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16-127 Giuliani & Kull, Inc., Partial Topographic Survey for Lawrence Mitty SiteC I TY OF a CUPERTINO AGREEMENT CITY OF CUPERTINO 10300 Torre Avenue Cupertino , CA 95014 408 -777 -3200 THIS AGREEMENT , made and entered into this ~day of ~. :u>t(c is by and between the CITY OF CUPERTINO (Hereinafter "CITY") and GiUlafli&' Kull, Inc ., 4880 Stevens Creek Blvd ., Suite 205 , San Jose , California 95129 , (408) 615-4000 , mhelton@gkengineers.com Hereinafter "CONTRACTOR "), in consideration of their mutual covenants , the parties agree as follows: CONTRACTOR shall provide or furnish the following specified services and/or materials: Perform a partial topographic survey of APN 375-21-001, also referred to as the Lawrence Mitty Site, located on the west side of Lawrence Expressway across from Mitty Way. Check box if services are further described in an Exhibit. 0 EXHIBITS: The following attached exhibits hereby are made part of this Agreement: Exhibit A- Giuliani & Kull , Inc . proposal for a partial topographic survey and earthwork calculations for the Lawrence-Mitty site . TERM: The services and/or materials furnished under this Agreement shall commence on September 6, 2016 and shall be completed no later than October 21 , 2016. COMPENSATION: For the full performance of this Agreement , CITY shall pay CONTRACTOR: $4,000 .00 California Labor Code, Section 1771 requires the payment of prevailing wages to all workers employed on a Public Works contract in excess of $1 ,000 .00 . GENERAL TERMS AND CONDITIONS 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 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 or active 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 . Subcontracting. Contractor has been retained due to their unique skills and Contractor may not substitute another, assign or transfer any rights or obligations under this Agreement. Unless prior written consent from City is obtained , only those people whose names are listed this Agreement shall be used in the performance of this Agreement. P age 1 of 3 Gi uli ani & Kull Agree m en t L aw rence Mitty Vo lume Survey Assignment. Contractor may not assign or transfer this Agreement, without prior written consent of CITY. Insurance. Contractor shall file with City a Certificate of Insurance consistent with the following requirements 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: $500,000 each occurrence $1,000 ,000 aggregate -all other Property Damage: $100 ,000 each occurrence $250,000 aggregate If submitted, combined single limit policy with aggregate limits in the amounts of $1 ,000 ,000 will be considered equivalent to the required minimum limits shown above . (3) Automotive: Comprehensive automotive liability coverage in the following minimum limits: Bodily Injury: $500,000 each occurrence Property Damage: $100 ,000 each occurrence or Combined Single Limit: $500 ,000 each occurrence ( 4) Professional Liability: Professional liability insurance which includes coverage for the professional acts , errors and omissions of Consultant in the amount of at least $1 ,000 ,000. 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. Termination of Agreement. The City reserves the right to terminate this Agreement with or without cause with a seven (7)-day notice. The Contractor may terminate this Agreement with or without cause with a seven (7)-day written notice. Non-Discrimination. No discrimination shall be made in the employment of persons under this Agreement because of the race, color, national origin, ancestry, religion, gender or sexual orientation of such person Page 2of3 Giuliani & Kull Agreement Lawrence Mitty Volume Survey Interest of Contractor. It is understood and agreed that this Agreement is not a contract of employment in the sense that the relationship of master and servant exists between City and undersigned. At all times , Contractor shall be deemed to be an independent contractor and Contractor is not authorized to bind the City to any contracts or other obligations in executing this Agreement. Contractor certifies that no one who has or will have any financial interest under this Agreement is an officer or employee of City. City shall have no right of control as to the manner Contractor performs the services to be performed . Nevertheless, City may, at any time, observe the manner in which such services are being performed by the contractor . The Contractor shall comply with all applicable Federal, State, and local laws and ordinances including , but not limited to , unemployment insurance benefits , FICA laws , and the City business license ordinance. Changes . No changes or variations of any kind are authorized without the written consent of the City. CONTRACT CO-ORDINATOR and representative for CITY shall be: NAME: John Raaymakers DEPARTMENT : Public Works This Agreement shall become effective upon its execution by CITY , in witness thereof, the parties have executed this Agreement the day and year first written above . CONTRACTOR : By ~~ #&~4 Title ~ 5"b14.P'fi?4e APPROVALS ,tµ-- P age 3of3 G iuli an i & Kull Agreem ent Lawren ce Mi tty Vo lum e Survey DJ)TE qrc,'{r? DA TE °1.fflt[lkJ DATE 1 ·1\-/{p CITY OF CUPER": By w //(____ Title :JZ,~ Wo/t-(,c,.r ~ /1/>;.../~/L • EXPENDITURE DISTRIBUTION 280-99-009-900-905 -P LM 001-01 -01 $4 ,000 EXHIBIT A PROPOSAL FOR SURVEYING SERVICES Lawrence Expressway future park site (APN 375-21-001) Cupertino , California CLIENT John Raaymakers City of Cupertino 10300 Torre Avenue Cupertino , CA 95014 CONSULTANT Giuliani & Kull , Inc. 4880 Stevens Creek Blvd., Suite 205 San Jose, California 95129 PROJE CT DESCRIPTION The proposed project is a potential park site in the City of Cupertino. This work will require the preparation of a partial topog raphic survey and earthwork calculations to determine the volume amount of debris in the debris piles on the site. SCOPE OF SERVICES The following scope of services is offered for the completion of the surveying work effort: Task 1 -Partial Topographic Survey Giuliani & Kull , Inc. will prepare a partial topographic survey of the site in order to prepare earthwork calculations to determine the volume amount of debris in the debris piles on the site . Within thirty days of our authorization to proceed, we will submit our partial topographic survey, in pdf format, along with the earthwork quantities of the debris piles. SERVICES NOT INCLUDED The following services are specifically not included as part of the consultants wo rk effort under this contract: (a) Soils or geotechnical engineering services Lawrence Expressway future park site Page 2 of 2 Pages EXHIBIT A (b) Structural engineering services (c) Civil Engineering plans (d) Boundary surveying, or setting permanent survey monuments The above listing is not intended to be exhaustive and shall not be construed to include any work as offered under this proposal specifically identified in the Scope of Services. CLIENT PROVIDED DAT A The following data, information and material are to be provided by the client: (a) Blueprinting and reproduction costs + 15%. COST OF SERVICES The professional services described in the Scope of Services are offered for the following fees: Task 1 -Partial Topographic Survey and Earthwork Calculations TOTAL COST OF SERVICES TERMS $4,000 .00 $4,0000.00 Compensation shall be payable monthly as the work is performed . Invoices shall be payable within 30 days of the date of invoice. Extra work items, or other additional services (beyond those described herein) will be provided in accordance with our standard schedule of hourly rates in effect at the time the work is performed. Respectfully Sub/ryt~ /j7~/~ ~ff'?t Mark A. Helton, PE, PLS Giuliani & Kull, Inc. GIUL&KU -01 DC AM PO ACORD" CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/Y YYY ) ~ 9 /6 /2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERT IFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND , EXT END OR ALTER THE COVERAGE AFFORDED B Y THEPOLIC JES 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 hold e r is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION JS WAIVED , subj e ct to the term s and cond itions of the policy , certain policies may require an endorsement. A statement on this certificate does not confer rights to th e c e rtificate holder in lieu of such endorseme nt(s). PRODUCER CONTAC T NAM E: Micheletti & Assoc i ates ---- 515 Ly e ll Drive, Suite 102 _(A~g.NJo Ext): (209) 576-2808 --__ _ r:i~. No): (209) 530 -38 ~8 Modesto, CA 95356 ~ifo'}l~ss : info@michelettiins.com --- INSU RER(S) AFFOR DI NG COVERAGE NAIC# INS URER A : American Casualty Company of Reading PA 20427 --INSUR ED INSURER fl: Continental Casualty Company 20443 - Giuliani & Kull -San Jose, Inc, INS URER C: ----+------ 4880 stevens Creek Blvd., Ste 205 INS URER D : -----Sa n Jose, CA 95129 INS URER E : __ j --- INS URER F : I COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TH IS IS TO CERTIFY TH AT THE POLIC IES OF I NSURANC E LI STED BE LOW HAVE BE EN ISSU ED TO TH E INSURED NA MED A BO V E FOR THE POLI CY PERIOD INDIC ATED . NOTWITHST A NDING A NY REQU IREMEN T , TERM OR COND ITION OF A NY CONTRACT OR OTHER DOC UMENT W ITH RESPECT TO WHICH THI S CERT IFIC A TE MAY BE ISSUED OR MAY PERTA IN, THE INSUR A NC E A FFORDED BY THE POLIC IE S DESCRIBED HERE IN IS SUBJECT TO A LL THE TE RMS , EXC LUS IONS AND CONDITIONS OF SUC H POLIC IES . LIMI TS SHOWN MAY HAV E BEEN REDUCED BY PA ID CLA IMS . TN5R~ ----~SUBR ' ' 1~2)-c\6~1 I 1~2hl6'fvWv1 -----·- LTR TYPE OF INSURANCE INSD I WVD I POLICY NUMBER LI MITS A i x COMM ER CI AL GENE RA L LI ABILI TY I I I EACH OCCURRENCE s 2,000 ,000 r--+----i CLA IM S-MAD E ~ OCCUR I 12097900033 /1 / 1 ,_DAMAGE TO RENrED ___ ----x x 07 /15 /2016 07 5 20 7 PREMISE:_§...(Ea occurrence) __ S _ 300,000 --r I -I . MED EXP (Any one person ) S 10,000 r-1 ·--------H --H I PERSONAL & ADV INJURY s 2,000 ,000 r---I f----- 1 GEN'L AGGREGATE LIMIT APP LI ES PER : I ' GENERALAGGREGATE s 4 ,000 ,000 ~ ·--1 .-----, ; I I --------·-- I ~ _j POLICY _ _J r,;rg '--LOC I I I I PRODUCTS -COMP/OP AGG s 4 ,000 ,000 I I -~----·- , OT HER: I s AUTOMOB ILE LI ABI LI TY 12097900064 COMBINED SINGLE LIMIT s 1 ,000 ,000 (Ea accident) -----B -x-ANY AU TO I x ' 07/15/2016 07/15/2017 BOD ILY INJURY (Pe r person) I s I ----' -1 ALL OWNED I SC HED ULED I [BODILY INJURY (Per accident) S I AU TOS · AU TOS I -x HIRED AU TOS '}(: NON -OWNED I I PROPERTY DAMAGE I S ~ AU TOS ~Per accident)_ 5 _ --' r--; I I UMBRE LLA LI AS ~OCCUR I I I I I EACH OCCURRENCE s ·- I .------------. --- EXC ESS LI AS . CLA IM S-M ADE I 1-AGGR_i:oG~T~-__ ~~-·--! H ' I RETENT ION s -, . ------· OED I s WORKERS COMP ENSA TI ON I I _L_~~~ TUlJ' ~----' ~~H -I -. /AND EMP LOYERS' LI AB ILI TY Y/N I --·· - I ANY PROPR IETOR /PARTNER /EXECUT IVE O N /A E.L E ~C H A_C_S'.I ~~ ___j S , f~:~~;~~~~~~~ EXC LUDED ? .. ·-- I E.L. DISEASE -EA EMPLOYE E S , Jf yes, describe unde r 1------__ ___,__ ·----- DESCRIPTION OF OPER AT IO NS be low I E.L. DISEASE -POLICY LIM IT s I I I I DESCRIPTION OF OPERATION S I L OCATIONS I VEH ICL ES (ACORD 10 1, Additi ona l Remarks Schedule , may be attached if more space is req u ired) R e: Pe rform a partial t o p o gra p hies survey of APN 375-21-001, Lawren ce M itty Site Th e City o f Cup ertino, its agent s or e mployees a r e named as additional insure d 's in c luding waiver of subrog ation p er th e attac h e d form #SB-14696 8-A a nd as res p ects th e a uto per the attach e d f o rm CERTIFICATE HOLDER CANCELLATION SHOULD AN Y OF THE ABOVE DES CR I B ED PO LI CIES BE CA NCELLED BEFORE City of Cupertino THE EXPIRATION DATE THERE OF, NOTICE WI LL BE DELI V ER ED IN A CCO RDA NCE WITH THE POLIC Y PROV ISION S. 10300 Torre Avenu e Cupertino, CA 95014 AUTHORIZED REPRESENTATIVE I o~~uct'l~ © 1988-2014 ACORD CORPORATION. All rights reserve d . ACORD 25 (2014/01) Th e ACORD name and logo are regi s tered marks of ACORD --= SB-i46968-A (Ed . 01/06) IMPORTANT: THIS ENDORSEMENT CONTAINS DUTIES THAT APPLY ro THE ADDITIONAL INSURED IN THE EVENT OF OCCURRENCE, OFFENSE, CLAIM OR SUIT. SEE PARAGRAPH C., OF THIS ENDORSIEMENl rFOR THESE DUTIES. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFUU .. V. BLANKET ADDITIONAL INSURED ENDORSEMENT WITH PRODUCTS .. COMPLETED OPERATIONS COVERAGE & !BLANKET WAiVER OF SUB ROG.A. T!ON Architects, Engineers and Surveyors This en dors emen t modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM BUSJNESSOWNERS COMMON POLICY CONDITIONS A. WHO IS AN INSURED {Section C.) of the Businessowners Li ab ility Coverage Form is amended to Include as an insured any person or organization whom you are required to add as an additional Insured on this policy under a written contract or written agreement; but the written coniract or written agreement rnusi be: i. Currently In effect or becoming effective during the term of this policy; and 2. Executed prior 1o the "bo dily injury,' "prop erty dam age," or "personal an d advertising injury." B. The ins urance provided to 1he additional insu re d ls limited as foll ows : 1. That p e rson or organization is an additional insured solely for liability due to your negligence specifically resu ltin g from "your worl<" for the additional Insured which is the subject of the written contract or wril!en agreement. No coverage applies to llablllty resulting from the sole neglfgence of the additional Insured. 4. The insurance provid ed to the additional insured does not apply to "bodily injury," "property d amage,• "personal and advertising injury " arising out of an architect's, engineer's, or surveyor's rendering of or failure to render any professional services lncludlng: a. The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions , reports, surveys, field orders, change orders or drawings and specliicatio ns by any architect, engineer or surveyor performing services on a project of which you serve as construction manager; or b. Inspection, supervision, quality control , engineering or architectural se rvices done by you on a project of which you serve as construction m!ln age r, 5. This Insurance does not apply to "bodily injury," "property damage," or "personal and advertising injury" arising out of: a. The construction or d em olltio n work while you ara acting as a construction or demolition ·contractor. This exclusion does not apply to work done for or by you at your premises. 2. The Limits of Insurance applicable to the additional insured are those specified in the written contract or written agreement or in the Declarations of this policy, whichever is less. These Limits of Insurance are Inclusive of, and not in addition to, the Lim its of Insurance show n In th e Declarations. C. BUSINESSOWNERS GENERAL LIABILITY 3. The coverage provided to the add!t!onal Insured within thls endorsement and section titled LIABILITY AND MEDICAL EXPENSE DEFINITIONS -"Insured Contract" {Section F.9.) within the Businessowners Liability Coverage Form , does not apply to "bodily injury" or 'property damage" arising out of the 'products-completed operations hazard" un less required by the written contract or written agreement SB-146968-A (Ed. 01/06) CONDITIONS -Duties In The Event oi Occurr ence, Offense, Claim or Suit (Section E.2.) of the Businessowners Liability Coverage Fo rm is amended to add the following: An additional insured under this endorsement w ill as soon as practicable: 1. Give written notice of an occurrence o r an offense to us which may result in a clalm or 'suit" under this Insurance; Page 1 of 2 2. Tender the defense and indemnity of any claim or "suit"· to us tor a loss we cover under th is Coverage Part; 3. Tender the detense and lndemnlty of any claim or "suit' to any other Insurer which also has insurance for a loss we cover under this Coverage Part; and 4. Agree to mal<e available any other insurance which the additional insured has for a loss we cover under this Coverage Part. We have no duty to defend or indemnify an addl\lonal ins ured under this endorsement until we receive written notice of a claim or "suit" from th e additional Insured. D, OTHER INSURANCE (Section H. 2. B! 3.) of the Businessowners Common Policy Conditions are deleted and replaced with the following: 2. This Insurance is excess over any other Insurance naming the additional insured as an insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance be either primary or primary and noncontributing to the additional insured's own coverage. This insurance Is excess over any other insurance to which the additional insured has been added as an additional insured by endorsement. 3. When this Insura nce is excess, we wil l have no duly under Coverages A or B to defend the additional Insured against any "suit" if any other insurer has a duty to defend the additiona l insured SB-146968-A (Ed. 01/06) SB-146968-A (Ed. 01 /DB) agr;'nst that "suit" If no other Insurer defends, we wil l undertake to do so, but we will be entitl ed to the additiona l insured's rights against all those other insurers. When this insurance Is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: · (a) The total amount that all such other Insurance would pay for the loss In the absence of this · insurance; and (b) The total of all deductible and se lf-In sured amounts under all that other Insurance. We will share the remaining loss, if any, with any other insurance that ls not described in this Excess Insurance provision and was no\ bought specifically to apply in excess of the Limits oi insurance shown In the Declarations of this Coverage Part. E. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHEHS TO US {Se ction K.2.) of the Businessowne rs Common Polley Conditions is deleted and replaced with the following: 2. We waive any right of recovery we may have against any person or organization against whom yo u have agreed to waive such right of recovery in a written contract or agreement because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a con tr act with that person or organ izati on and included within the "products-completed operations hazard." Page 2 of 2 Policy #2097900064 Business Auto T HI S ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CA REF ULLY. ADDITIONAL I NS URED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM It is agreed that the "Who Is An Insured " provision is amended to include as an insured the person or organization designated below as an additional insured , subject to the following provisions: (1 ). This insurance applies only with respect to any Liability arising QUt of the operation of covered autos on the additional insureds premises described below; (2). The Named Insured is authorized to act for such additional insured in all matters pertaining to this insurance, including receipt of notice of cancellation; (3). Return premium, if any, shall be paid to the Named Insured; (4). Nothing contained herein shall affect any right of recovery as a claimant w hich the additional insured would have if not designated as such . GIUL&KU-01 OCAMPO ACORD-CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/ODIY YYY) ~ 9/6/2016 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). PRO DUCER CONTAC T NAME : ---Micheletti & Associates tA~g,NJQ , Ext): (209) 576 -2808 ::_ r~fi_o) (209) 5J0-3888 515 Lyell Drive, Suite 102 --- Modesto, CA 95356 ~~DA~~ss : info@michelettiins.com ----------- --INSU RER (S) AFF ORD_l_l"G CQl,IERAG E ------1-NA IC # INSURER A: Hanover Insurance Corn pa_!:!!'_ _____ 22292 ---------.-------INSURED INSURER B : -----_, -- Giuliani & Kull -San Jose, Inc, INS URER C : ----------·--- 4880 stevens Creek Blvd., Ste 205 INSURER 0 : --I ----~---------San Jose, CA 95129 INS URER E : ---------, INS URER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TH IS IS TO CER TI FY TH AT THE POLIC IES OF INSUR ANC E LI STED BELOW HAV E BEEN ISSU ED TO THE IN SUR ED NAMED ABOVE FOR THE PO LI CY PER IOD IND ICA TED . NOTWITH STAND ING ANY REQU IREMENT , TE RM OR COND ITI ON OF ANY CONTRACT OR OTHER DOCUM ENT WITH RESPECT TO WH ICH TH IS CERT IFICATE MAY BE ISSUED OR MAY PERTA IN, TH E INSUR ANC E AFFORDED BY TH E POLIC IE S DESCR IBED HERE IN IS SUBJECT TO ALL THE TERMS , EXCL USlONS AN D COND ITI ONS OF SUC H POLICIES . LIM IT S SHOWN MAY HAV E BEEN REDUC ED BY PAID CL AIMS . ~~~ TYP E OF INSURANC E l ~~~~l ~~I POLI CY NUMBER i c~2}6'6~1 i 1~276%~1 i --LI MITS CO MM ERC IAL GENE RAL LI ABILI TY __J CL AIMS -MADE c OCCUR ~i------- I ' I I ~ EACH OCCURR ENC E S fQAMAG E TO-RENTE . .;;D ___ _:__ ___ _ PREM ISES (Ea occurrence) S I MED EXP (Any ~e perso:i_l __ S _ _ r----------- - GEN'L AGGREGATE LI MIT APP LIES PER : " _ PO LI CY ::= r;m I~~ LO C OTHER : AUTOMOB ILE LI AB ILITY ANY AU TO ALL OWNED AUTOS 1---HIRED AU TOS ----SCHEDULED AUTOS NON-OWNED ~AUTOS I H UMBRE LLA LIAS OCCUR I I -I EXC ESS LI AS -. -1 CLAIMS -MADE OED I l RETENT ION s I 1WO RKERS CO MPENSA TI ON 1 ,, : AN O EM PLOY ERS' LI ABILITY y I N I ANY PROPR IETOR /PARTNER /EXECUT IVE D NI A I I OF FICER /MEMBER EXCLUDED? (Ma nd atory in NH) I ~~~t~~~~r~~ ~:gPER ATIO NS be low l I I I I PERSONA L & ADV INJURY S GENERAL AGGR EGATE - PRODUCTS -COMP/OP AGG S --------·- $ COMB INED SINGLE LI MIT r lEa accide11t) ___ _ BODILY IN JURY (Pe r person) BODILY INJUR Y (Per accident) S -PROPERTY DAMAGE ------. s -- , (per ac ciden t) __ .......__ EACH OCCURRENC E S ---- AGGREGATE ' PER OTH-_______fil!.il!I_s__, _,_E ~ __ _ ~~AC H A CC I DE_t-JT ____ S __ E.L. DI SEASE - EA EMPLOYEE S I E.L. DISE ASE -POLICY LI MIT S - - - A Professional Liab. I A 1Professional Liab. LHF A880616 00 ILHF A880616 00 03/22/2016 103/22/2017 'Li m it 03/22/2016 03/22/2017 1 De ductible 1 ,000 ,000 25 ,000 I DESCR IPTION OF OPERAT ION S I LOCAT IONS I VEHICLE S (ACOR D 101 , Additiona l Remark s Schedu le, may be attache d if more space is required) Re : Perform a partial topographi es s urvey of APN 375-21-001 , Lawrence Mitty Sit e Evid ence of insurance CERTIFICATE HOLDER CA NC ELLA TION SHOULD AN Y OF THE AB OV E DES CRIBED POLICIES BE CAN CELLED BEFO RE City of Cupertino THE EXPIRATION DATE THE REOF, NOTICE WILL BE DE LI VE RED IN ACCORDANCE WITH THE PO LI CY PROVISIONS . 10300 Torre Avenu e Cupertino , CA 95014 AUTHORIZ ED REPR ESENTATI VE I 0J!..lw~u C.~ © 1988-2014 ACORD CORPORATION . All rights r eserve d. ACORD 25 (2014/01) The ACORD name and logo are registe red marks of ACORD GIUL&KU-01 OCAMPO ACORC>" CERTIFICATE OF LIABILITY INSURANCE I DAT E (MM/DDNYYY ) ~ 9/6/2016 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(ie s) must be endors e d. 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 endo r sement(s). PRO DU CER CONTAC T NAME : Micheletti & Assoc i ates J.itJg,NJo, Ext): (209) 576-2808 ___ ~-r~ No): (209) 530-3888 515 Lyell Dri ve, Suite 102 Modesto, CA 95356 ~oMDA~~ss : info@michelettiins.com -------~ - INSU RER(S) AFFO RDING CO".!"RA GE NAI C # ----- INSURER A: Republic Indemnity Company of Am_eri ca 2 2 179 -. ----------------------~--+----- INSURED INS URER B: -----------· --- Giulian i & Kull ·San Jose, Inc, ~R E R_~ -----------·- 4880 s t evens Cre ek Blvd ., Ste 205 INSURER D : ----------San Jose, CA 95129 INSUR ER E : -------------r--- INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: TH IS IS TO CERTI FY THAT TH E POLIC IE S OF INS U RANC E LI STED BELOW HAV E BEEN ISSUED TO TH E INSURE D NAMED A BOVE FOR THE PO LI CY PER IOD IND ICAT ED . NOTWITHSTAND ING ANY R EQU IR EM ENT, TERM OR CONDITION OF A NY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W HICH TH IS CERTIFIC A TE MAY BE ISSUED OR MAY PERTA IN, THE INSURA NC E AFFORDED BY THE POLIC IES DESCR IBED HEREIN IS SUBJECT TO AL L THE TERMS , EXC LUS IONS AND CONDITIONS OF SUCH POLIC IES. LI MITS SHOWN MAY HAV E BEEN REDUCED BY PA ID CL A IMS . INSR -------1ADD LJSUBR I PO LI CY EFFT POLI CY EXP ---- L TR TY PE OF INSURANC E INSD I/ND POLI CY NUMBER (MM/DDNYYY) I IMM/DDNYYY l LIM ITS CO MMERC IAL GE NERA L LI AB ILI TY I I >--------, l-t--J CLAIMS-M ADE __ I OCCUR I !----< -------------I . _J -----------1 I ~'L AGGR E~E LIM IT APPLIE _S PER: PO LI CY PRO-I LOC ------1 l___.; JE CT t_____ I OTHER : AUTOMO BILE LIAB ILITY ANY AU TO ALL OWNED AUTOS HIRE D AUTOS -SCHEDU LED _ . AU TOS NON -OWNED AUTOS _ _, UMBREL LA LIAB -_j OCCUR ' EXC ESS LI AB CLAIMS-MADE ~D 1 RETENTIONS I i I I I I I I I i I I I I I EACH OCCURRENCE S DAMAGE TO RENT!OD --- PREM ISES _(Ea occurrenc~~~ ____ _ MED EXP (Any one personL_., S __ _ i.Y ERSON AL & ADV INJ_U_RY_+-'-S -·- ~L _AGGREGAT~ I s - - PRODUCTS -COMP /OP AGG S ---s COMB INED SINGLE LIMIT s -~a ccid~n t L_ - - - BODI LY INJURY (Per person) s ' - -----· - - BODILY INJURY (Per accident) s ' PROPERTY DAMAGE s . (P~~cide~) s EACH OCCUR RE NCE s -----.. - AGG REG AT E s ------ s ·- --- - -- -- -·- - -- - 'WORKERS COMP ENSAT ION AN D EMP LOYER S' LI AB ILI TY y I N ! I 0 1N/A 1163133-13 I '-~-J~~TUIT_._ -·~~H -______ - 09/01/2016 1 09/01/2017 EL EAC H ACC IDENT S 1 ,000 ,000 A ANY PROPR IETO R/PARTN ER/EXECUTI VE OF FICER /MEMBER EXC LUDED? '(Ma nda tory in NH) If yes , des cribe under DESCRIPT ION OF OPERATIONS below x I I I I I I I I . . ---; ------ I ~-l. D I SE~S E -EA EMPLOYEE S 1 ,000,000 I I , E.L. DISE ASE -PO LI CY LI MIT 1 S 1 ,000 ,000 I I I I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEH ICLES (ACORD 10 1, Addi tio nal Remarks Schedu le, may be c.1ttached if mo re space is required) Re : Pe rform a partial t o pog ra phies surv ey of APN 375-21 -001 , L a wrence Mitty Site W a iver of subrogation a ppli e s p e r the attach e d form CERTIFICATE HOLDER CANCELLATION SHOULD AN Y OF TH E AB OV E DE SCR IB ED POLI CIE S BE CANC ELLED B EFO RE C ity of Cupertino THE EXPIRATION DATE THE R EOF, NOTICE WILL BE DELIVE RED IN A CCO RDAN CE WITH THE PO LI CY PROVISIONS . 10300 Torre Avenu e Cupertino , CA 950 1 4 AUTHOR IZED REPR ESENT ATIVE I ().~~ © 1g88-2014 ACORD CORPORATION. All rights r e served . ACORD 25 (2014/01) Th e ACORD name a nd logo are regis tered marks of ACORD Waiver of Our Right to Recover From Others Endorsement -Califo rnia WC040306 (Ed. 4-84) We have the right to recover our payments from anyone liable for an injury covered by this p olicy . We will not enforce. om 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 requ~es yo u to obtain this agre==t from us. You mus t mifi.ntain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additiona l premium for this endorsement shall be 5. O 0 % of the California workers' compensation premium otherwise due Oll such remuneration. Person or Organization Any person or organization for which the named insured has a g reed in a written contract executed prior to loss to provide this waiv~t Schedule Job Description RE: EVIDENCE OF INSURANCE This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Republic Indemnity Company of America Company No. 19739 Insured : GIULIANI AND KULL INC (A CORP) Policy Numb~r·: 163133-13 Endorsement Number: Endorsement Effective: 9/1 /16 Form No. WC306 10/93 111111111111111111111111111 ·11111111111111111111111 1111111111111111111111 lllll lllll lllll lllll llll llll RFl172P