Loading...
16-159 MSI Fuel Management Inc., Fuel Management System ReplacementAGREEMENT BETWEEN THE CITY OF CUPERTINO AND MSI FUEL MANAGEMENT INC. THIS AGREEMENT, for reference dated J t-JS , 2016, is by and between CITY OF CUPERTINO (hereinafter referred to as "City"), a municipal corporation, and MSI FUEL MANAGEMENT INC. (hereinafter referred to as "Contractor"), a California corporation whose address is 865 Catting lane, Suite E, Vacaville, CA 95688 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 FuelMaster Fuel Management System, in accordance with the adopted Specifications, Special Provisions and Plans. NOW, THEREFORE, it is mutually agreed by and between the undersigned parties as follows: 1. TERM: The Contractor shall begin work within thirty (30) working days after receiving notice from City to commence the work, and shall diligently prosecute the work to completion before the expiration of sixty (60) 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 Specifications, Special Provisions and Plans, which are 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 bid, 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 City, with checks drawn on the treasury of City, to be taken from the 630-85-849-900-990 fund. Payment will be made by City in the following manner: On the first day of each month, Contractor shall submit a written estimate of the total amount of work done the previous month. Payment shall be made up to 95 % of the value of the work. City shall retain 5 % of the value of the work as partial security for the completion of the work by Contractor. Retained amounts will Page 1 o f 20 be paid to Contractor 35 days after the acceptance by City and the recording of the Notice of Completion with the Santa Clara County Recorder's office. Payment shall not be construed as acceptance of defective work. No interest will be paid to Contractor on retained funds. 4. TIME IS OF THE ESSENCE: Contractor and City agree that time is of the essence regarding the performance of this Agreement. It is agreed by the parties to the Agreement that in case all the work called for under the Agreement is not completed before or upon the expiration of the time limit as set forth in paragraph 1 above, damage will be sustained by City, and that it is and will be impracticable to determine the actual damage which City will sustain in the event of and by reason of such delay. It is therefore agreed that the Contractor will pay to City the sum of Two Thousand Dollars ($ 2,000) per day for each and every day's delay beyond the time prescribed to complete the work; and the Contractor agrees to pay such liquidated damages as herein provided, and in case the same are not paid, agrees that City may deduct the amount thereof from any money due or that may become due the Contractor under the Agreement. It is further agreed that in case the work called for under the Agreement is not finished and completed in all parts and requirements within the time specified, City shall have the right to extend the time for completion or not, as may seem best to serve the interest of City; and if it decides to extend the time limit for the completion of the Agreement, it shall further have the right to charge the Contractor, his or her heirs, assigns, or sureties, and to deduct from the final payment for the work, all or any part, as it may deem proper, of the actual costs and overhead expenses which are directly chargeable to the Agreement, and which accrue during the period of such extensions. The Contractor shall not be assessed with liquidated damages during any delay in the completion of the work caused by an act of God or of the public enemy, acts of City, fire, flood, epidemic, quarantine restriction, strikes, freight embargoes, and unusually severe weather or delays of subcontractors due to such causes; provided that the Contractor shall, within one (1) day from the beginning of such delay, notify City iJ.1 writing of the causes of delay. City shall ascertain the facts and the extent of the delay, and its fo1dings of the facts thereon shall be final and conclusive. 5. STANDARD OF CARE: Contractor agrees to perform all services herew1der 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 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 Page 2 of 20 und er the co ntrol of Contractor, except to th e extent they are limited by s tatute, rule or regulation anu u ·1e expreciS Lenn:,; ut til1:,; Agreement. No c1vii service status or olher r ight ot empioyment will be acquired by v ir tue uf Contractor's services. No n e of th e b enefits provided by City to its employees, including but nol iimited to unemploym e nt ins uran ce, \•mrke rs' compensation plan s, vc1c;:1ti on and s ick leave are available from City to Contr;:ictoi, its employees or agents. Deductions s haii not be made for any s tate or federal taxes, FICA paym e nts, PERS payments, or other p urposes normaUy associated with an employer-e mployee relationship from any fees due Contractor. Payments of the above items, ii required, are the respon s ibility of Contractor. 7 . IMMIGRATION REFORM AND CONTROL ACT (IRCA ): Contractor assumPs ;my anrl r1 ll re s ponsibility for verifying the identity an d employment a u thorization uf a ll uf its employees perfor ming work hereunder, pursuant to all applicable IR CA or other federai, or sta te ru Jes and regulations. Contractor shall indemnify and hold City h;,1 ·1-n lP~~ frnm ;:int1 ~g~lnt;!t ~ny l nc~, dar11age, liability , costs or PxpPnSf\5 ?.r ising fTrn11 any noncomp1iance of this prevision by ContrLlctor. 8. NON-DISCRIMINATION: Consistent vvit h City's poJic_i that harassrr1ent and discrin-,ination are urtacceptablc employer/emp loyee conduct, Con irndur agrees th at harassment or di scrimination directed to ward a job applicant, a City e mployee, or a c iti zen by Contractor or Contractor's employee on the basis of race, religious creed, color, nationa l origin, ancestry, handicap, disability, marital status, pregnancy, sex, c1ge, or sexual orientation wili not be tojerated. Contractor agrees Lhal any and a ii violations oft-his provision shall constitute a material breach ot this Agreement. 9. HOLD HARMLESS: Contractor shall, to the fulle s t extent .:illowcd by iaw, indemnify, defend, and hold l1 arm le cis C ity and its officers, officiais, agents, em pioyees and voiunteers aga in st any and ai i liabil ity, claims, stop notices, actions, ca u ses of action or demands w hatsoever from and against any of them, including any injury to or death of any person or damage to property or other li ab ility of ~ .. r1y nature, arising o ut o( pertainin g to, o r related to t!.1e performance of this l\.greement by Contr~ctor or Contrt.1ctor's employees, officers, officia ls , agents or i ndependent con tra ctors. Contractor sh a ll not be obligated unde r this Agreement to indemnify Ci ty to th e extent that the damage is caused by th e s ole or active negligence or willful m isconduct of City, its agents or emp lo yees. Such cos ts and expenses sha ll inch1r1p rp;ison a ble attorneys' fees of co un sel nf City's rhnicP, PXpert fees and a ll other costs and fees 0£ litigation. Contractor agrees to obtain executed indemnity agreements with provis ion s identical to those set torth here in these sections from each and every su bcontractor o r any olher person or entity involved by, for, \•vith, or on behalf of Contractor in the perfor mance of this a greement. If Contra ctor fa il s to obtain such indemnity obligations from others a s required here, Contractor agrees to be folly responsible accord ing lo the lerms of this secti on. 10 TNSURANCF; On or before the com!11encement of the terms of th is l\greemcnt, Contr~ctor s.hti !l furni s h City with certificates s howing the type, amount, class of operations covered, effective dates and dates of expiration of insurance coverage in compliance with paragra ph 10 A, B, C and D. Such Page 3 of 20 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 lhirly (30) dJys' advJ.ncc written notice to City by certified mail, "Attrntion: City Manager." It is agreed that Contractor shall maintain in force at all times during the performa n ce of Lhis AgreemenL all appropriate coverage of in sura11ce required by th is Agreement with an insurance company that is acceptable to City and licensed to do insurance business in the State of California . Endorsements naming City os additional insured shall be submitted with the insurance certificates. Contractor shall complete the attached Document 00530 Insurance Forms. A. COVERAGE: Contractor sha!l maintain the follo~·ving in surance coverage: B. (1) Workers ' Comoensation: Statutory coverage as required by the State of California; Employers' Li;:ihil ilv $1,.000 ,.000 ricr nrr1_1 rrcncc (2) General Liability: Commercial general liability coverage in the following minimum limits: Bodily Injury: $2,000,000 each occurrence $4,0 00,000 aggregate -al I other Property Damage: $2,000,000 ec1ch occurrence $4,000,000 c1ggregale if submitted, combined single limit of $2,000,000 per occurrence; $4,000,000 in the aggregate will be considered equiva lent to the required minimum limits shown above. (3) Automotive: Comprehensive automobile liability coverage in the following minimum limits: Bodily injury: $1,000,000 each occurrence Properly Dani.age: $1,000,000 each occurrence 01' Combined Single Limit: $1,000,000 each occurrence SUBROGATION WAI~ER: Contractor agrees that in the event of lo ss due to any of the perils for which it ha s agreed to provide comprehensive general and automotive liability insurance, Contractor shall look solely to its insurance for recovery. Contractor hereby granls to City, on bchnlf 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 s ubrogation which any sud1 insurer of said Contractor may acquire against City by virtue of the p;:::yment of ~ny Joss un.dcr sucl1 .ir1surance . Page4 of 20 C. FAILURE TO SECURE: If Contractor at any time during the term hereof should fail lo secure or maintain the foregoing insurance, City sl1all 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 addit-ional insured under all insurance coverages, except worker's compensation insurance. The naming of an additiona l insured shall not affect any recovery to which such additional insured would be entitled under this poiicy if not named as such additional insured. An additional insured named herein s h all not be held liable for any premium, deductible portion of any lo ss, or expense of any nature on this policy or any extension thereof. Any o th er insurance heid by an additional insured sha ll not be requixed to contribute anything toward any loss or expense covered by t11e msurance prov 1cieu uy tn1s 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 Contrc:ictor. 11. BONDS: Bonds are not required for this agreement. 12. PR()J.ffRTTT()l\J a r.. I! Tl\JC:T TFJ\NC:llPRS· Contractor shill 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, subfessee, hypothecate or transferee shall acquire no right or 1.Y\terest by reason of such attempted assignment, l1ypothecation or transfer. However, claims for money by Contractor from City under this Agreement may be assigned to a bank, trust company or other financ ia l institution without prior written consent. Written notice of such assignment s hall 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 synd icate member or cotenant, ti Lonh·actor rs a partnersi11p or JOmt venture or synuKale or cotenancy, which shall result in changing the control of Contractor, shall be construed as an assignn,ent of this Agreemen t. Controi means fifty percent (50%) or more of the voting power of the corporation. Page 5 of 20 1:1. 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 subcontracti.ng 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 iiabiiity insurance in reasonable conformity to the insurance carried by Contractor. In addition, any work or services subcontracted heretmder 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 herew1der. 15. REPORTS: Each and every report, draft, wmk 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 mily retain ,1 copy of any report furnished to City pursuant to this Agreement. No report, information or other data given to or prepared or assembled by Contractor pursuant to this Agreement shall be rnade available to any individual or orgar1ization by Contractor without prior approval by City . Contractor shall, at such lime and in such form as City may require, furnish reports concerning the status of services required under this Agreement. 16. RECORDS: Contractor shall maintain complete and accurate records with respect to sales, costs, expenses, receipts and other such information required by C ity that relate to the performance of services under this i~~.greement. Contractor shall maintain adequate records of services provided in sufficient detail to permit-;m cvaluat-ion of services. All such records shall be maintained in accordance with generally accepted accounting principles and shall be clearly identified and readily accessible. Contractor sha ll 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 hanscripts therefrom as necessary, and to ailow inspection of ail work, data, documents, proceedings and activities related to this Agreement. Such records, togeth er with supporting Page 6 of 20 documents, shall be kept separate from other documents and records and shall be maintained for a period of three (3) years after receipt ot 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 City's supplemental examination or aud it of the records discloses a failure to adhere to appropriate internal financial contro ls, or other breach of contract or failure to act in good faith, then Contractor s halJ reimburse City for a ll reasonab le costs an d expenses associated with the s uppiemental examination or audit. 17. NOTICES: All notices, demands, requests or approvals to be given under this Agreement shall be given in writing and conclusively shaD 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: Lity or Cupertino Attn: Chris Orr 10555 Mary Ave. Cupertino CA 95014 All notices, demands, requests, or approvals from City to Conti-actor shall be addressed to Contractor at: MSI FUEL I\,1ANAGEMENT INC. 865 Cutting Lane, Suite E Vacaville, CA 95688 18 . URBAN RUNOFF MANAGEMENT: The Contractor shall avoid creating excess dust as the work is being prosecuted . I£ water is used for dust control, contractor shall use as li ttle as necessary. Contractor shall take all steps necessary to keep wash water out of the sli-eets, gutters, storm drains and streams. The Contractor shall develop and implement erosion and sediment control to prevent poiiution of storm drains m1d str eams. Such controi inciudes but is not iimited 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; shovei or vacuurn saw-cul siuny and rernove irom the site). B. Cover exposed piles of so il or construction material with plasiic s hPe ting. All construction materials must be stored in containers. C. Sweep and remove all materials from paved surfaces that drai11 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 Page 7 of 20 and disposed of offsite in ,m appropriate lo cation. D. After breakin g old pavement, Contractor s h a ll remove al! debris to avoid contact with rainfall or runoff. E. Contractor sha ll maintain a clean work area bv removing trasl1 , litte r , and d ebris at the end of each work day. Contrnctor shall also clean up any leaks, drips, and other spills as they occur. T h e objective is to ensure that t h e C ity and Coun ty of Santa C lara County-Wi de C lean Water Program is adequately enforced. These conh·ols s hould be implemented prior to the start of construction, up-graded as requ ired, 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 State of California's Best M anagement Practices Municipal and Construction Handbooks, local program gu id ance materials from municipalities, Section 7.1.01 of the Standard Specification s and any other appropriate donLments on storm water q u ality controls for construction. Failure to comply with lhi s program will result in the iss uance of noncompliance notices, citations, project stop orders or fines. The fine for noncompliance of the above program is two hundred and fifty dollars ($25 0.00) per occurrence per day. The State under the Fe deral C lean v\i'ater Act ca n 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 h ereunder, Contractor shall be deemed in default in the performance of thi s Agreement. If s uch default is not cured within a pe riod of two (2) days afte r 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 s ole discretion and without cause, of terminating this Agreement by g iving seven (7) d ays' prior writlen notice to Contractor as provided herein. Upon termination of this Agreement, each party shall pay to t.i..e other party that portion o f compensation specified in this Agreement that is e,imed and unpaid prior to the e ff ective date of tpr,r, i rir1 tinri 20. COMPLIANCES: Contractor shaii comp ly with ai l state or federal iaws a n d ail ordinances, rules and regulations enacted or issued by City . Spec.ifically, and vvitbout limitation, Contractor shall comply with all state, federal, or local regulation regarding the removal and disposal of hazardous waste. A. PREVAILING WAGES: To the extent applicable, Contractor sha ll comply with the City's Labor Compliance Program and all other requirements set forth in Labor Page 8of 20 Code section 1770 et seq. Contractor shall pay prevailing wages. Contractor will submit monthly certified payroll records lo City for all employees and subcontractors in a preapproved format or a City provided form. Any delay in remitting certified payroll reports to City upon request from City wiii result in either delay and/or forfeit of outstanding payment to Conb·actor. B. WORKING DAY: To the extent applicable, Conh·actor shall comply with Ca lifornia Labor Code Section 1810, et seq. which provides that work performed by employees uf contractors in excess of 8 hours per day, and 40 hours during any one week, must be cornpensc1ted as overtime, at not less th,111 l V2 times the basic rate of pay. C. PAYROLL RECORDS: To the extent applirnble, Contractor shall comply with Californin Labor Code Section 1776 which requires certified payroll records be maintained with the name, address, social sccmity number, work classification, straight time and overtime hours worked each day and week, and the actual per diem wages paid to l'ach journeyman, ,1~1prcntice, wurh'r, u1· other employee employed by him or her in co nnection vvith this Ag re e me nt. T he h1yroil Records shall be made available for inspection as provided in Ca lifornia Labor Cod e Sec tion 1776. U. APPRENTICcS; lo the extent applicable, Contractor shall comply with California Labor Code Section 1777.5 regarding apprentices. 21. CONFLICT OF LAW: This Agreement shall be interpreted under, and enforced by the laws of the State of California excepting any choice of law rules wh ich may direct the application of laws of another ju risdiction. The Agreement and obligations of the parties are subject to all valid laws, orders, rules, ancl 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 aliow 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, shal I not be deemed to be a waiver of any subsequent breach of the same or any other term, covenant, or cond ition 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 \•vhatsoever 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 tu vary the provisions hereat. Any modification of this Agreement will be effective only by Page 9 uf 20 written execution signed by both City and Contractor. 25. INSERTED PROVISIONS: Each provision and clause required by !av,• to be insertecl into the Agreement shall be deemed to be enacted herein, and the Agreement sh,ill be read and enforced as though each 1;vere included herein. If through mistake or otherwise, any such provision is not inserted or is not c0rrect-ly inserted, the Agreement sha ll be amended to make such insertion on application by either party. 26. CAPTIONS: The captions in this Agreement are for convenience only, are not a part of tJ-1e Agreement and in no way affect, lirnjt or amplify the terms or provisions of this Agreement. Page 10 of 20 P.O. No. 2017-00000271 IN WITNESS WHEREOF, the parties have caused the Agreement to be executed on the day and year first above written . CONTRACTOR Date tlov '5, 2 '2 I k Address 865 Catting lane Suite E. Vacaville, CA 95688 CITY OF CUPERTINO RECOMMENDED FOR APPROVAL: By ~~~ Printed Name C ft~t 5 0 fl~ . ::p~---11 _foAttomey .r \)I.../ A TIEST: Grace Sc hm idt, City Clerk Contra c t Amount: $21 ,000 Account No. : 630 -85 -849-900-990 DOCUMENT 00530 Page 11 of 20 INSURANCE FORMS INSURANCE FORMS INSTRUCTIONS FOR ITEMS 3, 4 AND 5, THE FORMS PROVIDED BY THE CITY OF CUPERTINO MUST BE USF.D . FORMS OTHER THAN THESE WILL NOT BE ACCEPTED. ALL DOCUMENTS MUST BE ORIGINALS -SUBMIT IN TRIPLICATE 1. insurance Agreement-Must be s igned by Contractor. 2. Certificate of lnsurance to the City of Cupertino -must be completed by the insurance agent or m ust provide a certificate on the company's form. They must contain the same in.forn1ation. 3 . Endorsement of Additional Insured and Primary Insurance and Notic e of Cancellation -must be signed by the insurance agent for genera l liability and automobile liability only. 4. Comprehens ive genernl liability/commercial general li ab ili ty endorsement of aggregate limits of insurance per proj ec t -must be signed by th e insurance agent for genera l liability only. 5. Waiver of Sllbroga rion endorsement worker's co mpen sation in surance -must be signed by the insurance agent for worker's compensation only. Page 12 of 20 CITY OF ,~, 1•1 CUPERT!NO lNSURANCC: A G HEEMENT A. Contractor is aware of the provisions of Section 3700 of the Labor Code, which requires every employer to be insured against liability for worker's compensation or undertake sel£- insurancP in ;:ircm·cl;:inrP with tllf' nmvisinns nf th;:it ('nrlP . ;:inrl will rnmnlv witl1 such orovisions II ;,, , -, , , , II / befor e commencing th 0 performance of th e work o f thfo Contract. jj B. Contractor and a ll subcontractors will carry worker's compensation insurance for the protection of its employees during the progress of the work. The insurer shall waive its rights of II ::;ulnuga i.iun .1ga u.1 si. i.h e Ci i.y,_ the City 's off icers, agents anu e rn pioyees an d s ha ll issue an I endorsement to the policy evidencing s ame. II C. Contractor shall carry at all times, on all operations hereunde r, comme rcial general liability insurance, automob il e liabili ty in surance a n d bui lder's all risk insu rance. A U insurance I coverage shall be in amoru1ts required by the City and shall be evidenced by the issuance of a I certific;te in a form prescribed b-y the City and si1all be underwritten by insurance companies II J/ satis.factory tu the City for all operations, sub-contract work, contractual obligations, product or 1 , II completed ope rations, all owned vehicles c1nd non-owned vehicles. Said insurance coverage II obta ined by the Contrac tor, excepting worker's compensation coverag , shc1l1 name the City, its/I I engineer, an d each o f its d irecto rs, officers, agents a n d e mpl oyees, as d e te rmined by the City, a s I additional insureds on s aid policies. Insurers must be licensed to do business in the State of California. The Insurers must also have an "A" policyholder's rating and a financial rating of at least Class VII in accordance with the current Best's Guide Rating or that is otherwise acceptable to the C ity. 'I D. Be fore Conb·a c tor p erforms any work al, or prepares or delivers materials to, the site ofl cons truction, Contractor sh a ll furnish certificates of insurance evidencing the foregoing in surance coverages and such certificates shall provide the name and policy number of each carrier and policy and that the insurance is in force and will not be canceled or modified without thirty (30) II days written notice to the City . Contractor shall maintain all of the foregoing insurance coverages J/ j in force until the work w1der this Conh·act is fully completed. The requirement for carrying the l'I for e going insurance shall not derogate from the provisions for indemnification of the City by r o nt-r::.r,t nr 1w"'lrl,n· t-hic rnnh·::;l c t-".:lnd fnr f-L.e '41n·~t1·"I' of .f-1 .... n 1:ATr"l ... ~·""'nhr p"riorl N T"turit-l,ci-~1,ri-i-nry I ~ "-'"-•V'-,~,-, uu~ ~vHlh, • ~" ,v, U I -''""' V '' -'''-••=""'\I '-'--'• v ,,._.,,,,.,.;_.,.,6 11 n m di1~1in_i shing tJ,e o bliga ti on s of C~ntrac t or. w ith r es pect to the for ego in g, _Co~tracto r s h~lJ 1., mamtam m full force a nd e ffect durmg the life of thi s Contract, the follo w mg msmance m II amounts not less than the amoru1ts specified and having a Best's Guide Rating of A , Class VTT or ! ;etter onhat is othe,wise acceptable to the City. I 1 LIMITS Page 13 o f 20 II /I ~~r~~r's Compensation and Employers' I L1aornty I I General Liability -commercial general liability; including provisions for contrachrn l liability, personal injury, independent contractors and products -completed operations hazard. , Automobile Liability -comprehensive IJ' covering owned, non-owned and hired I automobiles. ~SJ: 6'-eJ ~rrmvr ,µc.,. (Contractor's Name) In accordance with the Worker's Compensation Act of the State of California-Worker's Comp "statuto1y" per CA Law; Employers' Liability $1,000,000 per occurrence Combined single limit of $2.0 million per occurrence; $4.0 million in the aggregate Combined sing le limit of $1.0 million per occurrence. Dated: /Vo II S' 20 _Lt P:ige 14 of 20 CITY OF a CUPERTINO CERTIFICATE OF INSURANCE TO THE CITY OF CUPERTINO II This certi fie s to th e City of Cupertino that the followin g described policies h ave been issued to the it,sured named below-and are in force a l this time. Insured: _______________ _ Address: _______________ _ II Description of operations/locations/products insured (show contract name and/or number, if any): ____________________________ _ WORKER'S COMPENS.A TION * Stah1l"ory Min. * Employer's I Liability (Name of insurer) $ $ $ Insurance Company's State License No . Chec k Policy Type: Each Occurrence $ COMPREHENSIVE GENERAL LIABILITY f l Premises/Operations General Aggregate "' L :r, (if applicable) [ ] Owners & Contractors Protective Aggregate $ [ J Contractual for Specific Conlracl Personal Injury $ [ l Products Liability J [ ] XCUHazards I ~ J Broad Form P.O. Fire Da_mage ( any one fire) $_ J Severability of Interest /1 Clause J Personal Injmy with Med ic al Expen se $ Employee Exclusion Removed (any one person) or Self-Insured COMMERCIAL GENERAL LIABTT.JTY Re tention $ (Name of in s urer) Policy No.~-___ Expiration Date ..... A UTOMOTIVE/VEHTCLE LIABILITY BODILY INJURY PROPERTY DAMAGE Commercial Form Each Person Each Accident Page 15 of 20 l1 I I I I I Liability Coverage $ _______ $ _______ _ Each Accident (Name of in surer) $ ________ or Combined Single Limjt Policy No. _______ _ Expiration Date _____ _ I BUILDER'S RISK,, ALL RISK" $ ____ _ I -1 This is to certify that the following policy ha s been issued by the below-stated company in conformance with th e requirements of the project documents and is in force a t this time. N/A (Name of insurer) Policy No. ________ _ Expiration Date .. II Limits of Liability: _________ _ Deductible: ________ _ ===I A copy of all Endorsements to the policy(ies) which in any way limit the above-listed types of coverage are attached to th is (Agent's in itia i) Certificate of Insurance. This Certificate of In surance is not an insurance policy and does not amen d, exten d or alter th e coverage I afforded by the policies li sted herein. Notv,rithstand ing any requirement, term, or condition of any contract l or any other document w ith respect to whic h this C:ert ifica!P of fnsur;mce m;iy !)P iss11ed or 111;:iy pert;iin, j the insurance afforded by the poli cies described herein is subject to a ll the terms, excl u sions and conditions jJ I ot such policies. IT IS HEREBY CERTIFIED that the above policy(ies) provide liability insurance as required by the Agreement bet1,veen the City and the insured. By:-----------Dated: ___________ 20 __ Attach Certificate of Insurance and Add itional Insured Endorsement on comp,my forms. Page 16 of 20 CITY OF I~~! Iii CUPERTINO ADDITIONAL INSURED ENDORSEMENT and ENDORSEMENT OF PRIMARY INSURANCE and NOTICE OF POLICY CANCELLATION ENDORSEMENT Project Title and Number: In consideration of the policy premium and notwithstanding any inconsistent statement in the policy to which this Endorsement is attached or any other Endorsement attached thereto, it is agreed as follows: I' The City of Cupertino ("City") and its directors, officers, engineers, agents and employees, jl and all public agencies from whom permits will be obtained and their directors, officers, 1 engineers, agents and employees, and the State of California, and its officers, agents and employees, are hereby declared to be additiona l insureds under the terms of this policy, but only with respect to the opera lions of the Contractor at or upon any of the premises of the City in· connection wi th the Contract with the City, or acts or omission s of the additional insmeds in connection with, but limited to its general supervision or inspection of said operations. The insmance afforded by this policy is primaq insurance, a11d no additional insurance held or owned by the designated additional insmed(s) shall be called upon to cover a loss under /1 sai d ad ditional policy. Cancellation Notice. The insurance afforded by this policy sha ll not be suspended, voided, canceled, reduced in coverage or in limi ts, or materially altered , excep t after thirty (30) days' prior ,-vritten notice by certified maiJ, return receipt requested, has been g iven to the City I I of Cupertino ("City"). Such notice shall be addressed to the City as indicated below . Pa ge 17 of 20 II POLICY INFORMATION 1. Insurance Company: 2. Insurance Policy Number: ____________________ _ 3. Effectiv e Date of this Endorsement: _________________ 20 __ 4. Insured: ____________________________ _ All notices hereit provided to be given by the Insurance Company to the City in -:onnection I with this policy and these Endorsements, sha ll be mailed to or delivered to the City at 10300 Torre Avenue; Cupertino, California 95014. JI I,----------------------(print/type name) j I warrant that I have authority to b ind the below liste d In surance Company and by my signature hereon do so bind this Company . Signature of Authorized Representative: __________________ _ (Original s ignaliJre required on <1ll Endorse ments furnished to the District) Names of Agent/Agency: ____________ _ Title: _________ _ II ... ACTCTress: _______________ _ Telephone: _______ _ Facsimile: -------- Page 18 of 20 C I TY OF II CUPERTINO COMPREHENSIVE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ENDORSEMENT OF AG GREGA TE LIMITS OF INSURANCE PER PROJECT Proj ect Title and Number:______________________ I In consideration of the policy premium and notwithstandin.g any inconsistent s tatement in the I policy to which thi s Endorsement is attached or any other Endorsemen t attached thereto, it is as follows: This Endorsement modifies the insurance provided under the General Liability Coverage part of the below-referenced policy of insurance. The g eneral aggregate limit under LIMITS OF INSURANCE applies separc1te ly to tJ,e project described as ----------------------------1 POLICY INFORMATION 1 . Insurance Company: _______________________ _ 2. Insurance Policy Number: _____________________ _ 3 . Effec ti ve Date of this Endornement: _________________ 20 __ 4 . Insured: ___________________________ _ 5. Additional Insured: City of Cupertino, its directors, officers, agents and e mployees . AH notices herein provided to be given by the lnsurance Company to lhe City in connection / with this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Torre j Avenue; Cupertino, Cal ifor nia 95014. I I, -----··-------··-----·· _ __ _ ___________ (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind thi s Company. I Signature of Authorized Representative: _________________ _ (Origina l s ignature required on a ll Endorsements furnished to the District) Names of II Agent/Agency: Address: _______________ _ ---------------- Title: _________ _ Telephone: _______ _ Facsimile: -------- Page 19 of 20 I CITY OF fl CUPERTINO WAIVER OF SUBROGATION ENDORSEMENT WORKER'S COMPENSATION INSURANCE Project Title and Number: ______________________ _ In consideration of the policy premium and notwithsta nding any inconsistent sta tement in the policy to which this Endorsement is attached or any other Endorsement attached thereto, it is agreed as follows: It is agreed that with respect to such insurance as is afforded by the policy, the Insurance Company waives any right of subrogation against the City of Cupertino, and each of its directors, officers, agents, consultants and employees by reason of any payment made on account of injury, including death resulting therefrom, susta in ed by any emp loyee of the insured, arising out of the performance of the above-referenced Contract. POLICY INFOR.tvt:A TION 1. Insurance Company: ________________________ _ 2 . Insurance Policy Number: ______________________ _ 3 . Effective Date of this Endorsement: _________________ 20 __ 4. Insured: ____________________________ _ AU notices herein provided to be given by the Insurance Company to t11e City in connection with this policy and this Endorsement, shaU be mailed to or delivered to the City at 10300 Torre Avenue; Cupertino, California 95 014. I, _______________________ (print/type name) 1 warrant that I have authority to bind the below listed In surance Company and by my signature h ereon do so bind this Company . Signature of A uthorized Representa tiv e: __________________ _ j (Original signatme required on all Endorsements furnished to the District) I Names of Agent/Agency:_____________ Title: _________ _ Address: _______________ _ I Telephone: _______ _ Facsimi le : -------- END OF DOCUMENT Page 20 of 20 ACORD~ I OAre (MMiOOIYYYY) ··- CERTIFICATE OF LIABILllY INSURANCE \,,,,_.-.,,. 10/19/2016 THIS CERTIFICATE IS 1ssugo AS A MATIER OF iNFORMATION ONlY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOlOl:;R, THIS CfRTlflCATB. Dbl:$ NOf AFf!RMATIVE;LY OR NEOATIVE'LV AMEND, EXTEND OR AL lER THE COVl:RAGE AFFoROEti BY 'fHE POLICIES BELOW, THIS CERTIFICATE .<)F INSURANCE DOES NOT CONSTITUTE A CONTRACT BElWl=EN THE ISSUING INSURER(S), AUTHORIZED REPRESEWTATIVI: OR PRODUCER, ANO THI: CERTIFICATE HOLDER, IMPORTANT: If lhil cortlflcalo hcildor Is .in ADDITIONAi. INSURHD, tho pollcy(ios) must be ondorsod , If SUBROGATION IS WAIVED, subject to lho terms and condlllons of lho poltcy, certain policies may roqulre .in endorsement. A st atomont on this certlllcate dot;1s not confer rights to the cortmcate holder In lleu of such ondorsomont(s), PROl1JCER ~Xllt"' COASTAL BROKERS INSURANCE· FOR QUESTIONS CONTACT: PHOl.1!; . I PA1' OIABLO VALLEY INSURANCE AGENCY ·Wtf§!t E!Q;·-·~--~-·--· . J"l.<:,tto)~; -·-··----- 801 YGNAC!O VALLEY ROAD ,L __ !;~~· . . --.=---·-.. -~----_,,,, ___ ,_ .. INSURER($) AFFOROIHG COVERA'!E «AJC# WALNUT CREEK CA 94598 INsURi:'RA :. BURLINGJON,INSJJ RANCE COMPANY -_._ ~ -· -·-...... "-"'.-= ... ......__~-·-· . -... ··-···-·----:..-..~.;..-,-;.,;,~ IIISUREµ MS!. FUEL MANAGEMENT, INC , l ~l/!l!.l'I~; 865 COTT!NG COURT SUITE E INSURl<RC : INSllRf RD : ·----·-·· ·-· -··-· ----· VACAVILLE CA 95668 lm\/RERE: 11-r,;URER F : SV COVERAGES CERTIFICATE NUMBER: REVISION NUMBER : 1111$ I$ ro CERTIFY THAT ilH! POLIOIES OF INSURANCE LISTED eELCfN HAVE 8!H:N ISSIJEO TO TH£ INSUREO NAMED AB<Jvrf, FOR THE f>OllOY PERIOD INOICATEO, NOlWITHSTANDING ANY REQUIREMf:NT; TERM OR CONOITION OF MY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO W}JICH THIS CERTIFICATE I.IAY 66 ISSUED OR MAY PERTAIN, iliE INSURANCE AFFORDED BY nm POLICIES OESCRIBEO HEREIN IS SUBJECT TO All THE TERMS . i:XCLUSiONSANO (;<»101110NS OF .SUCH PQLICli:$, ~IMriS SHOWN MAYHAV¥ 81:EN REOUCi;O BY PAIO CLAIMS . 't<f~ 'IYl'll Ofl/jSU~l_lC!l ~.; ~; PO~lCY N.JM B~R : r&Bkl&M?½ 103~1 LIMIT$. GEIIERAL LiABl1.11Y u.o:H ,;,ccURll f;I/C E J..2.000,000 O S/ X . CQ M\'E RCIAl GHI F.RA!. llMJi Uf'I rxr r,1i~r.;;r:rv~ l 100 000 ry , fi RE MIS.E S !Ea OCl':tJ.f!ifr{O I =o ClAIM S•l,\A.f.>f: IBJ OCO.!R J.i f;O i!XP IN1y <m r,~ Mn} i 5000 A 84GB004062 05/22/2016 05/22/2017 f'!'RSO :W S ;.t N lt l.UR V f 2,000.00-0 ---. (,[:fl !;RA!. AG\'>Rc<;',A,11; 14,000 ,000 - H tH. AGC,Rf.GAlE LMfi f\PFi.lES f ER F'ROC•JCT$ • COMP/VP AGG t 2.0Ql)_.OOQ xl f'l'.ol.l Cl' n ~~ff n Lut. 1 AUTOMOBILE llASILtlY [] r , IE~'·:.~~~:;:f fl<!lt: l .... ,, f t-- A'IV/>!JT O BODll y N,!Jfl Y jPN rm·~} i -fL L OVtllEO -S(Hf:(}IJLEO RODI\. V IN.lJ fl '( {Pern:,:iJHi} f ,-,'l/TQS -,m os l'><<Jfl r ,.,, ',W'.,'"'r. llO tl-0\'l.l EO H:REDP..UI OS f ,JJ 10& Jr...-,,,;,1;nl f ,_ -1 UMBRELLA LIAS I _,O C.(:lill i---1 [J &DI OCOJ f,fl EIIC E 1 -Gl1Cll$SLIA8 W >Ms-11.A!;i; AGuR f.(,Af f.; t oc v I I Rf:l f /ll ~)II i I WORKERS COM ~ENSATION . -I ;~~?: ~I',-/s I 1orn- ,'ND~ P~OYERS' LIABILITY y / ER /.,)fl' FROffilET OOiP,\RTl,'filH:Xf:•;l;nvr, [] ti/A '; lo L £Ac t! f..CO::C~llf __ f OFflC EJMc,\'JxR EXCUCE:cn {fd~rtdatory lo N)i · EL DI E-EA.'iE -p,,et.lf'l()):!f f Uy4'i ,~·!(.1 f.,.a tm~ E.L Dl$EA~-!: · f OL~;n11.m I r J''<l'<11Pti<'.N ('.t l'or.fli .;11<11 ;; t.J:o, rJ r : DESCRIPTIOtl OF QPl;R,l,TIONSILOCATIOIIS/Vls\11<:~!;$ (,l,11~,il/\CORO 101,AddiUOl\ll Rem11!(f SclmMo, If mOl6 lp•Ct Ii rt(!Lrlled) CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED PfcR fORM CG2033 , ADDITIONAL INSURED· COMPLETED OPS · CG2037 AND WAIVER OF SUBROGATION CITY OF CUPERTINO, ITS CITY COUNCIL. BOARDS AND COMMISSIONS, OfFICER$, EMPLOYEES AND VOLUNTEERS ARE NAMED AS ADDITIONAL INSUREDS CERTIFICATE HOLDER CITY OF' CUPE'.RnNO 10555 MAAY AVENUE CUPERTINO, CA 95014 ACORD 25 (2010/05) CANCElLATION SHOULD AUY OF THE ABOVE OESCRIBEO POl!CIES BE; CANCE1.LED BEFORE THE EXPIRAllOtl DAYE THEREOF, NOTICE .~Ill BE DELIVERED Ill ACCORDANCE wnH THE POLICY PR0\/1610NS . :::::o:::~:~:~:: SVCS l~ £ 1~~ ____ __, © 1988-2010 ACOKt;H;:t,~N. All r rghts reserved. Tho ACORD namo and logo aro rogistotod marks of ACORD POLICY NUMBER: 8468004062 COMMERCIAL GENERAL LIABILITY CG20370413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizatl on(s) Location And Description Of Completed Operations City of Cupertino, its City Council, boards and commissions, officers, employees and volunteers 10555 Mary Ave Cupertino CA 95014 ·- Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II -Who Is An Insured is amended to include as an additional insured the person(s) or organlzation(s) shown In the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described In the Schedule of this endorsement performed for that additional insured and included in the "products-completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted bylaw; and 2. If coverage provided to the additional Insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section Ill -Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance : 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown In the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the De clarations . CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of1 POUCYNUMBER: 84 6 80040 62 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: CITY OF CUPERTINO, ITS CI TY COUN C IL, BOARDS 1\ND COMMISSIOlTS, OFFICERS , EMPLOYEES AND VO L-C-NTEE RS 1055 5 MARY AVENUE CUPERTINO, CA 95 0 1 4 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following Is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV -Conditions: 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 organiz:ation and induded in the "products-completed operations hazard". This waive r applies only to the person or organization shown In the Schedule above. CG 2404 05 09 ©Insuran ce Servi ces Office, Inc ., 2008 Pag e 1 of 1 MSIFU-1 OP ID: JY ACORD'· CERTIFICATE OF LIABILITY INSURANCE I DATE (Ml,!/DDIYYYY) ~ 11/04/2016 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($), 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 ~2mfCT Dennis Mulhall Diablo Valley Insurance Agency rt8Ntro Exti :925-210-1717 I ;ffc 1101, s2s-210-1818 801 Ygnacio Valley Rd, Ste 100 Walnut Creek, CA 94596 E-MAlL ADDRESS: Dennis Mulhall INSURER(SI AFFORDING COVERAGE NAICI/ 11rnuRER A: Burlington Insurance Company - INSURED MSI Fuel Management, Inc. INSURER B: 865 Catting Court, Suite E JIISURER C: Vacaville, CA 95688 J!lSURER D; 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. JNSR TYPE OF INSURANCE ADDL SUBH 1tifil-J%MVv, POLICY EXP LIMITS LTR INSD IWD POLICY NUMBER (MM/DDIYYYYI COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE s f--0 CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED PREMISES /Ea occurreocel s MEO EXP (Any coo person) $ ,_ - PERSONAL & ADV INJURY $ -GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ q DPRO-OLoc PRODUCTS -COi.iP/DP AGG $ POLICY JEC T OTHER: s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 /Ea accidenll - A X NJY AUTO X 57UECZM1238 12/16/2016 12/16/2017 BODILY INJURY (Per person) s -AL L OWNED -SCHEDULED AUTOS AUTOS BODJL Y INJURY (Per ecci<lent) $ f-- X x NON-OWNED PROPERTY DAMAGE s HIRED AUTOS AUTOS IPer accident\ - $ Ul,\B RELLA LlAB HOCCUR EACH OCCURRENCE $ f-- EXCESS LIAB CLAIMS -MADE AGGREGATE s OED I I RETENTION s $ WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS' LIABILITY STATUTE ER YIN ANY PROPRIETORIPARTNER/EXECUl1VE D N/A E.L EACH ACCIDENT s OFACERIMEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $ If yes, desc<ibe vnder DESCRIPTION OF OPERATIONS beicm E.L. DISEASE· POLICY LIMIT s DESCRlPTIOII OF OPERATIONS I LOCAllOIIS I VEHI CLES (ACORD 101, Additional Remarks Schedule, may be altached Jr more space Is required) See Next Page CERTIFICATE HOLDER City of Cupertino 10555 Mary Avenue Cupertino, CA 95014 I ACORD 25 (2014/01) CANCELLATION CITCU -1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESEIITATNE ~~~.~ © 1988-2014 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD NOTEPAD: HOLDER CODE INSURED'S NAME CITCU-1 MSI Fuel Management, Inc. MSIFU-1 OP ID: JY City of Cupertinoi and its directors, officers, engineers, agents and employees, and al public agencies from whom permits will be obtained and their directors, ofricers, engineers, agents and employees, and the State of California, and its officers, agents and employees, are hereby declared to be additional insureds with respect to auto liability under the term of this policy, but only with respect to the operations of the Contractor at or upon an¥ of the premises of the City in connection with the Contract with the City or acts or omissions of the additional insureds in connection with, but limited to its general supervision or inspection of said operations per the attached endorsement. Date PAGE 2 11/04/2016 ___, AEH AC:C>RC,® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) ~ R046 11/4/2016 THIS CERTIFICATEIS 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION 15 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: NORTHWESTERN INSURANCE AGENCY/PHS PHONE (NC , No, Ext): ( 866) 467 -8730 rAX (A/C, No), ( 8 8 8 ) 443 -6112 129417 P: (866) 467 -8730 F: ( 888) 443 -6112 E-MAIL ADDRESS: PO BOX 33015 INSURER(S) AFFORDING COVERAGE NAie# SAN ANTONIO TX 78265 INSURER Ac Property & Casualty Co o f Hartford 34690 INSURED INSURER B : TRENT DOUGLASS OBA MSI FUEL INSURERC , MANAGEMENT, INC. INSURER D: 865 COTTING LN STE E INSURER E , VACAVILLE CA 95688 INSURERF : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HA VE BEEN ISSU ED TO THE INSURED NAMED A BO VE FOR THE POLIC Y PERIOD INDIC ATED . 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 A LL THE TERMS ,EXC LUSIONS AND CONDITIONS OF SUCH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TNSR TYPE OF INSURANCE ADDL SUHR POJ.JCY NUMBER POI.ICYEFF POI.ICY EXP LIMITS TD I N.\'ll nn= (MMIDD!YYYYl ,1 a111.1n~J•nnn.rv\ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ I CLAIMS-MADE O occuR DAMAGE TO RENTED PREM ISES (Ea occu rrence) $ MED EXP (Any one person) $ - PERSONAL & ADV INJURY $ - GEN'L AGGR EG ATE LIMIT APPLIES PER: GENERAL AGGREGATE $ R POLICY D j:gT D LOG PRODUCTS -COMP/OP AGG s OTHER: s AUTOMOBILE LIABILITY COM BINED SINGLE LI MIT (Ea accident) $ ~ ANY A UTO BODILY INJURY (Per person) $ --OWNED SCHEDULED AUTOS ONLY A UTOS BOD ILY INJU RY (Per accident) $ -,-- HIRED NON-OWNED PROPERTY DAMAG E AUTOS ONLY A UTOS ONLY (Per accident) $ >--- s UMBRELLA LIAB ~ OCCUR EACH OCCURRENCE $ >-- EXCESS LIAB CLAIMS-MADE AGGR EG ATE $ DED I !RETENTIONS $ WORKERS COMPEN!,:~ TION IPER I I OTH- AN D EMPI.OYERS' l./AH/l/TY X STATUTE ER ANY PROPR IE TOR /PAR TNER /EXECUTI VE YIN E.L. EACH ACC IDENT $1,000,000 OFFICER/M EMBER EXCLUDED? D NI A ~ $1,000,000 A (M andatory in NH) 57 WEC DU7411 10/2 1/2 016 10/21/2017 E.L. DISEASE-EA EMPLOYEE ~ If yes , describe under E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS !VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured 's Operations . CERTIFICATE HOLDER CANCELLATION City of Cupertino SHOULD AN Y OF THE ABOVE DESCRIBED POLICIES BE CANCELLED -BEFORE THE EX PIRATION DATE THEREOF, NOTICE WILL BE e ach of its directors,officers,agents , DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. co nsultants and employees AUTHORIZED REPRESENTATIVE . 10555 MARY AVE 7~ /~L~ CUPERTINO, CA 95014 © 1988-2 015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 8468004062 NAMED INSURED:MSI FUEL MANAGEMENT, INC. INSURANCE COMPANY: Burlington Insurance Company PRODUCER: Coastal Brokers Insurance Services, Inc. 6602 Owens Drive ENDORSEMENT#: 31 -----·-.. ·-~·~-. "-·~-,-I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. GENERAL CHANGE ENDORSEMENT Th is endorsement modifies insurance provided under the followinQ : COMMERCIAL GENERAL LIABILITY LIMITS OF LIABILITY IS HEREBY INCREASED TO THE FOLLOWING: GENERAL AGGREGATE LIMIT (OTHER THAN PRODUCTS-COMPLETED OPERATIONS): $4 ,000,000 PRODUCTS-COMPLETED OPERATIONS AGGREGATE LIMIT: $2,000,000 PERSONAL AND ADVERTISING INJURY LIMIT: $2,000,000 EACH OCCURRENCE LIMIT: $2,000,000 CG2037 -ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -COMPLETED OPERATIONS IS 1-ll='Rt=RV Anni::n '"' FA\/flR nF r.!TY nF r! IPFRTINn ND CITY OF NOVATO. BG-G-243-AMENDATORY ENDORSEMENT-OTHER INSURANCE PROVISION IS HEREt:5Y ALJLJt:LJ IN 1-AVUK OF CITY OF LIVERMORE. CG2404 -WAIVER OF SUBROGATION IS HEREBY ADDED IN FAVOR OF CITY OF CUPERTINO . Due Date: Premium for this Change Endorsement: ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED. IFG-1-0151 01 05 Issue Date: 10/20/2016 August 24, 2016 Mike Loomis City of Cupertino 10 300 To rre Ave Cupertino, CA 95014 Reference : City of Cupertino Fuel Management System Replacem e nt. Description MASTER UNIT, PROKEE AND PASSIVE RF SYSTEM ADDI T IONAL HOSE CONTROLLER WIRELESS N ETWORK RADIO Software & Optional System Access FUELMASTER PLUS WINDOWS SOFTWARE PROKEE ENCODER -USS PROKEE -Black, Blue, Red, Green or Orange Other Costs Equipment Sub Total Sales Tax SO FTWARE IMPLEMENTATION AN D TRAINING FUELMASTER INSTALLATION REMOVE EXSISTING PETRO VEND INSTALL DELIBERANT OR CATSe CABLE System Grand Total Build Customer Database and Encode Prokees SCOPE OF WORI< Qty 200 Price $8,570.00 $125.00 $575 .00 $2,250 .00 $585.00 $5.85 8.75% $795.00 $2 ,995 .00 $395.00 $795 .00 I Extension $8,570.00 $125.00 $575.00 $2,250.00 ,' $585.00 $·1.170.00 I $13.275.oo I $1:161.561 $795.00 $2 ,995.00 $395.00 $795.00 J $19,416.56 $1 ,125.00 Remove existing PetroVend system and replace with FuelMaster Fuel Management System. Configure system to specific site and test for correct operation . Software training will be conducted on site at t h e City of Cupertino Corporation yard and wil l includ e basic system functions . Software imple mentation and IP address assignment will req ui1-e the assistance of t he Informatio n Technology Department. Custome 1-will need to provide a PC with a network co n nection to connect with FM U at the fuel island. Quote assumes a ll ex ist in g conduit ca n be used and w ill be free and clear of blockage or decay. Quote assumes all existing wiring can be used and is in good working condition. 865 Catting Lane, Suite E, Vacaville, CA 95688 Phone (707)449-4550 Fax (707)449-3752 8 Quote does not include AIM Kits or installation of AIM kits on vehicles. If installation is desired by the customer the cost is $165.00 per vehicle. Special terms and conditions will apply. >" Delivery: 45 Days 'r F .O .B.: Destination ~ Terms: Net 30 Days );;, Price Quote is valid until December 1 , 2016 Sho u ld any questions arise, please fee l free to contact me . Sincerely; ~___z_ Trent Douglass 865 Catting Lane, Suite E, Vacaville, CA 95688 Phone (707)449-4550 Fax (707)449 -3752 CUPERTINO en 2: -0 -i 0 City of Cupertino Service Center 10555 Mary Ave nue C U PERT INO , CA 95 01 4 www. Cupertino. org V ENDOR 516 -M S I F U EL MANAG EM EN T, INC. &' MS I FUEL MANAGEMENT, INC. ;:?, 865 Colling lane , Ste E ~ VACAVILLE , CA 95688 - REFERE NC E # CD -i 0 City of Cupert ino Serv ice Cente r 10555 Ma ry Avenue CUPE RTINO , CA 95 01 4 www.Cupertino.org Purchase Order No. 2017-00000271 DAT E 09/13/2016 PURCHASE ORDER NUMBER MUST APPEAR ON ALL INVOICES. SHIPPERS, B ILL OF LADING AND CORRESPONDENCE DELIVER BY SHIP VIA FREIGHT TERMS PAGE 1 of1 ORIGINATOR: Chyle ne Osbo rn e DE SCR IPT ION : New Fuel Maste r Sy stem ~00A~T:IT¥ ... __ , --·-----t&)mitl oescR1~WN~~~--~:=-~-=~·~~-: .. S':.-~lffNJT~cosT: =-'f0IAf=COSm-~ -----~--~,:__~-~_::--~~::-"'::. ~----=-=----,__. --~~~--- 1 .0000 Each I 2 1 .000 .0000 I $21 ,000 .00 630-85-849 900-990 -Capita l Outlay Special Projects -PW 21 ,000 00 ------ I I I ... , . TOTAL DUE $21 ,000.00 B DATE 09/13/20'16 A uthorized Signatu re Special Ins tructions