relalin_, to
notificalion of police. protection or e.�onain,ltioLl of the
proper(\. \shich \sds subject to the "'loss.'
BLANKET WAIVER OF SUBROGATION
Transfer Of Rights Of Recmery Against Others To Us is
deleted and replaced by the foilo\sill":
We wake all\ ri-lit of reccmix we uia\ ha\c ag.Iin.sl ;mu
Pei-soil or org uai anon to (lie e:xtcnl required of \oil b\_ a
\\ritien cotivinct executed prior to itn\ "accident.. or 1ciss.
pro\:ided that the "accident" or "loss ;trines out of rl,e
operations contemplated b\ such contract. The +sai\er
i\' s old to the person or or ailization desigimied in stich.
cotar('act.
GE:N'ERAL CON1)1T10NS
UNINTENTIONAL E:R.RORS OR OLMISSIONS
Concealment, II lisrepresentatiun Or Fraud is amended by
ildd'ing the toilo \sing:
The unintentional omission of. or till illielitloual error in. a11\
information given by \ou shall not prejudice \our righls
under this insur.utcc. Fto\\e\er. this provision does 11o1 aflccl
our right to collect additional premium or exercise our right
of cancell :ition or non- rcaersal.
SECTION V— DEFINITIONS - Amendmcnt
MEN`IALANGUISH
LOSS The dchnition of -bodih irtjun" is amended to indtide
nrenrll anz;llish resulling from an\ "bodily injun'. sickness
The requirements for reporti.n�, and seudin , cl; nt or ""suit or disease snsmiued b\ ,i person.
inforuunion to us. including pro\ isiolis related PO (he.
I clwlr I at�nnl .I' 1S() hoI)Q1 III ;.Inc. \ \ill) il� 1:v111 i"i- n r'a,,e 3 e1 .I
POLICY NUIV16ER.- 000572080
COMMERCIAL GENERAL LIABILITY
CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- OWNERS, LESSEES OR
CONTRACTORS - SCI-11EDULED PERSON OR
ORGANIZATION
Tl'iis enclorsemerit mcc-lifies insurance proviclec' under the following:
COI\/Ii%,,IERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
N f —
Name Of Additional Insured Person(s)
Or Organization(s).
— —
Location(s) Ot Covered Operations
I
�0/h�ere requireiJ by writterl c
-ontracl. of, agreenlem
All operations of [lie nanled insured'
F
Inforniaticil required to corrip-%lele this Schedule, if not shown above, will be shown i-f-i the DeclarcIions.
A. Section 11 — Who Is An Insured is amended to
illClUde as an 2CIdiliO11131 111SUred the person( ) o I-
organization(s) shov n ill the S,checlule• :gut (Illy
with respect to liability for "bodily 01JUry". "property
damage" or "personal and adverlisillg iI1jLI('V"
CaL)Se(',, in whole or in part, by.-
1. Your acts or omissions, or
2. The acts Gr omissions of :hose acting on your
behalf:
in [lie performance of your ofigoillg operalions for
the additional insureds) at the location(s", de _ic
iiafe,d above.
B. 'Nith respect to Uie insurance afforded to these
additional insureds, the following additional eXcILJ-
sions apply:
This insurance does not In "bodily injurv" of
properly darnage" occurring after:
1. All work, including nint ' eri?ls: parts or eq�jip-
I'llellt furnished ill connection with such work,
on the project than service. maimenance,
or repairs) to be performed by or on behalf of
the additional insured(s, at the location of the
covered operations has been completod; or
2. That portion of "your work" 01.1t Of kAlhiGh the
it-ijUCY Or has beC-fl [)W to its in-
tended use by army person of org3fl'izLjjiofj oth-
er thin another contractor Of SLibcomractor
engaged in performing operations for a prin-
cipal as a part of the same project.
CG 20 10 0.7 04 ISO propertit,:s. Inc.. 2010-1 Sample Page 1 of 1 ❑
Sa
POLICY NUMBER': 000 -572080
COMMERCIAL GENERAL LIABILITY
CG 20 37 07 04
THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED -- OWNERS, LESSEES OR
CONTRACTORS - COMPLETED OPERATIONS
This endorsement modifies I!1SU1(7!li;F, l IDiICIe' (.IIICa I'the i( QIq/IiIC;
COI`,,I!MERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s):
Location And Description Of Completed Opera -
tions
Where reclulred by written conlrL1Gt or L-iqrelernelit
Ali opera ions of the earned 111SUred
_Iniofinattlon I'c1qLl1red to compIG'tc' this Schedule, it not Si'i �lNl'1 at)O`JCJ. will be shown In tile; Declaratiuns.
CG 20 37 07 04
Section II — Who Is An Insured is amended to include
LIS alt aCICdIIr911L11 IIISLIPe;l the persons) OI OIg
iicin(s) sho vii in the Schec:'ule, but only `with respect to
liabiliiv for "bodily injury" or "prcpe!zy dannagr," caused.
in vnole cr in part, by 'your rv'ork" at the location ,lesi -
natecl and described in the schedule of Ihis endol:se-
ment performed for that additional insured and included
in the " products - completed operations hazard ".
ISO Properties, Inc.. 2004
Sample
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