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17-031 Tennyson Electric, Inc., Agreement for Traffic Signal Modification at S. De Anza Blvd and Rodrigues Avenue, Project NO. 74,366.08A; Contract No. 2017-08RECORDING REQUESTED BY City of Cupertino WHEN RECORDED MAIL TO City Clerk's Office City of Cupertino 10300 Torre A venue Cupertino, CA 95014-3255 NO FEE IN ACCORDANCE WITH GOV. CODE 27283 23686046 Regina Alcomendras Santa Clara County -Cl k R er -ecorder 06/28/2017 02:39 PM Ti ties: 1 Fees : $0.00 Taxes : $0 Total : $0 .00 Pages: 3 1111 w,1r.,~,,~: 1U:1,~"M/11j ,1.~,: ,, ~11:•1'~'1:~,,,,, ~~1:,1,•,, "M, 11111 (SPACE ABOVE THIS LINE FOR RECORDER'S USE) NOTICE OF COMPLETION CITY PROJECT NAME: Traffic Signal Modifications at S. De Anza Blvd and Rodrigues Ave City Project No. 2016-18 Original D For Fast Endorsement a CUPERTINO Recording Requested By: City of Cupertino When Recorded Mail To : City of Cupertino 10300 Torre Ave . Cupertino , CA 95014 SPACE ABOVE THIS LINE IS FOR RECORDER 'S USE NOTICE OF COMPLETION Civil Code§§ 8182 , 8184 , 9204 , and 9208 NOTICE IS HEREBY GIVEN THAT : 1. The undersigned is the agent of the owner of the project described below . 2 . Owne r's full name is : City of Cupertino , Cal ifornia . 3 . Owner's address is : City Hall, 10300 Torre Ave., Cupertino , CA 95014 . 4. The nature of owner's interest in the project is : _X_ Fee Ownership Lessee Other: __________ _ 5 . Construction work on the project performed on the owner's behalf is generally described as follows : City Project Name: Traffic Signal Modifications at S. De Anza Blvd and Rodrigues Ave (City Project No .: 2016-18) Modifications to the existing traffic signal at the S . De Anza Boulevard and Rodrigues Avenue intersection to accommodate an 8-phase traffic signal operation. Work included removing and/or relocating existing traffic signal equipment and roadway signs; furnishing and installing new hardware and conduits ; constructing a new curb ramp ; and installing related concrete and asphalt pavement work . 6. The name of the original contractor for the project is : Tennyson Electric , Inc . 7. The project was completed on: June 23 , 2017. 8 . The project is located at: The intersection of S. De Anza Boulevard and Rodrigues Avenue. Verification : In signing this document, I, the undersigned, declare under penalty of perjury under the laws of the State of California that I have read this notice , and I know and understand the contents of this not ice, and that the facts stated in this notice are true and correct. June 28, 2017; Santa Clara County .. ~ Date and Place ~,--. _n._,.a-tu-r""'e~=------------ Timm Bo rden Dire ctor of Public Works and City Eng ineer++ "NO FEE" City of Cupertino NOTICE OF COMPLETION is hereby given in order to comply with the provisions of Section 27283 of the Government Code. This is to certify that the Notice of Completion dated June 28, 2017 for CITY PROJECT NAME: Traffic Signal Modifications at S. De Anza Blvd and Rodrigues Ave City Project No. 2016-18 and the City of Cupertino, a governmental agency is hereby accepted by the City of Cupertino on June 28, 2017 and the grantee consents to recordation thereof by its duly authorized officer. I certify under Penalty of Perjury under the laws of the State of California that the foregoing paragraph is true and correct. Dated: By: June 28, 2017 Lauren Sapudar Senior Office Assistant Project No. 74 ,366.08A (2016-18) f, ~. ').f) 17-<f l/.) DOCUMENT 00650 AGREEMENT AND RELEASE OF ANY AND ALL CLAIMS TRAFFIC SIGNAL MODIFICATION ATS. DE ANZA BOULEVARD AND RODRIGUES AVENUE PROJECT NUMBER 74,366.0SA (2016-18) THIS AGREEMENT AND RELEASE OF ANY AND ALL CLAIMS ("Agreement and Release"), made and entered into this 12'h day of July, 2017 , by and between the City of Cupe1iino ("City"), and Tennyson Electric , Inc. ("Contractor"), whose place of business is at 7275 National Drive, Li vermore, CA 94550. RECITALS A . City and Contractor entered into Contract Number 2017-08 (the "Contract"). B . The Work under the Contract has been completed . Now , therefore , it is mutually agreed between City and Contractor as follows: AGREEMENT 1. Contractor will not be assessed liquidated damages except as detailed below: Original Contract Sum Modified Contract Sum Payment to Date Liquidated Damages Payment Due Contractor $107 ,975 .00 $128 ,317.68 $ 120,464 .27 $ 0.00 $ 7,853.41 2. Subject to the provisions of this Agreement and Release, City will f01ihwith pay to Contractor the sum of Seven Thousand, Eight Hundred Fifty-Three Dollars and Fo1iy-One Cents ($7,853.41) under the Contract, less any amounts withheld under the Contract or represented by any Notice to Withhold Funds on file with City as of the date of such payment. 3 . Contractor acknowledges and hereby agrees that there are no unresol ved or outstanding claims in dispute against City arising from the Contract, except for the claims described in paragraph 4 of this Document 00650 . It is the intention of the pa1iies in executing this Agreement and Release that this Agreement and Release shall be effecti ve as a full , final and general release of all claims , demands , actions , causes of action , obligations, costs , expenses, damages , losses and liabilities of Contractor against City , and all if its agents , employees, consultants (including without limitation Consulting Cupe1iino), inspectors , representatives , assignees and transferees except for the Disputed Claims set fo1ih in paragraph 4 of this Document 00650 . Nothing in this Agreement and Release shall limit or modify Contractor 's continuing obligations described in paragraph 6 of this Document 00650. City of Cupertino 00650 -1 Agreement and Release of Any and All Claim s Traffic Signal Modification at S . De An za Bl vd . and Rodrigues Ave Project No . 74 ,366.08A (2016-18) 4. The following claims are disputed (hereinafter, the "Di sputed Claims") and are specifically excluded from the operation of this Agreement and Release: Claim No. Date Submitted Description of Claim Amount of Claim None 5. Consistent with California Public Contract Code Section 7100, Contractor hereby agrees that , in consideration of the payment set forth i_n paragraph 2 of this Document 00650, Contractor hereby releases and forever discharges City, and all of its agents , employees, consultants, inspectors, assignees and transferees from any and all liability, claims, demands, actions or causes of action of whatever Jcind or nature arising out of or in any way concerned with the Work under the Contract 6. Guarantees and waJTanties for the Work, and any other continuing obligation of Contractor, shall remain in full force and effect as specified in the Contract Documents. 7. Contractor shall immediately defend , indemnify and hold harmless the City of Cupertino , Santa Clara County, its Architect, any of their Representatives, and all of their agents , employees, consultants, inspectors , assignees and transferees, from any and all claims, demands, actions, causes of action , obligations, costs, expenses, damages, losses and liabilities that may be asse11ed against them by any of Contractor's suppliers and/or Subcontractors of any tier and /or any suppliers to them for any and all labor, materials , supplies and equipment used, or contemplated to be used in the performance of the Contract, except for the Disputed Claims set forth in paragraph 4 of this Document 00650. 8. Contractor hereby waives the prov isions of California Civil Code Section 1542, which provides as follows: A general release does not extend to claims that the creditor does not know or suspect to exist in his favor at the time of executing the release, which if known by him, must have materially affected his settlement with the debtor. 9 . The provisions of this Agreement and Release are contractual in nature and not mere recitals and shall be considered independent and severable, and if any such provision or any pai1 thereof shall be at any time held invalid in whole or in pa11 under any federal, state, county, municipal or other Jaw , ruling, or regulation , then such provision, or pai1 thereof shall remain in force and effect only to the extent permitted by law, and the remaining provisions of this Agreement and Release shall also remain in full force and effect , and shall be enforceable. 10 . Contractor represents and warrants that it is the true and lawful owner of all claims and other matters released pursuant to this Agreement and Release, and that it has full right , title and authority to enter into this instrument. Each pa11y repre sents and waJTants that it has been represented by counsel of its own choosing in connection with this Agreement and Release. 11. All rights of City shall survive completion of the Work or termination of the Contract, and execution of this Agreement and Release. City of Cupe11ino 00650 -2 Agreement and Release of Any and All Claims Traffic Signal Modification at S. De Anza Blvd. and Rodrigues A ve Project No. 74,366.0SA (2016-18) * * * CAUTION: THIS IS A RELEASE -READ BEFORE EXECUTING * * * THE CITY OF CUPERTINO, a Municipal Corporation of the State of California ~~ 7 -:1-~-r7 City Clerk TENNYSON ELECTRIC, INC. By : ----'-'--£&~.,___~+-=-r,~-=----- Name : -",v[__,_A=4:..__,--r;'""" ... = .... _~=o=,..,.~-------I Its : __ L,-.;:0'-'0'------------- By:--------------- Name:-------------- Its : _______________ _ REVIEWED AS TO FORM: j\<1) }( _,,k:5::\:::L ~ City Attorney ~__._·:),__~~...___~".2_i)~--''20 END OF DOCUMENT City of Cupertino 00650 -3 Agreement and Release of Any and All Claims Traffic Signal Modification at S. De Anza Blvd. and Rodrigues Ave DOCUMENT 00630 GUARANTY Project No. 74 ,366.0SA TO THE CITY OF CUPERTINO, a Municipal Corporation of the State of California ("City"), for construction of TRAFFIC SIGNAL MODIFICATION ATS. DE ANZA BOULEVARD AND RODRIGUES AVENUE PROJECT NUMBER 74,366.0SA CUPERTINO, CALIFORNIA The undersigned guarantees all construction performed on this Project and also guarantees all material and equipment incorporated therein . Contractor hereby grants to City for a period of one year following the date of Final Acceptance, or such longer period specified in the Contract Documents, its unconditional warranty of the quality and adequacy of all of the Work including, without limitation , all labor, materials and equipment provided by Contractor and its Subcontractors of all tiers in connection with the Work. Neither final payment nor use or occupancy of the Work performed by the Contractor shall constitute an acceptance of Work not done in accordance with this Guaranty or relieve Contractor of liability in respect to any express wa1i-anties or responsibilities for faulty materials or workmanship . Contractor shall remedy any defects in the Work and pay for any damage resulting therefrom , which shall appear within one year, or longer if specified , from the date of Final Acceptance. If within one year after the date of Final Acceptance, or such longer period of time as may be prescribed by laws or regulations, or by the terms of Contract Documents, any Work is found to be defective, Contractor shall promptly, without cost to City and in accordance with City 's written instructions , correct such defective Work . Contractor shall remove any defective Work rejected by City and replace it with Work that is not defective, and satisfactorily correct or remove and replace any damage to other Work or the work of others resulting therefrom . If Contractor fails to promptly comply with the terms of such instructions, or in an emergency where delay would cau s e serious risk of loss or damage, City may have the defective Work corrected or the rejected Work removed and replaced. Contractor shall pay for all claims, costs, losses and damages caused by or resulting from such removal and replacement. Where Contractor fails to correct defective Work, or defects are discovered outside the correction period , City shall have all rights and remedies granted by law. Inspection of the Work shall not relieve Contractor of any of its obligations under the Contract Documents. Even though equipment, materials, or Work required to be provided under the Contract Documents have been inspected , accepted , and estimated for payment, Contractor shall, at its own expense, replace or repair any such equipment, material, or Work found to be defective or otherwise not to comply with the requirements of the Contract Documents up to the end of the guaranty period . All abbreviations and definitions of terms used in this Agreement shall have the meanings set fo1ih in the Contract Documents, including, without means of limitation , Section 00700 (General Conditions). The foregoing Guaranty is in addition to any other warranties of Contractor contained in the Contract Documents, and not in lieu of, any and all other liability imposed on Contractor under the Contract Documents and at law with respect to Contractor's duties , obligations , and performance under the Contract Documents. In the event of any conflict or inconsistency between the terms of this Guaranty and any warranty or obligation of the Contractor under the Contract Documents or at law , such inconsistency or conflict shall be resolved in favor of the higher level of obligation of the Contractor . :W,oo~w t1P0t:V1 G Contractor's Na e -=t'L½ NCH1()Qa 1 O,. S:te,A2 Address µ~ CA CfL{sc;o City /State/Zip END OF DOCUMENT City of Cupetiino 00630 -1 Traffic Signal Modification at S. De Anza Blvd. and Rodrigues Ave Guaranty Project No. 74 ,366.0SA DOCUMENT 00520 CONTRACT THIS CONTRACT, dated this fD::-: day of-{ielQ , 20 J..3:, by and between TENNYSON ELECTRIC, INC . whose place of business is located at 7275 NATIONAL DRIVE, LIVERMORE, CA 94550 ("Contractor"), and the CITY OF CUPERTINO, a Municipal Corporation of the State of California ("City") acting under and by virtue of the authority vested in the City by the Jaws of the State of California . WHEREAS, City, on the 8th day of February, 2017 awarded to Contractor the following Project: PROJECT NUMBER 74,366 .0SA TRAFFIC SIGNAL MODIFICATION ATS. DE ANZA BOULEY ARD AND RODRIGUES A VENUE NOW, THEREFORE, in consideration of the mutual covenants hereinafter set fo1ih , Contractor and City agree as follows: Article 1. Work 1.1 Contractor shall complete all Work specified in the Contract Documents, in accordance with the Specifications, Drawings, and all other terms and conditions of the Contract Documents. Article 2. Agency and Notices to City 2.1 City has designated Jennifer Chu, Associate Civil Engineer, to act as City's Authorized Representative(s), who will represent City in performing City's duties and responsibilities and exercising City 's rights and authorities in Contract Documents. City may change the individual(s) acting as City 's Authorized Representative(s), or delegate one or more specific functions to one or more specific City 's Representatives, including without limitation engineering, architectural , inspection and general administrative functions , at any time with notice and without liability to Contractor. Each City 's Representative is the beneficiary of all Contractor obligations to City, including without limitation, all releases and indemnities. 2.2 All notices or demands to City under the Contract Documents shall be to City 's Authorized Representative at: 10300 Torre Avenue, Cupe1iino, California 95014 or to such other person(s) and address(es) as City shall provide to Contractor. Article 3. Contract Time and Liquidated Damages 3 .1 Contract Time. The Contract Time will commence to run on the date indicated in the Notice to Proceed. City may give a Notice to Proceed at any time within 30 Days after the Notice of Award . Contractor shall not do any Work at the Site prior to the date on which the Contract Time commences to run. Contractor shall achieve Final Completion of the entire Work and be ready for Final Payment in accordance with Section 00700 (General Conditions) within 60 Calendar Days from the date when the Contract Time commences to run as provided in Document 00700 (General Provisions) 3.2 Liquidated Damages. City and Contractor recognize that time is of the essence of this Contract and that City will suffer financial loss in the form of contract administration expenses (such as project management and consultant expenses), if all or any pa1i of the Work is not completed within the times specified above, plus any extensions thereof allowed in accordance with the Contract Documents. Consistent with Document 00700 (General Conditions), Contractor and City agree that because of the nature of the Project, it would be impractical or extremely difficult to fix the City of Cupe1iino 00520 -I Traffic Signal Modification at S . De Anza Blvd. and Rodrigues Ave Contract Project No. 74 ,366 .0SA amount of actual damages incurred by City because of a delay in completion of all or any part of the Work. Accordingly, City and Contractor agree that as liquidated damages for delay Contractor shall pay City: 3.2.1 $1,500 for each Calendar Day that expires after the time specified herein for Contractor to achieve Final Completion of the entire Work as specified above. 3.2.2 $1,000 for each occuJTence of a violation of Document 00800 , Section 1.7 WORK DAYS AND HOURS. 3.2.3 Three Months Salary for each Key Personnel named in Contractor's SOQ pursuant to Article 2.G of Document 00450 (Statement of Qualifications for Construction Work) who leaves the Project and /or Contractor replaces at any point before Final Completion, for any reason whatsoever, that Contractor can demonstrate to City's satisfaction is beyond Contractor 's control. Liquidated damages shall apply cumulatively and , except as provided below, shall be presumed to be the damages suffered by City resulting from delay in completion of the Work. 3.3 Liquidated damages for delay shall only cover administrative, overhead, interest on bonds , and general loss of public use damages suffered by City as a result of delay. Liquidated damages shall not cover the cost of completion of the Work, damages resulting from defective Work, Jost revenues or costs of substitute facilities , or damages suffered by others who then seek to recover their damages from City (for example, delay claims of other contractors, subcontractors, tenants, or other third-pa1iies), and defense costs thereof. Article 4. Contract Sum 4.1 City shall pay Contractor the Contract Sum for completion of Work in accordance with Contract Documents as set fo1ih in Contractor's Bid , attached hereto : See Exhibit "A" attached Article 5. Contractor's Representations In order to induce City to enter into this Contract, Contractor makes the following representations and waJTanties : 5 .1 Contractor has visited the Site and has examined thoroughly and understood the nature and extent of the Contract Documents, Work, Site, locality, actual conditions, as-built conditions, and all local conditions, and federal , state and local Jaws and regulations that in any manner may affect cost, progress, performance or furnishing of Work or which relate to any aspect of the means , methods, techniques, sequences or procedures of construction to be employed by Contractor and safety precautions and programs incident thereto . 5 .2 Contractor has examined thoroughly and understood all rep01is of exploration and tests of subsurface conditions, as -built drawings, drawings, products specifications or repo1is , available for Bidding purposes, of physical conditions, including Underground Facilities, which are identified in Document 00320 (Geotechnical Data, Hazardous Materials Surveys and Existing Conditions), or which may appear in the Drawings. Contractor accepts the determination set fo1ih in these Documents and Document 00700 (General Conditions) of the limited extent of the information contained in such materials upon which Contractor may be entitled to rely. Contractor agrees that except for the information so identified, Contractor does not and shall not rely on any other information contained in such repo1is and drawings. 5 .3 Contractor has conducted or obtained and has understood all such examinations, investigations, explorations, tests , repo1is and studies (in addition to or to supplement those refe1Ted to in Section 5.2 of this Document 00520) that pe1iain to the subsurface conditions, as-built conditions, underground facilities , and all other physical conditions at or contiguous to the Site or otherwise that may affect the cost , progress , performance or furnishing of Work, as Contractor considers necessary for the performance or furnishing of Work at the Contract Sum , within the Contract Time and in accordance with the other terms and conditions of the Contract Documents, including specifically the provisions of Document 00700 (General Conditions); and no additional examinations , investigations, explorations, tests, repo1is , studies or similar information or data are or will be required by Contractor for such purposes. City of Cupe1iino 00520 - 2 Contract Traffic Signal Modification at S . De Anza Blvd . and Rodrigues Ave Project No. 74 ,366.08A 5.4 Contractor has correlated its knowledge and the re s ult s of all such observations, examinations, investigations , explorations, tests, reports and studies with the te1111s and conditions of the Co ntract Documents. 5 .5 Contractor has given City prompt written notice of all conflicts, errors, ambiguities, or discrepancies that it has discovered in or among the Contract Documents and as-built drawings and actual conditions and the written resolution thereof through Addenda issued by City is acceptable to Co ntractor. 5 .6 Contractor is duly organized , existing and in good standing under applicable state law, and is duly qualified to conduct business in the State of California. 5.7 Contractor has duly authorized the execution , delivery and performance of this Contract , the other Co ntract Documents and the Work to be performed herein . The Contract Documents do not violate or create a default under any instrument, contract , order or decree binding on Contractor. 5.8 Contractor has li sted Subcontractors pursuant to the Subcontractor L isting Law, Ca liforni a Public Contracting Code §4 100 et seq. in document 00340 (Subcontractors List) Article 6. Contract Documents 6.1 Contract Documents consist of the following documents, including all changes, addenda, and modifications thereto: Document 00400 Bid Fo1m Document 00430 Subcontractors List Document 00450 Statement of Qua li fications Document 00481 Non-Collusion Affidavit Document 00482 Bidder Certifications Document 00510 Notice of Award Document 00520 Co ntract Document 00530 Insurance Forms Document 00550 Notice to Proceed Document 00610 Construction Performance Bond Document 00620 Construction Labor and Mate1ial Payment Bond Document 00630 Guaranty Document 00650 Agreement and Release of Any and All Claims Document 00660 Substitution Request Fo1111 Document 00680 Escrow Agreement for Security Deposit in Lieu of Retention Document 00700 General Conditions Document 00800 Special Conditions Document 00820 Special Environmental Conditions Document 00821 Insurance Document 00822 Apprenticeship Program Technical Specification/Special Provisions Addenda(s) Drawings/Plan s 6.2 There are no Contract Documents other than those li sted in this Document 00520, Artic le 6. Document 00320 (Geotechnical Data , Hazardous Material Surveys and Existing Conditions), and the information supplied therein , are not Contract Documents. The Contract Documents may only be amended , modified or supplemented as provided in Document 00700 (General Conditions). Cit y of Cupe11ino 00520 -3 Traffic Signal Modification at S. D e Anza B lvd . and Rodrigues Ave Co ntract Project No . 74 ,366.08A Article 7. Miscellaneous 7.1 Tenns used in thi s Contract are defined in Document 00700 (General Conditions) and will have the meaning indicated therein . 7.2 It is understood and agreed that in no instance are the persons signing this Contract for or on behalf of City or acting as an employee, agent, or representative of City, liable on thjs Contract or any of the Contract Documents, or upon any warranty of authority , or otherwise, and it is fu11her understood and agreed that liability of the City is limited and confined to such liability as authorized or imposed by the Contract Documents or applicable law . 7.3 Contractor shall not assign any po11ion of the Contract Documents, and may subcontract p011ions of the Contract Documents only in compliance with the Subcontractor Listing Law , California Public Contracting Code §4100 et seq. 7.4 The Contract Sum includes all allowances (if any). 7 .5 In entering into a public works contract or a subcontract to supply goods, services or materials pursuant to a public works contract, Contractor or Subcontractor offers and agrees to assign to the awarding body all rights , title and interest in and to all causes of action it may have under Section 4 of the Clayton Act (15 U.S.C. §15) or under the Ca11wright Act (Chapter 2 ( commencing with Section 16700) of Pa11 2 of Di vision 7 of the Business and Professions Code), arising from purchases of goods , services or materials pursuant to the public works contract or the s ubcontract. This assignment shall be made and become effective at the time City tenders final payment to Contractor, without fu11her acknowledgment by the pai1ies. 7.6 Copies of the general prevailing rates of per diem wages for each craft, classification, or type of worker needed to execute the Contract , as determined by Director of the State of California Depa11ment oflndustrial Relations , are deemed included in the Contract Documents and on file at City 's office , or may be obtained of the State of California web site http ://www.dir.ca.gov/DLSR/PWD/No11hern.html and shall be made available to any interested pai1y on request. Pursuant to Section 1861 of the Labor Code, Contractor represents that it is aware of the provision s of Section 3700 of the Labor Code which require every employer to be in sured again st liabilit y for workers ' compensation or to unde11ake self-insurance in accordance with the provisions of that Code , and Contractor shall comply with such provisions before commencing the performance of the Work of the Contract Documents. 7. 7 Should any part , term or provision of this Contract or any of the Contract Documents , or any document required herein or therein to be executed or delivered , be declared invalid , void or unenforceable , all remaining pai1s , terms and provisions shall remain in full force and effect and shall in no way be invalidated , impaired or affected thereby. If the provisions of any law causing such invalidity , illegality or unenforceability may be waived , they are hereby waived to the end that thjs Contract and the Contract Documents may be deemed valid and binding contracts , enforceable in accordance with their terms to the greatest extent permitted by applicable law . In the event any provision not otherwise included in the Contract Documents is required to be included by any applicable law , that provision is deemed included herein by this reference(or, if such provision is required to be included in any pa11icular po11ion of the Contract Documents, that provision is deemed included in that po11ion). 7.8 This Contract and the Contract Documents shall be deemed to have been entered into in the County of Santa Clara, State of Californja, and governed in all respects by Californja law (excluding choice of law rules). The exclusive venue for all disputes or litigation hereunder shall be in Santa Clara County. Both pa11ies hereby waive their rights under Califorrua Code of Civil Procedure Section 394 to file a motion to transfer any action or proceeding arising out of the Contract Documents to another venue. Contractor accepts the Claims Procedure in Document 00700 , Article 12 , established under the California Government Code, Title I, Division 3.6 , Pa11 3, Chapter 5. City of Cupertino 00520 -4 Traffic Signal Modification at S. De Anza Blvd. and Rodrigues Ave Contract Project No . 74 ,366 .08A IN WITNESS WHEREOF the parties have executed this Contract in quadruplicate the day and year first above written. TRAFFIC SIGNAL MODIFICATION ATS. DE ANZA BOULEY ARD AND RODRIGUES A VENUE CITY: CITY OF CUPERTINO, a Municipal Corporation of the State of California Attest: r,rc;,ti::!i;,hd&= ~ :.__ Approved as to form by City Attorney: ~ Cit Attorney: Randolph Stevenson Hom I hereby certify, under pena lty ofpe1jury, that Timm Borden, Director of Public Works of the City of Cupertino was duly authorized to execute this document on behalfofthe City of Cupertino. orde , · · ctor of Public Works of the City of Cupertino , a Municipal Corporation of the State of Ca lifornia Designated Representative: Name: Jennifer Chu Title: Associate Civil Engineer Address: 10300 Tone Ave ., Cupe1iino , CA 95014 Phone: 408-777-3354 Facsimile : 408-777-3333 AMOUNT: $107 ,975 .00 ACCOUNT NUMBER: 100-88-845-900-990 FILE NO.: 74 ,366.08A CONTRACTOR: Title: Pd?,Sl d~ [If Corporation: Chairman , President, or Vice President] By:---------------- [Signature] [Please print name here] Title: _________________ _ [If Corporation: Secretary, Assistant Secretary, Chief Financial Officer, or Assistant Treasurer] 010 State Contractor 's License No. Classification Expiration Date Taxpayer ID No. Cl\..l ' '3'22. C.0'3 "3l Name: _________________ _ Title: _________________ _ Address: ________________ _ Phone: _________________ _ Facsimile: _______________ _ NOTARY ACK 'OLEDGEMENT IS REQUIRED. IF A CORPORATIO ', CORPORATE SEAL A 'D CORPORATE NOTARY ACKNOWLEDE 1ENT AND FEDERAL TAX ID ARE REQUIRED. IF NOT A CORPORATION SOCIAL SECURITY '0. IS REQUIRED END OF DOCUMENT City of Cupe1iino 00520 - 5 Traffic Signal Modification at S. De Anza Blvd. and Rodrigues Ave Contract '""''""""''·"'"'"""·"''·"'''"u=,m"'"'"'~"'""'"""""""'""''•C•U~V<S,,<•-'""~·"""''"·~'"'"""'''•"""""'"' """""'''"~"'' '"'""""'·'=""''"""'~"'""''•"-U"'"""'''°""''"'""'''"''"""'"""'~' "''"'"'"''·"·'"""'"' ,, ''''""''''"'"""'"'"'~, ~~~:i~i J~~~~n°;i ~:i;1°:h~~i~ 0 n:~~it~n9ot:~~c:~~i~i:~i~r~~~: ~;r':J~:te CAL I FOR N I A ALL-PU RPO SE ; is attached, an d not t he t ru t hfuln ess, acc uracy, or va lidity of that doc um ent. CERTIFICATE Q F i State of California ACKNOWLEDGMENT On personally appeared _t'D~~'~~ C-h~~<t..-~e-,{ ___ z\:~-·-l/_£_¥1.........,.0'"""•"""lj-G~<-Jv::::\ _____ 1 __________ _ who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is /are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. 9 Commiss ion ti 2147 180 ~ • Nota ry Public • Ca liforn ia f WI TNESS my hand an d offi cial sea l. i Alameda County t J. •: 0 0 Jl £,oT"!" [•~r!s !fl L6}~2&,: Signatu r (Se al) OPTIONAL INFORMATION Although the information in this section is not required by law, it could prevent fraudulent removal and reattachment of this acknowledgment to an unautho r ized document and may prove useful to persons relying on the attached document. Description of Attached Document The pre ce ding Cert ificate of Acknow ledgment is attached to a document titled/for the purpose of Do e-0 O 'S :2-C> C.ru 2tI o-e_;r- containing 5 page s, and dated ~:>~{~/_O~J~~-D_____._l _'--J-1-- The signer(s) ca pacity or autho r it y is/a re as : D lndi vidual (s) D A~-in-Fact [¥orporate Officer(s) -----+~~-~Al~~~~--~-~-~-------- Tit l e(s) D Guardian/Conservator D Partner -Limited /General D Trustee (s) Tennyson Elect ric, Tn c. D Other: ________________________ _ represent ing: ______________________ _ Name(s) of Person(s) or Entity(ies) Signer is Representing Method of Sign e r Id e ntifi cation Pro ved to me on the basis of satisfactory evidence: LO fo rm (s) of identificat io n O c red ible wit ness(es) Notarial event is detailed in notary journal on: Page # Entry# Notar y contact: ___________ _ Other D Additio nal Signer(s) 0 Signer(s) Thumbprint(s) D ---------------- ~ l",~.,=..,.=n==~=,.=m,=•~=,,,_=.,,=,.,=..,.=n"°'"=,.=m,=..,.=,~=,.=,.,=..,.=,-=.,,=,.,=,~=n=,==,.=,.,1=..,.=n•=o~=,,=,s,=..,.=,-=,.='"="""=,w=,,.,,.,=m="""'=n=v,,,=,,.=!i.=um=,w=a=~,.=.,=i,,Xl=,-=,,.="=l,,:>0=r=.,,,,,.=. ="=,==,=.,.,,,=»=,,.=,..,.=,=·,,,.=,.=,.=,.,.=,=-.=,,.=,.=,mo=,=«.,..=.,=,m=,..,.=,=-=,=)•1~=,,,.,,,=,=-=,=,.m=,..,.=,=~=c=• © Copyright 2007-2014 Notary Rotary, Inc. PO Box 41400, Des Moines, IA 503 I 1-0507. All Rights Reserved. Item Number 101772. Please contact your Authorized Reseller to purchase copies of this form. r~···'-'...,._.,,,,_ __ u~-'1-.l',.,..,,r,.,y....;,, •• \'> .... ....--.,. f 'T°:. F DOCUMENT 00610 CONSTRUCTION PERFORMANCE BOND Bond No. 9232877 Premium: $1,170 .00 Project No. 74,366.08A THIS CONSTRUCTION PERFORMANCE BOND ("Bond") is dated February 10, 2017 , is in the penal sum of **ONE HUNDRED SEVEN THOUSAND NINE HUNDRED SEVENTY FIVE AND N0/100** ________________________ [which is one hundred percent of the Contract Price], and is entered into by and between the parties listed below to ensure the faithful performance of the Construction Contract listed below. This Bond consists of this page and the Bond Terms and Conditions, paragraphs 1 through 12, attached to this page. Any singular reference to TENNYSON ELECTRIC , INC. ("Contractor"), FIDELITY AND DEPOSIT COMPANY OF MARYLAND ("Surety"), the City of Cupertino, a Municipal Corporation of the State of California ("City") or other party shall be considered plural where applicable. CONTRACTOR: TENNYSON ELECTRIC INC Name 7275 National Avenue Address Livermore, CA 94550 City /State/Zip CONSTRUCTION CONTRACT: SURETY: EIDE! IIY AND DEPOSIT COMPANY OE MARYLAND Name 1400 American Lane, To wer I 18th Floor Principal Place of Business Schaumburg, IL 60196-1056 City/State/Zip TRAFFIC SIGNAL MODIFICATION ATS. DE ANZA BOULEY ARD AND RODRIGUES AVENUE at Cupertino, California. DATED February 10 Company: PROJECT NUMBER 74,366.0SA , 20~ in the Amount of$ __ ··_1_o_7,_9_75_._oo_·_· ______ (the "Penal Sum") SURETY FIDELITY AND DEPOSIT COMPANY :i:::t::: _(_t==+'o'll'rp~·-,S_e-al_)_O_F_M_A_R_Y_L_A_N_D ____ _ Name and Title: Karen Amin, Attorney-in-Fact BOND TERMS AND CONDITIONS 1. Contractor and Surety, jointl y and severally, bind themselves, their heirs, executors, administrators, successors and assigns to City for the complete and proper perfo1mance of the Construction Contract, which is incorporated herein by reference . 2. If Contractor completely and properly performs all of its obligations under the Construction Contract, Surety and Contractor shall have no obligation under this Bond. 3. If there is no City Default, Surety's obligation under this Bond shall arise after: 3.1 City has declared a Contractor Default under the Construction Contract pursuant to the terms of the Construction Contract; and 3.2 City has agreed to pay the Balance of the Contract Sum: 3.2.1 To Surety in accordance with the terms of this Bond and the Construction Contract; or City of Cupertino 00610 -I Traffic Signal Modification at S. De Anza Blvd. and Rodrigues Ave Construction Performance Bond Project No. 74,366.0BA 3.2.2 To a contractor selected to perform the Construction Contract in accordance with the terms of this Bond and the Construction Contract. 4. When City has satisfied the conditions of paragraph 3, Surety shall promptly (within 30 days) and at Surety's expense elect to take one of the following actions: 4.1 An·ange for Contractor, with consent of City, to perform and complete the Construction Contract (but City may withhold consent, in which case the Surety must elect an option described in paragraphs 4.2, 4.3 or 4.4, below); or 4.2 Undertake to perform and complete the Construction Contract itself, through its agents or through independent contractors; provided, that Surety may not se lect Contractor as its agent or ind ependent contractor without City's consent; or 4 .3 Undertake to perform and complete the Construction Contract by obtaining bids from qualified contractors acceptable to City for a contract for performance and completion of the Construction Contract, and, upon determination by City of the lowest responsible bidder, arrange for a contract to be prepared for execution by City and the contractor selected with City's concurrence, to be secured with performance and payment bonds executed by a qualified surety equivalent to the bonds issued on the Construction Contract; and, if Surety 's obligations defined in paragraph 6, below, exceed the Balance of the Contract Sum, then Surety shall pay to City the amount of such excess; or 4.4 Waive its right to perform and complete, arrange for completion, or obtain a new contractor and with reasonable promptness under the circumstances, and, afte r investigation and consultation with City, determine in good faith its monetary obligation to City under paragraph 6, below, for the performance and completion of the Construction Contract and, as soon as practicable after the amount is determined, tender payment therefor to City with full explanation of the payment's calculation. If City accepts Surety's tender under this paragraph 4.4, City may still hold Surety liable for future damages then unknown or unliquidated resulting from the Contractor Default. If City disputes the amount of Surety's tender under this paragraph 4.4, City may exercise all remedies available to it at law to enforce Surety's liability under paragraph 6, below. 5 . If Surety does not proceed as provided in paragraph 4, above, then Surety shall be deemed to be in default on this Bond ten days after receipt of an additional written notice from City to Surety demanding that Surety perform its obligations under this Bond. At all times City shall be entitled to enforce any remedy available to City at law or under the Construction Contract including, without limitation, and by way of example only, rights to perform work, protect work, mitigate damages, advance critical work to mitigate schedule delay, or coordinate work with other consultants or contractors. 6 . Surety's monetary obligation under this Bond is limited by the Amount of this Bond identified herein as the Penal Sum . This monetary obligation shall augment the Balance of the Contract Sum. Subject to these limits , Surety's obligations under this Bond are commensurate with the obligations of Contractor under the Construction Contract. Surety's obligations shall include, but are not limited to: 6.1 The responsibilities of Contractor under the Construction Contract for completion of the Construction Contract and correction of defective work; 6.2 The responsibilities of Contractor under the Construction Contract to pay liquidated damages, and for damages for which no liquidated damages are specified in the Construction Contract, actual damages caused by non-performance of the Construction Contract including, but not limited to, all valid and proper backcharges, offsets, payments , indemnities, or other damages; 6.3 Additiona l legal, design professional and delay costs resulting from Contractor Default or resulting from the actions or failure to act of the Surety under paragraph 4, above (but excluding attorney's fees incurred to enforce this Bond). 7. No right of action shall accrue on this Bond to any person or entity other than City or its successors or assigns. City of Cupertino 00610 - 2 Construction Performance Bond Traffic Signal Modification at S . De Anza Blvd. and Rodrigues Ave Project No. 74,366.08A 8. Surety hereby waives notice of any change, alteration or addition to the Construction Contract or to related subcontracts, purchase orders and other obligations, including changes of time. Surety consents to all terms of the Construction Contract, including provisions on changes to the Contract. No extension of time, change, alteration, modification, deletion, or addition to the Contract Documents, or of the work required thereunder, shall release or exonerate Surety on this Bond or in any way affect the obligations of Surety on this Bond. 9. Any proceeding, legal or equitable, under this Bond shall be instituted in any court of competent jurisdiction where a proceeding is pending between City and Contractor regarding the Construction Contract, or in the courts of the County of Santa Clara, or in a court of competent jurisdiction in the location in which the work is located. Communications from City to Surety under paragraph 3 .1 of this Bond shall be deemed to include the necessary contracts under paragraph 3.2 of this Bond unless expressly stated otherwise. 10. All notices to Surety or Contractor shall be mailed or delivered (at the address set forth on the signature page of this Bond), and all notices to City shall be mailed or delivered as provided in Document 00520 (Contract). Actual receipt of notice by Surety, City or Contractor, however accomplished, shall be sufficient compliance as of the date received at the foregoing addresses. 11. Any provision in this Bond conflicting with any statutory or regulatory requirement shall be deemed deleted herefrom and provisions conforming to such statutory requirement shall be deemed incorporated herein. 12 . Definitions . 12.1 Balance of the Contract Sum: The total amount payable by City to Contractor pursuant to the terms of the Construction Contract after all proper adjustments have been made under the Construction Contract, for example, deductions for progress payments made, and increases/decreases for approved modifications to the Construction Contract. 12 .2 Construction Contract: The contract between City and Contractor identified on the signature page of this Bond, including all Contract Documents and changes thereto. 12.3 Contractor Default: Material failure of Contractor, which has neither been remedied nor waived, to perform or otherwise to comply with the terms of the Construction Contract including, but not limited to, "default" or any other condition allowing a termination for cause as provided in Document 00700 (General Conditions).' 12.4 City Default: Material failure of City, which has neither been remedied nor waived, to pay Contractor progress payments due under the Construction Contract or to perform other material terms of the Construction Contract, if such failure is the cause of the asserted Contractor Default and is sufficient to justify Contractor termination of the Construction Contract. END OF DOCUMENT City of Cupertino 00610 • 3 Traffic Signal Modification at S. De Anza Blvd . and Rodrigues Ave Construction Performance Bond DOCUMENT 00620 Bond No. 9232877 Premium : Included in Conjunction with Performance Bond Project No. 74,366 .0SA CONSTRUCTION LABOR AND MATERIAL PAYMENT BOND THIS CONSTRUCTION LABOR AND MATERIAL PAYMENT BOND ("Bond") is dated February 10 , 2017 , is in the penal sum **ONE HUNDRED SEVEN THOU SAND NINE HUNDRED SEVENTY FIVE AND N0/100 ** [one hundred percent of the Contract Price], and is entered into by and between the parties listed below to ensure the payment of claimants under the Construction Contract listed below. This Bond consists of this page and the Bond Terms and Conditions, paragraphs 1 through 14, attached to this page. Any singular reference to TENNYSON ELECTRIC INC . ("Contractor"), FIDELITY AND DEPOSIT COMPANY OF MARYLAND ("Surety"), the City of Cupertino, a Municipal Corporation of the State of California ("City") or other party shall be considered plura l where app li cable. CONTRACTOR: SURETY : TENNYSON ELECTRIC, INC. Name 7275 National Avenue Address Li ve rm ore, CA 94550 FIDELITY AND DEPOSIT COMPANY OF MARYLAND Name 1400 American Lane, Towe r I., 18th Fl oor Principal Place of Business Schaumburg , IL 60196-1056 City/State/Zip City/State/Zip CONSTRUCTION CONTRACT: TRAFFIC SIGNAL MODIFICATION ATS. DE ANZA BOULEVARD AND RODRIGUES AVENUE at Cupertino, California . DATED February 1 O PROJECT NUMBER 74,366.08A , 20~ in the Amount of$_*_*1_0_7_,9_75_._oo_*_* _______ (the "Penal Sum") FIDELITY AND DEPOSIT COMPANY OF MARYLAND SURETY c_ompany:v Signature: -~+-'!~------------- Name and T itl e: Karen Amin , Attorney-in-Fact BOND TERMS AND CONDITIONS 1. Contractor and Surety, jointly and severally, bind themselves, their heirs, executors, administrators, successors and assigns to City and to Claimants, to pay for labor, materials and equipment furnished for use in the performance of the Construction Contract, which is incorporated herein by reference. 2. With respect to City, this obligation shall be null and void if Contractor: 2.1 Promptly makes payment, directly or indirectly, for all sums due Cla imants; and 2.2 Defends, indemnifies and holds harmless City from a ll claims, demands, liens or suits by any person or entity who furnished labor, materials or equipment for use in the performance of the Construction Contact, provided City has promptly notified Contractor and Surety (at the address set forth on the signature page of this Bond) of any claims, demands, liens or suits and tendered defense of such claims, demands, liens or suits to Contractor and Surety, and provided there is no City Defau lt. 3 . With respect to Claimants, this obligation shall be null and void if Contractor promptly makes payment, direct ly or indirectly through its Subcontractors, for all sums due Claimants. If Contractor or its Subcontractors, however , fail to pay any of the persons named in Sect ion 3181 of the California Civil Code, or amounts due City of Cupertino 00620 -1 Construction Labor and Material Payment Bond Traffic Signal Modification at S. De Anza Blvd. and Rodrigues Ave Project No. 74,366.08A under the Unemployment Insurance Code with respect to Work or labor performed under the Contract, or for any amounts required to be deducted, withheld, and paid over to the Employment Development Department from the wages of employees of Contractor or Subcontractors pursuant to Section 13020 of the Unemployment Insurance Code, with respect to such Work and labor, then Surety shall pay for the same, and also, in case suit is brought upon this Bond, a reasonable attorney's fee, to be fixed by the court. 4. Consistent with the California Mechanic 's Lien Law, Civil Code §3082, et seq ., Surety shall have no obligation to Claimants under this Bond unless the Claimant has satisfied all applicable notice requirements. 5. Surety's total obligation shall not exceed the amount of this Bond, and the amount of this Bond shall be credited for any payments made in good faith by Surety under this Bond. 6. Amounts due Contractor under the Construction Contract shall be applied first to satisfy claims, if any, under any Construction Performance Bond and second, to satisfy obligations of Contractor and Surety under this Bond. 7. City shall not be liable for payment of any costs, expenses, or attorney's fees of any Claimant under this Bond, and shall have under this Bond no obligations to make payments to, give notices on behalf of, or otherwise have obligations to Claimants under this Bond. 8. Surety hereby waives notice of any change, including changes of time, to the Construction Contract or to related subcontracts, purchase orders and other obligations. Surety further hereby stipulates and agrees that no change, extension of time, alteration or addition to the terms of the Construction Contract, or to the Work to be performed thereunder, or materials or equipment to be furnished thereunder or the Specifications accompanying the same, shall in any way affect its obligations under this Bond, and it does hereby waive any requirement of notice or any such change, extension of time, alteration or addition to the terms of the Construction Contract or to the Work or to the Specifications or any other changes. 9. Suit against Surety on this Bond may be brought by any Claimant, or its assigns, at any time after the Claimant has furnished the last of the labor or materials, or both, but, per Civil Code §3249, must be commenced before the expiration of six months after the period in which stop notices may be filed as provided in Civil Code §3184 . 10. All notices to Surety or Contractor shall be mailed or delivered (at the address set forth on the signature page of this Bond), and all notices to City shall be mailed or delivered as provided in Document 00520 (Contract). Actual receipt of notice by Surety, City or Contractor, however accomplished, shall be sufficient compliance as of the date received at the foregoing addresses. 11 . This Bond has been furnished to comply with the California Mechanic's Lien Law including, but not limited to, Civil Code §§3247, 3248, et seq . Any provision in this Bond conflicting with said statutory requirements shall be deemed deleted herefrom and provisions conforming to such statutory or other legal requirements shall be deemed incorporated herein. The intent is that this Bond shall be construed as a statutory bond and not as a common law bond. 12 . Upon request by any person or entity appearing to be a potential beneficiary of this Bond, Contractor shall promptly furnish a copy of this Bond or shall permit a copy to be made. 13 . Contractor shall pay to persons performing labor in and about Work provided for in the Contract Documents an amount equal to or more than the general prevailing rate of per diem wages for (1) work of a similar character in the locality in which the Work is performed and (2) legal holiday and overtime work in said locality. The per diem wages shall be an amount equal to or more than the stipulated rates contained in a schedule that has been ascertained and determined by the Director of the State Department of Industrial Relations and City to be the general prevailing rate of per diem wages for each craft or type of workman or mechanic needed to execute this Contract. Contractor shall also cause a copy of this determination of the prevailfog rate of per diem wages to be posted at each Site. City of Cupertino 00620 - 2 Construction Labor and Material Payment Bond Traffic Signal Modification at S . De Anza Blvd. and Rodrigues Ave Project No. 74,366.0SA 14 . Definitions. 14.1 Claimant: An individual or entity having a direct contract with Contractor or with a Subcontractor of Contractor to furnish labor, materials or equipment for use in the performance of the Contract, as further defined in California Civil Code §3181. The intent of this Bond shall be to include without limitation in the terms "labor, materials or equipment" that part of water, gas, power, light, heat, oil, gasol ine, telephone service or rental equipment used in the Construction Contract, architectural and engineering services required for performance of the Work of Contractor and Contractor's Subcontractors, and all other items for which a stop notice might be asserted. The term Claimant shall also include the Unemployment Development Department as referred to in Civil Code §3248(b). 14 .2 Construction Contract: The contract between City and Contractor identified on the signature page of this Bond, including all Contract Documents and changes thereto. 14.3 City Default: Material failure of City, which has neither been remedied nor waived, to pay the Contractor as required by the Construction Contract, provided that failure is the cause of the failure of Contractor to pay the Claimants and is sufficient to justify termination of the Construction Contract. END OF DOCUMENT City of Cupertino 00620 -3 Construction Labor and Materia l Payment Bond Traffic Signal Modification at S. De Anza Blvd. and Rodrigues Ave ACKNOWLEDGMENT A notary public or other officer completing this certificate verifies only the identity of the individual who signed the document to which this certificate is attached , and not the truthfulness , accuracy, or validity of that document. State of California County of San Joaquin On ___ F_eb_r_ua_ry_1_0_, 2_0_17 ____ before me, ____ K_._so_ia_r_i, _No_ta_ry_P_u_b_lic _______ _ (insert name and title of the officer) personally appeared Karen Amin who proved to me on the basis of satisfactory evidence to be the person(~) whose name(~ is~ subscr ibed to the within instrument and acknowledged to me that M/she~1 executed the same in Krs/her~ authorized capacity~~. and that by~herXK~ signature~) on the instrument the person(~). or the entity upon behalf of which the person~) acted , executed the instrument. I certify under PENAL TY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS m~ J7r offi :ial se: Signature-~,....__---'=-=--------- ~~•+7s~A~._.._,, ~~~-~~~~,. ~~ COMM . #2068 716 rj 2 !~:-:.4'· , ~O TARY PLJBLIC · CAUF QR :,., A ~ · "' SA\ JOAQ UI ~ GOU\ 1Y I ~~Y Co rn rn issicn Exoires 1,~ay 18 . 2018 (Seal) ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUALTY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND POWER OF ATTORNEY KNOW ALL MEN BY THESE PRESENTS: That the ZURICH AMERICAN INSURANCE COMPANY, a corporation of the State of New York, the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, a corporation of the State of Maryland, and th e FIDELITY AND DEPOSIT COMPANY OF MARYLAND a corporation of the State of Maryland (herein collectively called the "Companies"), by MICHAEL BOND, Vice President, in pursuance of authority granted by Article V, Section 8, of the By-Laws of said Companies, which are set forth on the reverse side hereof and are hereby certified to be in full force and effect on the date hereof, do hereby nominate, constitute, and appoint Daniel M. CONNOLLY, David SCHNAPP, Karen AMIN and Jennifer LOPER, all of Lodi, California, EACH it s true and lawful agent and Attorney-in-Fact, to make, execute, sea l and deliver, for, and on its behalf as surety, and as its act and deed: any and all bonds and undertakings, and the execution of such bonds or undertakin gs in pursuance of these present s, shall be as binding upon said Companies, as fully and amp ly, to all intents and purposes, as if they had been duly executed and acknowledged by the regularly elected officers of the ZURICH AMERICAN INSURANCE COMP ANY at its office in New York, New York., the regularly elected officers of the COLONIAL AMERICAN CASUALTY AND SURETY COMPANY at its office in Owings Mills, Maryland., and the regularly elected officers of the FIDELITY AND DEPOSIT COMPANY OF MARYLAND at its office in Owings Mills , Maryland., in their own proper persons . The said Vice President does hereby certify that the extract set forth on the reverse side hereof is a true copy of Article V, Section 8, of the By-Laws of said Companies, and is now in force. IN WITNESS WHEREOF, the said Vice-President has hereunto subscribed his/her names and affixed the Corporate Seals of the said ZURICH AMERICAN INSURANCE COMPANY, COLONIAL AMERICAN CASUALTY AND SURETY COMPANY, and FIDELITY AND DEPOSIT COMP ANY OF MARYLAND, this 21st day of April, A.D. 2016. By. Secretary Eric D . Barnes State of Maryland County of Baltimore ATTEST: ZURICH AMERICAN INSURANCE COMPANY COLONIAL AMERICAN CASUAL TY AND SURETY COMPANY FIDELITY AND DEPOSIT COMPANY OF MARYLAND Vice President Michael Bond On thi s 21st day of April, A.O. 20 16, before th e subscriber, a Notary Public of the State of Maryland, duly commissioned and qualified , MICHAEL BOND, Vice President, and ERIC D. BARNES, Secretary, of the Companies, to me personally known to be the individuals and officers described in and who executed the preceding instrument, and acknowledged the execution of same, and being by me duly sworn, deposeth and saith , that he/she is the said officer of the Company aforesaid , and that the seals affixed to the preceding instrument are the Corporate Seals of said Companies, and that the said Corporate Seals and the signature as such officer were duly affixed and subscribed to the said instrument by th e authority and direction of the sa id Corporations. fN TESTIMONY WHEREOF, I have hereunto set my hand and affixed my Official Seal the day and year first above written. POA-F 016-3033D Constance A. Dunn, Notary Public My Commission Expires: July 9, 20 19 ,,,,,H1111,111 ,:rt[I~!~ l111111H'' EXTRACT FROM BY-LAWS OF THE COMPANIES "Article V, Section 8, Attorneys-in-Fact. The Chief Executive Officer, the President, or any Executive Vice President or Vice President may, by written instrument under the attested corporate seal, appoint attorneys-in-fact with a uthority to execute bonds, polici es, recognizances, stip ul ations, undertakings , or other like instruments on behalf of the Company , and may authori ze any officer or any such attorney-in-fact to affix the corporate seal thereto; and may with or wit hout cause modify of revoke any such appo intm ent or authority at any time." CERTIFICATE I, the undersigned, Vice President of the ZURJCH AMERJCAN INSURANCE COMPANY, the COLONIAL AMERJCAN CASUAL TY AND SURETY COMP ANY, and the FIDELITY AND DEPOSIT COMP ANY OF MARYLAND, do hereby certify that the foregoing Power of Attorney is still in full force and effect on the date of this certificate; and I do further certify that Article V, Section 8, of the By-Laws of the Companies is still in force . This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following reso lution of the Board of Directors of the ZURJCH AMERJCAN INSURANCE COMPANY at a meeting dul y called and held on the 15th day of December 1998 . RESOLVED: "That the signature of the President or a Vice Presi dent and the attesting signature of a Secretary or an Assistant Secretary and the Seal of the Company may be affixed by facsimile on any Power of Attorney ... Any such Power or any certificate thereof bearing such facsimile signature and seal sha ll be valid and binding on the Company." This Power of Attorney and Certificate may be signed by facsimile under and by authority of the following resolution of the Board of Directors of the COLONIAL AMERJCAN CASUALTY AND SURETY COMP ANY at a meeting duly called and held on the 5th day of May, 1994, and the following reso lution of the Board of Directors of the FIDELITY AND DEPOSIT COMP ANY OF MARYLAND at a meeting dul y called and he ld on the I 0th da y of May, 1990 . RESOLVED: "That the facsimile or mech anica lly reproduced seal of the company and facsimile or mechanically reproduced signature of any Vice-President, Secretary, or Assistant Secretary of the Company, whether made heretofore or hereaft er, w hereve r appearing upon a certified copy of any power of attorney issued by the Company, shall be va lid and binding upon the Company with the same force and effect as though manually affixed. ~1;,ESTIMO~hAHEREOF, I h ave T1unto subscribed my name and affixed the corporate seals of the said Companies, this -N\¥-\day of -ft-ti\-\~ , 20 . .. .......... , " ..... ~ \Nsc,i::~ ,.,·~~---;;;;;;;;···::'f<\. fjl:t~ \\~'; ix{ -·-}8j \'%,\ 1M/,,,_fj ·, "" ··---··' ... T" •• ..... ,,~,,,H'!!ttltt.i,\,I Gerald F. Haley, Vice President TO REPORT A CLAIM WITH REGARD TO A SURETY BOND, PLEASE SUBMIT ALL REQUIRED INFORMATION TO: Zurich American Insurance Co. Attn: Surety Claims 1299 Zurich Way Schaumburg, IL 60196-1056 CITY OF m Project No. 74 ,366 .0SA CUPERTINO INSURANCE AGREEMENT 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 unde11ake self- insurance in accordance with the provisions of that Code, and will comply with such provisions before commencing the performance of the work of this Contract. B. Contractor and all 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 subrogation against the City, the City 's officers , agents and employees and shall issue an endorsement to the policy evidencing same. C . Contractor shall carry at all times , on all operations hereunder, commercial general liability insurance , automobile liability insurance and builder 's all risk insurance . All insurance coverage shall be in amounts required by the City and shall be evidenced by the issuance of a ce11ificate in a f01m prescribed by the City and shall be underwritten by insurance companies satisfactory to the City for all operations, sub-contract work, contractual obligations , product or completed operations, all owned vehicles and non-owned vehicles . Said insurance coverage obtained by the Contractor, excepting worker 's compensation coverage, shall name the City, its engineer, and each of its directors , officers, agents and employees , as determined by the City, as additional insureds on said 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 City . D. Before Contractor perfo1ms any work at, or prepares or delivers materials to, the site of constrnction, Contractor shall furnish ce11ificates of insurance evidencing the foregoing insurance coverages and such ce11ificates shall provide the name and policy number of each canier and policy and that the insurance is in force and will not be canceled or modified without thi11y (30) days written notice to the City. Contractor shall maintain all of the foregoing insurance coverages in force until the work under this Contract is fully completed. The requirement for carrying the foregoing insurance shall not derogate from the provisions for indemnification of the City by Contractor under this Contract and for the duration of the warranty period. Notwithstanding nor diminishing the obligations of Contractor with respect to the foregoing, Contractor shall maintain in full force and effect during the life of this Contract, the following insurance in amounts not less than the amounts specified and having a Best's Guide Rating of A , Class Vil or better or that is otherwise acceptable to the City. C ity of C upe1iino 00530 - 2 In s urance Form s Traffic Si g na l Modifica tion at S . D e A nza Bl vd. and Rodri g ues Ave Proj ec t No. 74 ,36 6.0 SA LIMITS Worker 's Compensation & Emp lo yers ' Liability General Liability -commercial general liability; including provisions for contractual liability, personal injury, independent contractors and products -completed operations hazard . Automobile Liability -comprehensive covering owned, non-owned and hired automobiles. C it y of C up e rtin o 00530 -3 In accordance with the Worker 's Compensation Act of the State of California -Worker 's comp "statutory" per CA Law ; Employers ' Liability $1,000 ,000 per occmTence. Combined single limit of $2 .0 million per occuITence ; $4.0 million in the aggregate Combined single limit of $1.0 million per occmTence. In s uran ce Fo rm s Traffic S ig na l Modification at S. De Anza Blvd. a nd Rodrigues Ave CITY OF m Proj e ct No. 74 ,36 6.0SA CUPERTINO INSURANCE AGREEMENT 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 self- insurance in accordance with the provisions of that Code , and will comply with such provisions before commencing the perfo1mance of the work of this Contract. B . Contractor and all 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 subrogation against the City, the City 's officers , agents and employees and shall issue an endorsement to the policy evidencing same. C . Contractor shall caITy at all times , on all operations hereunder, commercial general liability insurance , automobile liability insurance and builder 's all risk insurance. All insurance coverage shall be in amounts required by the City and shall be evidenced by the issuance of a ce11ificate in a f01m prescribed by the City and shall be underwritten by insurance companies satisfactory to the City for all operations, sub-contract work, contractual obligations, product or completed operations , all owned vehicles and non-owned vehicles . Said insurance coverage obtained by the Contractor, excepting worker 's compensation coverage , shall name the City, its engineer, and each of its directors , officers, agents and employees , as determined by the City, as additional insureds on said 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 City. D . Before Contractor perfo1ms any work at , or prepares or delivers materials to , the site of construction, Contractor shall furnish ce11ificates of insurance evidencing the foregoing insurance coverages and such ce11ificates shall provide the name and policy number of each canier and policy and that the insurance is in force and will not be canceled or modified without thi11y (30) days written notice to the City. Contractor shall maintain all of the foregoing insurance coverages in force until the work under this Contract is fully completed. The requirement for caITying the foregoing insurance shall not derogate from the provisions for indemnification of the City by Contractor under this Contract and for the duration of the warranty period. Notwithstanding nor diminishing the obligations of Contractor with respect to the foregoing , Contractor shall maintain in full force and effect during the life of this Contract, the following insurance in amounts not less than the amounts specified and having a Best 's Guide Rating of A , Class VII or better or that is otherwise acceptable to the City. C it y of C upe1iino 00530 -2 In s urance Fo rm s Tra ffic Signa l Modifica tion a t S. D e An za Bl vd. and Rodri g ues A ve Project No . 74,366.0SA LIMITS Worker 's Compensation & Employers ' Liability General Liability -commercial general liability; including provisions for contractual liability, personal injury, independent contractors and products -completed operations hazard. Automobile Liability -comprehensive covering owned, non-owned and hired automobiles. C ity of C up e rtino 00530 - 3 In accordance with the Worker 's Compensation Act of the State of California -Worker 's comp "statutory" per CA Law; Employers ' Liability $1 ,000,000 per occmTence. Combined single limit of $2.0 million per occmTence; $4.0 million in the aggregate Combined single limit of$ I. 0 million per occmTence. 20J.]_ In surance Forms Traffic Signal Modification a t S. De Anza Blvd. and Rodrigues Ave CITY OF II Project No. 74 ,366.0SA CUPERTINO INSURANCE AGREEMENT 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 self- insurance in accordance with the pro v isions of that Code, and will comply with such provisions before commencing the perfo1mance of the work of this Contract. B . Contractor and all 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 subrogation against the City, the City 's officers , agents and employees and shall issue an endorsement to the policy evidencing same. C . Contractor shall caiTy at all times , on all operations hereunder, commercial general liability insurance, automobile liability insurance and builder 's all risk insurance . All insurance coverage shall be in amounts required by the City and shall be evidenced by the issuance of a certificate in a form prescribed by the City and shall be underwritten by insurance companies satisfactory to the City for all operations , sub~contract work, contractual obligations, product or completed operations, all owned vehicles and non-owned vehicles . Said insurance coverage obtained by the Contractor, excepting worker 's compensation coverage, shall name the City, its engineer, and each of its directors, officers, agents and employees, as detennined by the City, as additional insureds on said 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 City. D . Before Contractor perfo1ms any work at, or prepares or delivers materials to, the site of constrnction, Contractor shall furnish certificates of insurance evidencing the foregoing insurance coverages and such certificates shall provide the name and policy number of each canier and policy and that the insurance is in force and will not be canceled or modified without thi1ty (30) days written notice to the City. Contractor shall maintain all of the foregoing insurance coverages in force until the work under this Contract is fully completed. The requirement for canying the foregoing insurance shall not derogate from the provisions for indemnification of the City by Contractor under this Contract and for the duration of the warranty period . Notwithstanding nor diminishing the obligations of Contractor with respect to the foregoing, Contractor shall maintain in full force and effect during the life of this Contract, the following insurance in amounts not less than the amounts specified and having a Best's Guide Rating of A, Class VII or better or that is otherwise acceptable to the City. Ci ty of C up ertino 00530 - 2 In s uranc e Forms Traffic Signal Modification at S . De A nza Blvd. a nd Rodrigues Ave Proj ec t No. 74 ,366.0SA LIMITS Worker 's Compensation & Employers ' Liability General Liability -commercial general liability; including provisions for contractual liability, personal injury, independent contractors and products -completed operations hazard . Automobile Liability -comprehensive covering owned , non-owned and hired automobiles . :fQo~ -voetnc..1V\G eonir;ctor's Name) ' C it y of C upertino 00530 - 3 In accordance with the Worker 's Compensation Act of the State of California -Worker 's comp "statutory" per CA Law ; Employers ' Liability $1,000 ,000 per occmTence . Combined single limit of $2 .0 million per occmTence; $4 .0 million in the aggregate Combined single limit of $1.0 million per occmTence. In s uranc e Form s Traffi c Si g nal Modifi ca tion at S . D e An za Blvd. a nd Rodri g ues Ave CITY OP a CUPERTINO ADDITIONAL INSURED ENDORSEMENT and ENDORSEMENT OF PRIMARY INSURANCE and NOTICE OF POLICY CANCELLATION ENDORSEMENT Project No . 74,366 .08A Project Title and Number: Job #117-012 -Traffic Signal Mods at Deanza Blvd In consideration of the policy premium and notwithstanding any inconsistent statement in the policy to wh ich this Endorsement is attached or any other Endorsement attached thereto , it is agreed as follows: The City of Cupertino ("City") and its directors , officers, engineers, agents and employees, and all public agencies from whom pe1mits will be obtained and their directors, officers , engineers, agents and employees, and the State of California, and its officers, agents and employees, are hereby declared to be additional insureds under the terms of this policy, but only with respect to the operations of the Contractor at or upon any 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. The insurance afforded by this policy is primary insurance, and no additional insurance held or owned by the designated additional insured(s) shall be called upon to cover a loss under said additional policy. Cancellation Notice. The insurance afforded by this policy shall not be suspended, voided, canceled, reduced in coverage or in limits, or materially altered, except after thirty (30) days' prior written notice by certified mail , return receipt requested, has been given to the City of Cupertino ("C ity"). Such notice shall be addressed to the City as indicated below. POLICY INFORMATION 1. Insurance Company: Travelers Indemnity Co. of CT 2. Insurance Policy Number:_D_T_2_2_C_O_8_G_2_3_9_93_6_T_C_T_l 7 __________ _ 3. Effective Date of this Endorsement: March 7th 20 17 ------------------ 4. Insured: Tennyson Electric , Inc. All notices herein provided to be given by the Insurance Company to the City in connection with this policy and these Endorsements, shall be mailed to or delivered to the City at 10300 Torre A venue; Cupertino, California 95014. I, Elena Rogan (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. City of Cupertino 00530 - 6 Insurance Forms Traffic Signal Modification at S. De Anza Blvd. and Rodrigues Ave Signature of Authorized Representative: t1 U~ Project No. 74,366.0SA (Original signature required on all Endorsements furnished the District) Names of Agent/Agency: Woodruff-Sawyer & Co. Address: 50 California Street, Floor 12 San Francisco, CA 94550 City of Cupertino 00530 -7 Traffic Signal Modification at S. De Anza Blvd. and Rodrigues Ave Title : Senior Account Manager Telephone: 415-391-214...,l'---- Facsimile: 4 15-989 -9923 -------- Insurance Forms CITY OF Project No. 74,3 66 .0SA II CUPERTINO COMPREHENSIVE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ENDORSEMENT OF AGGREGATE LIMITS OF INSURANCE PER PROJECT Project Title and Number: Job # 117-012 -Traffic Signal Mods at Deanza Blvd. 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 as follows: This Endorsement modifies the insurance provided under the General Liability Coverage part of the below-referenced policy of insurance. The general aggregate limit under LIMITS OF INSURANCE applies separately to the project described as POLICY INFORMATION 1. Insurance Company: Travelers Indemnity Co . of CT 2 . Insurance Policy Number: DT22CO8G239936TCT17 3. Effective Date of this Endorsement: March 7 th 20 17 ----------------- 4. Insured: Tennyson, Electric, Inc. 5. Additional Insured: City of Cupertino, its directors, officers, agents and employees . All notices herein provided to be given by the Insurance Company to the City in connection with this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Torre A venue; Cupertino, California 95014. I, Elena Rogan (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. Signature of Authorized Representative: _____ ~~~~---~------ (Original signature required on all Endorsements furnished to the Names of Agent/Agency: Woodruff-Sawyer & Co. Title: Senior Account Manager Address: 50 California Street Floor 12 Telephone: 415-391-214'""1 __ _ San Francisco CA 94111 Facsimile : 415-989-992_3 __ _ City of Cupertino 00530 -8 Insurance Forms Traffic Signal Modification at S. De Anza Blvd. and Rodrigues Ave CITY OP g CUPERTINO ADDITIONAL INSURED ENDORSEMENT and ENDORSEMENT OF PRIMARY INSURANCE and NOTICE OF POLICY CANCELLATION ENDORSEMENT Project N o. 74 ,366 .08A Project Title and Number: Job #11 7-012 -Traffic Signal Mods at Deanza Blvd 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: The City of Cupertino ("City") and its directors, officers, engineers, agents and employees, and all public agencies from whom permits will be obtained and their directors, officers, engineers, agents and employees, and the State of California, and its officers, agents and employees, are hereby declared to be additional insureds under the terms of this policy, but only with respect to the operations of the Contractor at or upon any 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. The insurance afforded by this policy is primary insurance, and no additional insurance held or owned by the designated additional insured(s) shall be called upon to cover a loss under said additional policy. Cancellation Notice. The insurance afforded by this policy shall not be suspended, vo ided, canceled, reduced in coverage or in limits, or materially altered, except after thirty (30) days' prior written notice by certified mail, return receipt requested, has been given to the City of Cupertino ("City"). Such notice shall be addressed to the City as indicated below. POLICY INFORMATION 1. Insurance Company: Travelers Indemnity Co. of CT 2. Insurance Policy N umber:-'D~T-'-2.c:...2C_O_8_;;G_2_3_99_3--'6_T_C:;_T--'l-'-7 __________ _ 3. Effective Date of this Endorsement:----"M--=.:.ar:...:c=h:;_7=-t=h'---_____________ 20 _!.Z__ 4. Insured: Tennyson Electric, Inc. All notices herein provided to be given by the Insurance Company to the City in connection with this policy and these Endorsements, shall be mailed to or delivered to the City at I 0300 Torre Avenue; Cupertino, California 95014. I, Elena Rogan (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. City of Cupertino 00530 - 6 Insurance Forms Traffic Signal Modification at S. De Anza Blvd. and Rodrigues Ave Names of Agent/Agency: Woodruff-Sawyer & Co. Address: 50 California Street, Floor 12 San Francisco, CA 94550 City of Cupertino 00530 -7 Traffic Signal Modification at S. De Anza Blvd. and Rodrigues Ave Title: Senior Account M anager Telephone: 415 -391-214=-=l~-- Facsimile: 415 -989-9923 -------- Insurance Forms CITY OF Project No . 74,366.08A II CUPERTINO COMPREHENSIVE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ENDORSE:MENT OF AGGREGATE LIMITS OF INSURANCE PER PROJECT Project Title and Number: Job #117-012 -Traffic Signal Mods at Deanza Blvd . 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 as follows: This Endorsement modifies the insurance provided under the General Liability Coverage part of the below-referenced policy of insurance. The general aggregate limit under LIMITS OF INSURANCE applies separately to the project described as POLICY INFORMATION l . Insurance Company: Travelers Indemnity Co. of CT 2. Insurance Policy Number: DT22CO8G239936TCT 17 3. Effective Date of this Endorsement: March 7th 20 17 ----------------- 4. Insured: Tennyson, Electric, Inc. 5. Additional Insured: City of Cupertino, its directors, officers, agents and employees. All notices herein provided to be given by the Insurance Company to the City in connection with this policy and this Endorsement. shall be mailed to or delivered to the City at 10300 Torre A venue; Cupertino, California 95014. I, Elena Rogan (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. A , Signature of Authorized Representative: li'.'.?0:ffi D ~11'------ (Original signature required on all Endorsements furnished to the D(§J;ict) Names of Agent/Agency: Woodruff-Sawyer & Co. Title: Senior Account Manager Address: 50 California Street Floor I 2 Telephone: 415-391-214_1 __ _ San Francisco CA 94111 Facsimile: 415-989-992_3 __ _ City of Cupertino 00530 - 8 Insurance Forms Traffic Signal Modification at S. De Anza Blvd. and Rodrigues Ave CITVOP a CUPERTINO ADDITIONAL INSURED ENDORSEMENT and ENDORSEMENT OF PRIMARY INSURANCE and NOTICE OF POLICY CANCELLATION ENDORSEMENT Project No . 74 ,366.08A Project Title and Number: Job #11 7-012 -Traffic Signal Mods at Deanza Blvd 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: The City of Cupertino ("City") and its directors, officers, engineers, agents and employees, and all public agencies from whom pe1mits will be obtained and their directors , officers, engineers, agents and employees, and the State of California, and its officers, agents and employees, are hereby declared to be additional insureds under the terms of this policy, but only with respect to the operations of the Contractor at or upon any 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. The insurance afforded by this policy is primary insurance, and no additional insurance held or owned by the designated additional insured(s) shall be called upon to cover a loss under said additional policy. Cancellation Notice. The insurance afforded by this policy shall not be suspended, voide d, canceled, reduced in coverage or in limits , or materially altered, except after thirty (30) days' prior written notice by certified mail, return receipt requested, has been given to the City of Cupertino ("City"). Such notice shall be addressed to the City as indicated below. POLICY INFORMATION I. Insurance Company: Travelers Indemnity Co. of CT 2. Insurance Policy N umber :_D_T_2_2C_O_8_G_2_3_9_93_6_T_C_T_l_7 __________ _ 3. Effective Date of this Endorsement: March 7th 20 17 ---"--'--'-'-'--'-"--------------- 4. Insured: Tennyson Electric, Inc. All notices herein provided to be given by the Insurance Company to the City in connection with this policy and these Endorsements , shall be mailed to or delivered to the City at 10300 Torre A venue; Cupertino, California 95014. I, Elena Rogan (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company . City of Cupertino 00530 - 6 Insurance Forms Traffic Signal Modification at S. De Anza Blvd . and Rodrigues Ave Pi Project No. 74,366 .0SA Signature of Authorized Representative: l) ~ (Original signature required on all Endorsements furnished 6 the District) Names of Agent/Agency: Woodruff-Sawyer & Co. Address: 50 California Street, Floor 12 San Francisc o, CA 94550 City of Cupertino 00530 - 7 Traffic Signal Modification at S . De Anza Blvd . and Rodrigues Ave Title: Senior Account Manager Telephone: 415-391 -214""'1.__ __ Facsimile: 415-989-9923 -------- Insurance Forms CITY OF Project No . 74,366 .08A a CUPERTINO COMPREHENSIVE GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY ENDORSEMENT OF AGGREGATE LIMITS OF INSURANCE PER PROJECT Project Title and Number: Job # 117-012 -Traffic Signal Mods at Deanza Blvd. 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 as follows: This Endorsement modifies the insurance provided under the General Liability Coverage part of the below-referenced policy of insurance . The general aggregate limit under LIMITS OF INSURANCE applies separately to the project described as POLICY INFORMATION I. Insurance Company: Travelers Indemnity Co. of CT 2. Insurance Policy Number:-'D:::......::T..:::2=2..:::Cc...::O;_:8:...,;G=2=3c..:.9-'-9-'-3-'-6T~C..:::T..:::l"'-7 ____________ _ 3 . Effective Date of this Endorsement: March 7 th 20 1 7 ----------------- 4. Insured: Tennyson, Electric, Inc. 5. Additional Insured : City of Cupertino, its directors, officers, agents and employees. All notices herein provided to be given by the Insurance Company to the City in connection with this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Torre Avenue; Cupertino, California 95014 . I, Elena Rogan (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. Names of Agent/Agency: Woodruff-Sawyer & Co. Title: Senior Account Manager Address: so California Street Floor 12 Telephone: 415-391-214=1 __ _ San Francisco, CA 94111 Facsimile: 415-989-992_3 __ _ City of Cupertino 00530 -8 Insurance Forms Traffic Signal Modification at S. De Anza Blvd. and Rodrigues Ave CITY OF II CUPERTINO WAIVER OF SUBROGATION ENDORSEMENT WORKER'S COMPENSATION INSURANCE Project Title and Number: Traffic Signal mods at Deanza Project No. 74,366.0SA 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: 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, sustained by any employee of the insured , arising out of the perfonnance of the above-referenced Contract. POLICY INFORMATION 1. Insurance Company: ACE AMERICAN INSURANCE COMPANY 2. Insurance Policy Number:~R~W~C~6~4~3~7~60~2~0~----------------- 3. Effective Date of this Endorsement: 03/01 20 17 --=-..c"--=-~--------------- 4. Insured: TENNYSON ELECTRIC , INC. All notices herein pro vi ded to be given by the Insurance Company to the City in connection with this policy and this Endorsement, shall be mailed to or deli ve red to the City at 10300 Torre A venue; Cupertino, California 95014. I, Richard Poling (print /type name) warrant that I ha ve authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. Signature of Authorized Representative:_<{. __ =.L...":-~~~~<(2..s;:::,~--,,--------------- (Original signature required on all Endorsementsfurtilihed to the District) Names of Agent/ Agency: Arrowhead General Insurance Agency Address : 8000 E Maplewood Ave #350 Greenwood Village CO 80111 Title: ------------ Telephone: ...8.6..6_ __fi3j_ 6555 Facsimile: 866 631 6554 END OF DOCUMENT C ity of C upertino 00530 - 9 In s urance Forms Traffic Signal Modification a t S. D e Anza Blvd . and Rodrigues Ave CITY OF m CUPERTINO W AIYER OF SUBROGATION ENDORSEMENT WORKER'S COMPENSATION INSURANCE Project Title and Number: Traffic Signal mods at Deanza Project No. 74 ,36 6.0 SA In consideration of the policy premium and notwithstanding any inconsistent st a 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 , sustained by any employee of the insured, mising out of the perfo1mance of the above-referenced Contract. POLICY INFORMATION 1. Insurance Company: ACE AMERICAN INSURANCE COMPANY 2. Insurance Policy Number: RWC 64376020 ~~~~~=-=---------------------- 3 . Effective Date of this Endorsement: 03/01 20 17 ------------------ 4 . Insured: TENNYSON ELECTRIC , INC. All notices herein prov ided to be given by the Insurance Company to the City in connection with this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Torre A venue ; Cupertino , California 95014 . I, Richard Poling (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. Signature of Authorized Representative:_~_,,_=L....:" ... .,.,~ ..... '-~-=---------------- (Original signature required on all Endorsementsfurn1Toed to the District) Names of Agent/ Agency: Arrowhead General Insurance Agency Address: 8000 E Maplewood Ave #350 Greenwood Village CO 80111 Title: ------------ Telephone: _8_6.6__ _6__3_L 6555 Facsimile: 866 631 6554 END OF DOCUMENT C it y of C upertino 00530 -9 In s uranc e Form s Traffic Signal Modi fi ca tion at S. D e An za Bl vd . a nd Rodri g ues A ve CITY OF m CUPERTINO W AIYER OF SUBROGATION ENDORSEMENT WORKER'S COMPENSATION INSURANCE Project Title and Number: Traffic Signal mods at Deanza Project No. 74 ,366.0SA 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: 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 Cupe1tino, and each of its directors, officers, agents, consultants and employees by reason of any payment made on account of injury, including death resulting therefrom , sustained by any employee of the insured, arising out of the performance of the above-referenced Contract. POLICY INFORMATION 1. Insurance Company: ACE AMERICAN INSURANCE COMPANY 2. Insurance Policy Number:~R~W~C~6~4~3~7~60=2~0~----------------- 3. Effe ctive Date of this Endorsement: 03/01 20 17 ~~-'----------------- 4. Insured: TENNYSON ELECTRIC, INC. All notices herein provided to be given by the Insurance Company to the City in connection with this policy and this Endorsement, shall be mailed to or delivered to the City at 10300 Torre A venue; Cupertino, California 95014. I, Richard Poling (print/type name) warrant that I have authority to bind the below listed Insurance Company and by my signature hereon do so bind this Company. Signature of Authorized Representative :_~--.L.:'=~~~~~~---------------- (Original signature required on all Endorsemeutsf'unilihed to the District) Names of Agent/ Agency: Arrowhead General Insurance Agency Address: 8000 E Maplewood Ave #350 Greenwood Village CO 80111 Title: ------------ Telephone: ....8..6..6._ -6.31.._ 6555 Facsimile: 866 631 6554 END OF DOCUMENT C it y of C up e rtino 00530 -9 Insurance Forms Traffic Signal Modification a t S. De Anza Blvd. an d Rodrigues Ave ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM IDD /YYYY) ~ 2/28/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICA TE 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 co nfer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Raniani Sharma NAME : Woodruff-Sawyer & Co . P~9NJ~ r ... 415-391-2141 I rn~ "'~'· 415-989-9923 50 California Street, Floor 12 San Francisco CA 94111 E~~A~L,~.rs harma@wsandco .com INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Travelers Prop Casualty Co of Ameri 25674 INSURED TENNYS0-01 INSURER B : Travelers Indemnity Company of CT 25682 Tennyson Electric, In c . INSURER C : 7275 National Drive, Suite A-2 INSURER D : Livermore CA 94550 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER· 237996416 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 COND ITION 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 COND ITIONS OF SUCH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . INSR ,. '" ,~w POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER CMMIDD/YYYYl (MMIDD/YYYYl LIMITS B X COMMERCIAL GENERAL LIABILITY y y DT22C08G239936TCT17 3/1/2017 3/1/2018 EACH OCCURRENCE $1 ,000 ,000 -~ CLAIMS-MADE GJ OCCUR DAMAGE TO RENTED -PREMISES /Ea occ urrence\ $300,000 -MED EXP (Any one person) $5,000 -PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER : GENERAL AGGREGAT E $2,000,000 9 0PRO-DLOC $2,000 ,00 0 POLICY JECT PRODUCTS -COMP/OP AGG OTHER : $ A AUTOMOBILE LIABILITY y y DT8108G239936TIL 17 3/1/2017 3/1/2018 )t:";:~~'id~~trlNG Lt: LIMIT $1,000,000 - X ANY AUTO BODILY INJURY (Pe r person) $ -ALL OWNED -SCHEDULED AUTOS AUTOS BODILY INJURY (Pe r accident) $ -NON-OWNED PROPERTY DAMAGE X HIRED AU TOS X AUTOS (Pe r accident) $ -$ A UMBRE LLA LIAB MOCCUR CUP2J1204071726 3/1/2017 3/1/2018 EACH OCCURRENCE $2,000,000 -X EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 OED I I RETENTION$ $ WORKERS COMPENSAT ION 1 r\%uTE I I OTH- AND EMPLOYERS' LIABILI TY ER Y/N ANY PROPRIETOR/PARTNER/EXECUTI VE D N/A E.L. EACH ACCIDEN T $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE -EA EMPLO YE E $ If yes , des cribe under DESCR IPTION OF OPERATIONS bel ow E.L. DISEASE -POLICY LIMIT $ DES CR IPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedu le, may be attached if more space is required) Job #117-012 -Traffic Signal Mods at Deanza Blvd . The City of Cupertino , its officers , engineers , agents, and employees, and the State of California, and its officers , agents and employees, are additional insured per the attached forms . Coverage is primary and Non-Contributory per the attached form. P olicies contain a 30 day notice of cancellation and a 10 day notice of cancellation for non-payment of premium . CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Cupertino THE EXPIRATION DATE THEREOF , NOTICE WILL BE DELIVERED IN 10300 Torre Avenue ACCORDANCE WITH THE POLICY PROVISIONS . Cupertino CA 95014 AUTHORIZED REPRESENTATIVE I f<(l,n~i Sl..,n-..c.-- © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Policy No. DT8108G239936TIL17 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTJON OF COVERAGE -This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered , A. BROAD FORM NAMED INSURED H. HIRED AUTO ,PHYSICAL DAMAGE -LOSS OF B. BLANKET ADDITIONAL INSURED USE -INCREASED LIMIT C. EMPLOYEE HIRED AUTO 0. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS -INCREASED LIMITS . . F. HIRED AUTO -LIMITED WORLDWIDE COV- ERAGE -INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE -GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION 11 -COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50% or more ownership interest and that is not separately insured for Business Auto Coverage. Cove rage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II -COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executeo by you befOre the "bodily injury" or "property damage" occurs and that is in effect during t he policy period, to be named as an addi- t ional insu red is an "insured" for Covered Autos Liability Coverage, but only for damages to which I. PHYSICAL DAMAGE -TRANSPORTATION EXPENSES -INCREASED LIMIT J. PERSONAL PROPERTY K. AIRBAGS L. NOTICE ANO KNOWLEDGE OF ACClDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who fs An Insured, of SECTION H -COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an ''insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your busi· ness. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV -BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1} Any covered "auto" you lease, hire, rent or borrow; and (2} Any covered ''auto" hired or rented by your "employee" under a contract in an "employee's" name, with your CA T3 53 0215 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 lncludes copyrighted material of Insurance Services Office, Inc. with Its permission , COMMERCIAL AUTO permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed wlth a driver is not a covered "auto". D. EMPLOYEES AS INSURED The followlng is added to Paragraph A.1., Who Is An Insured, of SECTION II -COVERED AUTOS LIABILITY COVERAGE: Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow in your business or your personal affairs. E. SUPPLEMENTARY PAYMENTS -INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2), of SECTION II -COVERED AUTOS LIABIL- ITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola - tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4), of SECTION ll -COVERED AUTOS LIABIL- ITY COVERAGE: (4) All reasonable expen~es incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. F. HIRED AUTO -LIMITED WORLDWIDE COV- ERAGE -INDEMNITY BASIS The following replaces Subparagraph (5) in Para- graph B.7., Policy Period, Coverage Territory, of SECTION JV -BUSINESS AUTO CONDI- TIONS: (5) Anywhere in the world, except any country or Jurisdiction while any trade sanction, em- bargo, or similar regulation imposed by the United States of America applies to and pro- hibits the transaction of business with or within such country or jurisdiction, for Cov- ered Autos Liability Coverage for any covered "auto" that you lease, hire, rent or borrow without a driver for a period of 30 days or less and that is not an "auto" you lease, hire, rent or borrow from any of your "employees", partners (if you are a partnership), members (if you are a limited liability company) or members of their households. (a) With respect to any claim made or "s uit" brought outside the United States of America, the tenitories and possessions of the United States .of America, Puerto Rico and Canada : (i) You must arrange to defend the "in- sured" against, and investigate or set- tle any such claim or "suit" and keep us advised of all proceedings and ac- tions. (ii) Neither you nor any other involved "insured" will make any settlement wlthout our consent. (Hi) We may, at our discretion, participate in defending the "insured" against, or in the settlement of, any claim or ''suit". (iv) We will reimburse the "insured" for sums that the "insured" legally must pay as damages because of "bodily injury" or "property damage" to which this insurance applies, that the "in - sured" pays with our consent, but only up to the limit described in Para- graph c., Limits Of Insurance, of SECTION II -COVERED AUTOS LIABILITY COVERAGE. {v) We will reimburse the "insured" for the reasonable expenses incurred with our consent for your investiga- tion of such claims and your defense of the "insured" against any such "suit", but only up to and included within the limit described in Para- graph C., Limits Of Insurance, of SECTION II -COVERED AUTOS LIABILITY COVERAGE, and not in addition to such limit. Our duty to make such payments ends when we have used up the applicable limit of insurance in payments for damages, settlements or defense expenses. (b) This insurance is excess over any valid and collectible other insurance available to the "insured" whether primary, excess, contingent or on any other basis. (c) This insurance Is not a substitute for re- quired or compulsory insurance in any country outside the United States, its ter- ritories and possessions, Puerto Rico and Canada . Page 2 of 4 © 2015 The Travelers Indemnity Company. All rights reserved. CA T3 53 0215 Includes copyrighted materlal of Insurance Services Office, Inc. with Its permission. You agree to maintain all required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage afforded by this policy, but we will only be liable to the same extent we would have b~en liable had you complied with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted or authorized insurer outside the United States of America, its territories and possessions, Puerto Rico and Can- ada. We assume no responsibility for the furnishing of certificates of insurance, or for compliance in any way · with the laws of other countries relating to insurance. G. WAlVER OF DEDUCTIBLE -GLASS The following is added to Paragraph o., Deducti- ble, of SECTION IU -PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to gfass damage if the glass is repaired rather than replaced. H. HIRED AUTO PHYSICAL DAMAGE -LOSS OF USE -INCREASED LIMIT The following replaces the last sentence of Para- graph A.4.b., Loss Of Use Expenses; of SEC- TION Ill -PHYSICAL DAMAGE COVERAGE: However, the most we will pay for any expenses for loss of use is $65 per day, to a maximum of $750 for any one "accident". I. PHYSICAL DAMAGE -TRANSPORTATION EXPENSES -INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTlON Ill -PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. J. PERSONAL PROPERTY The following is added to Paragraph A.4., Cover- age Extensions, of SECTION Ill -PHYSICAL QAMAGE COVERAGE: Personal Property We will pay up to $400 for "loss" to wearing ,a p- parel and other personal property which is: (1) Owned by an "insured"; and COMMERCIAL AUTO (2) In or on your covered "auto". This coverage applies only in the event of a total theft of your covered "auto". No deductibles apply to this Personal Property coverage. K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION Ill -PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of "loss" set forth in Paragraphs A.1.b. and A.1 .c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally Inflated. We will pay up to a maximum of $1,000 for any one "loss". L NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is added to Paragraph A.2.a., of SECTION IV -BUSINESS AUTO CONDITI_ONS: Your duty to give us or our authorized representa- tive prompt notice of the "accident" or "loss" ap- plies only when the "accident" or "loss" is known to: {a) You (if you are an individual); (b) A partner (if you are a partnership); (c) A member (if you are a limited liability com- pany); (d} An executive officer, director or insurance manager (if you are a corporation or other or- ganization}; or {e) Any "employee" authorized by you to give no- tice of the "accident" or "loss". M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV -BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of yo u by a written contract signed and executed prior to any ttaccident" or "loss ", provided that the ''accident" or "loss" arises out of operations contemplated by CA T3 53 0215 © 2015 The Travele rs Indemnity Company. All rights reserved. Page 3 of 4 Includes copyrighted material or Insurance Services Office, Inc. wlth its permission. COMMERCIAL AUTO such contract. The waiver applies only to the person or organization designated in such contract. N. UNINTENTIONAL ERRORS OR OMISSIONS The following is added to Paragraph B.2., Con- cealment, Misrepresentation, Or Fraud , of SECTlON IV -BUSINESS AUTO CONDITIONS: The unintentional om1ss1on of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. How- ever this prov isi on does not affect our right io col- lect additional premium or exercise our right of cancellation or non~renewal. Page 4 of 4 © 2015 The Travelers Indemnity Company. All rights reserved . CAT3 53 0215 Includes copyrighted material of Insurance Services Office, Inc. With Its permission. PolicyNo. DT22C08G239936TCT 17 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED {CONTRACTORS) This endorsement modifies insurance provided under the follow ing: COMMERCIAL GENERAL LIAB I LITY COVERAGE PART 1. WHO IS AN INSURED -(Section II) is amended to include any person or organization that you agree in a "written contract requ iring insurance" to include as an additional insured on this Cover- age Part, but: a) Only with respect to liabil ity for "bodily injury", "property damage" or "personal injury"; and b) If, and only to the extent thaf, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" appl ies. The person or organization does not qualify as an additional insured with respect to the in de pendent acts or omissions of such person or organization . 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written co ntract requiring insurance'', the in- surance provided to the additional insured shall be limited to the limits of liability re- quired by that "written contract requiring in- surance". This endorsement shall not in- crease the lim its of insurance described in Section Ill -Limits Of Insurance . b} The insurance provided to the additional in- su red does not apply to "bodily injury", "prop- erty damage" or ''personal injury" aris ing out of the rendering of, or failure to render, any professional architectural, engineering or su r- veying services , including: i. The preparing, approving, or failing to prepare or approve , maps, shop draw- ings, opinions , reports, surveys, field or- ders or change orders, or the preparing, approving , or failing to prepare or ap- prove , drawings and specifications; and ii. Supe,vis ory, inspection, architectural or e ngineering activities . c) The insurance provided to the additional in- sured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products-completed op- eration s hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that oc- curs before the end of the period of time for which the "written contract requiring insur- ance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary , excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract re quiring insurance" specifically requi res that this insurance app ly on a primary basis or a primary and non-contributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additional insured by this endorsement st ill is excess over any valid and collectible "other in- surance", whether primary, excess, contingent or on any other basis, that is available to the addi- tional insured when that person or organization is an additional insured under such "other insur- ance". 4. As a condition of coverage provided to the additional insured by th is endorsement: a) The additional insured must give us written notice as soon as practicable of an "occur- rence" or an offense which may result in a claim. To the extent possible , such notice should include: CG D2 46 08 05 © 2005 The St. Paul Travelers Companies , Inc . Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the ''occurrence" or offense took place; Ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of t he "occurrence" or offense. b) If a claim is made or "suit" is brought against t he additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers rece ived ln co nnection with the claim or "suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insur- ance provided to the additional insured by this endorsement is primary to "other insur- ance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. -DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional in- sured on this Coverage Part, provided that the "bod ily injury" and "property damage" oc- curs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2005 The St. Paul Travelers Companies, Inc. CG D2 46 08 05 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD /YYYY) 3/8/2017 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 SUBROGRATION 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 On Point Underwriting Inc. 8390 E Crescent Pkwy, Suite 200 Greenwood Village , CO 80111 CONTACT NAME: Steven McComb PHONE (A/C, No Ext): (360) 828-0644 FAX (A/C , NO): (360) 828-0699 EMAIL ADDRESS : --------- INSURER(S) AFFORDING COVERAGE INSURER A: ACE American Insurance Company NAIC# 22667 ,__ ____________________ __,_ INSURED Barrett Business Services , Inc. UC/F TENN YSON ELECTRIC, INC. INSURER B: INSURER C: IN SURER D : OFFICE PAYROLL ,7275 NATI ONAL DRIVE SUITE A2 ~~ERE: LI V ERMORE , CA 94550 INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THI S IS TO CERTIFY THAT THE POLICIES O F IN SU RANC E LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI OD IND ICAT ED . NOTWITHSTANDING ANY REQUIREMENT, TERM OR COND ITI ON OF ANY CON TRACT OR OTHER DOCUMENT WITH RESPECT TO W HI CH THIS CERTIFICATE MAY BE ISSU ES OR MAY PERTAIN . THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJ ECT TO ALL T HE TERMS, EXC LUSIONS AND COND ITI ONS OF SUCH POLICIES. LIMITS SHOWN MAY HAV E BEE N REDU CED BY PAID CLA IMS . INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLIC Y EXP LIMITS LTR INSR WVD (MM/DD/YYYY) (MM /DD/YYYY) GENERAL LIABILITY EACH OCCURRENCE $ -COMM ERC IA L GENERAL LI ABI LITY DAMAGE TO RENTED PREMISES (Ea s I CLAIMS-M ADE D OCCUR occurence) MED EXP (Any one person ) s PERSONAL & ADV INJURY $ GENERAL AGGREGATE s GEN'L AGGREGATE LIMIT A PPLIES PER: n POLICY n ~~~J-n LOC PRODUCTS -COMP/OP AGG $ s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ -(Ea accident) ANY AUTO -BODILY INJURY (Per person) s A LL OWNED AUTOS B SCHEDULED AUTOS -BODIL Y INJURY (Per accident) $ HIRED AU TOS NON-OWNED AUTOS -PROPERTY DAMAGE s ,_ $ UMBRELLA LIAB ~OCCUR EACH OCCURRENCE $ -EXCESS LIAB OCCUR AGGREGATE s -I OED RET ENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' RWC 03/01/17 03/01 /2018 ../ I we STATU-I I OTH- LI A BILITY Y/N C64376020 TORY LIMITS ER A N Y PROPRIETOR/PARTNER/ EX ECUTIVE c= N /A E.L. EACH ACCIDENT 52 ,000,000 OFFICER/MEMBER EXCLUDED? Covered states: E.L. DISEASE -EA EMPLOYEE S2 ,000 ,000 (Mandatory in NH) If yes , describe under CA DESCRIPTION O F OPERATIONS below E.L. DISEASE -POLICY LIMI T $2 ,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS/ V EHI CLES (Attach ACORD 101 , Additional Remarks Schedule, if more space is required) In th e even t of any payment under this policy for a Loss for which the named in sured has waived the right of recovery in a written contract entered into prior to the Loss, insurer hereb y agrees to also waive our right of recove ry but only w ith respect to such Lo ss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Cupertino EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS . 1300 Torre Ave AUTHORIZED REPRESENTATIVE Cupertino CA 950 14 c;i~~ Richard Poling c) 1988 -2010 ACORD CORPORATION. Al l right s reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD . AGENCY CUSTOMER ID: ____________ _ LOC : #: _____________ _ ADDITIONAL REMARKS SCHEDULE Page_2_ of_2_ AGENCY NAMED INSURED OnPoint Underwriting Inc. Barrett Business Services, Inc . 8100 NE Parkway, Suite 200 POLICY NUMBER Vancouver WA 98662 RWC C64376020 CARRIER NAIC CODE ACE American Insurance Company 22667 EFFECTIVE DATE: 03/01/17 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER : 25 FORM TITLE : Certificate of Liability (01/14) CERTIFICATE HOLDER: City of Cupertino ADDRESS: 1300 Torre Ave Cupertino CA 95014 Traffic Signal at S De Anza Blvd and Rodrigues Ave; #117-12 ACORD 101 (2008/01) c) 1988-2010 ACORD _CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD . C H u B B " ACE COMPANIES ACE USA PROPERTY & CASUAL TY CENTRALIZED OPERATIONS 1 BEAVER VALLEY ROAD WILMINGTON, DE 19803 BARRETT BUSINESS SERVICES , INC . 8100 NE PARKWAY DRIVE, STE . 200 VANCOUVER WA 98662 OFFICE 61760 Z04954 PRO 20170314 SO .TYP C64376020 PRO WCINSSEP CK-1 X3 5 BEGINNING OF POLICY OFFICE 61760 Z04954 PRO 20170314 SO.TYP C64376020 - -- - Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number BARRETT BUSINESS SERVICES , INC . L/C/F TENNYSON ELECTRIC , INC . Poli cy Number 8100 NE PARKWAY DRIVE , STE . 200 Symbol: RWC Number: C64376020 Policy Period Effective Date of Endorsement 03-01-2017 TO 03-01-2018 03-08-2017 Issued By (Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number . The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy . POLICY INFORMATION PAGE ENDORSEMENT The following item(s) 1. D lnsured's Name 11 . D Item 3.B. Limits 2. D Policy Number 12 . D Item 3.C. States 3. D Effective Date 13. [x] Item 3.D . Endorsement Numbers 4. D Expiration Date 14 . D Item 4. *Class, Rate, Other 5. D lnsured's Mailing Address 15. D Interim Adjustment of Premium 6. D Experience Modification 16 . D Carrier Servicing Office 7. D Producer's Name 17. D Interstate/Intrastate Risk ID Number 8. D Change in Workplace(s) of Insured 18. D Carrier Number 9. D lnsured's Legal Status 19 . D Issuing Agency/Producer Office Address 10 . D Item 3.A. States is changed to read: THE FOLLOW I NG ENDORSEMENT(S) HAVE BEEN ADDED/REVISED TO THE POL I CY : WC 990322 CA CAL I FORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT WC 99 06 00B (08/14) Authorized Representative © Includes copyright material of the National Council on Compensation Insurance , Inc. used with its permission. 03-14-2017 NYU INSURED COPY CKE-1U76A Page 1 of 1 Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number BARRETT BUSINESS SERVICES , INC . L/C/F TENNYSON ELECTRIC , INC . Policy Number 8100 NE PARKWAY DRIVE , STE . 200 Symbol: RWC Number: C643 76020 Poli cy Period Effective Date of Endorsement 03-01-2017 TO 03-01-2018 03-08-2017 Issued By (Name of Insurance Company) ACE AMERICAN INSURANCE COMPAN Y In sert the oolicv number. The remainder of the informat ion is to be comole ted onl y when this endorsement is issued subsequent to the preparation of the policy . CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because Californ ia is shown in Item 3.A. of the Information Page . We have the right to recover our payments from anyone liable for an injury covered by this policy . We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us . You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule . 1. ( X ) Specific Wa iver Name of person or organization: CI TY OF CUPERTINO 1300 TORRE AVE CUP ERTIN O CA 950 14 ( ) Blanket Waiver Schedule Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Prem ium : The premium charge for this endorsement shall be INCLUDED percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described . 4. Minimum Premium : INCLUDED Authorized Representative WC 99 03 22 CHUBB" CALIFORNIA NOTICE OF WORKERS' COMPENSATION COVERAGE CORPORATE OFFICERS/DIRECTORS, GENERAL PARTNERS AND LLC MANAGING MEMBERS Effective January 1, 2017, AB 2883 (Assembly Insurance Committee) makes certain changes to the definition of employee and exclusions to the definition of employee set forth in sections 3351 and 3352 of the Labor Code . I. Corporate Officers and Directors Officers and members of boards of directors while rendering actual service for the corporation for pay will be covered employees unless the officer or member of the board of directors owns at least 15 percent of the issued and outstanding stock of corporation and executes a written wa iver of his or her rights under the Labor Code stating under penalty of perjury that the person is a qualifying officer or director. Pursuant to California Labor Code section 3352(p ), as a corporate officer or director, of a quasi -public or private corporation , and you own at least 15 percent (15 %) of the issued and outstanding stock of the corporation, you have the option to be excluded from your corporation 's workers ' compensation insurance policy . 11. General Partners and LLC Managing Members Wo rking members of a partnersh ip or limited liab ility company rece iv ing wages irrespective of profits from the partnersh ip or limited liability company will be covered employees unless the individual is a general partner of a partnership or a managing member of a limited liability company and executes a wr itten waiver of his or her rights under the Labor Code stating under penalty of perjury that the person is a qualifying general partner or managing member. Pursuant to California Labor Code section 3352(q), as a general partner (if the insured is a partnership) or a managing member (if the insured is a limited liability company), you have the option to be excluded from your company 's workers' compensation insurance policy . Please see the required waiver form provided to you by the Insurer as part of your pol icy/program proposal for accep ti ng the exclusion for the above qual ifying individuals . W C 90 03 63 (01 /17 ) Page 1 of 1