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18-164 J Marez Ocean Plumbing, Replacing Drinking Fountains at Quinlan Community CenterCIT Y OF a PUBLIC WORKS CONTRACT $45,000 OR LESS CUPERTINO 1. PARTIES This public works contract ("Contract") is made and entered into on August 10 , 2018 ("Effective Date") by and between the City of Cupertino , a municipal corporation ("City"), and J Marez Ocean Plumbing , a Sole Proprietorship/Individ ("Contractor") for replacing drinking fountains at Quinlan Community Center. 2. SCOPE OF WORK Contractor will perform and provide all labor, materials, equipment, supplies, transportation and any other items or work necessary to perform and complete the work required for the Project ("Work"), as required in the Scope of Work, attached here and incorporated as Exhibit A, and in accordance with the terms and conditions of this Contract. 3. TIME FOR COMPLETION 3.1 Term. This Contract begins on the Effective Date and ends on March 29, 2019 ("Contract Time") unless terminated earlier as provided herein. Contractor's Work shall begin on the date shown on a written Notice to Proceed ("NTP") and must be fully completed within the Contract Time or on the date specifically provided in the Notice to Proceed. The City Engineer will not issue a NTP until the Contract is fully executed by both parties and City has received satisfactory proof of insurance and any performance and payment bonds that may be required. 3.2 Time is of the essence for Contractor's performance and completion of the Work. Contractor must have sufficient time, resources, and qualified staff to deliver the work on time. 3.3 Liquidated damages of$ 200.00 will be charged for each day of unexcused delay, or City may deduct the amount from Contractor's payments. Liquidated damages are based on reasonably foreseeable consequences of delay and may include intangible losses which the Parties agree may be difficult to ascertain, such as loss of public confidence in City and its contractors, interference or loss of use of public facilities, and extended disruption to the public. 4. COMPENSATION 4.1 Maximum Compensation. City will pay Contractor for satisfactory performance of the Work an amount that will based on actual costs but that will be capped so as not to exceed$ 8,500.00 ("Contract Price"), for all of Contractor's direct and indirect costs, including all labor , materials, supplies, equipment, taxes, insurance, bonds and all overhead costs. 4.2 Invoices and Payments. Contractor must submit an invoice on the first day of each month, describing the Work performed during the preceding month, itemizing labor, materials, equipment and Public Works Project Quinlan Community Center -Drinking Fountain Replacements Public Works Contract $45,000/Rev. May 22, 2018 Page I of 11 any incidental costs incurred. Contractor will be paid 95% of the undisputed amounts billed within 30 days after City receives a properly submitted invoice. Any retained amounts will be included with Contractor's final payment within 60 days of City's acceptance of the Work as complete. 5. INDEPENDENT CONTRACTOR 5.1 Status. Contractor is an independent contractor and not an employee of City . Contractor is solely responsible for the means and methods of performing the Work and for the persons under this employment. Contractor is not entitled to worker's compensation or any other City benefits. 5.2 Contractor's Qualifications. Contractor warrants on behalf of itself and its subcontractors that they have the qualifications and skills to perform the Work in a competent and professional manner and according to the highest standards and best practices in the industry. 5.3 Permits and Licenses. Contractor warrants on behalf of itself and its subcontractors that they are properly licensed, registered, and/or certified to perform the Work as required by law, and have procured a City Business License. Contractor shall possess a California Contractor's License in good standing for the following classification(s): C-36 , which must remain valid for the entire Contract Time. 5.4 Subcontractors. Only Contractor's employees are authorized to work under this Contract. Prior written approval from City is required for any subcontractor, and the terms and conditions of this Contract will apply to any approved subcontractor. 5.5 Tools, Materials and Equipment. Contractor will supply all tools, materials and equipment required to perform the Work under this Contract. 5.6 Payment of Taxes. Contractor must pay income taxes on the money earned under this Contract. Upon City's request, Contractor will provide proof of payment and will indemnify City for violations pursuant to the indemnification provision of this Contract. 6. CHANGE ORDERS Amendments and change orders must be in writing and signed by City and Contractor. Contractor's request for a change order must specify the proposed changes in the Work, Contract Price, and Contract Time. Each request must include all the supporting documentation, including but not limited to plans/drawings, detailed cost estimates, and impacts on schedule and completion date. 7. ASSIGNMENTS; SUCCESSORS Contractor shall not assign, hypothecate, or transfer this Contract or any interest therein, directly or indirectly, by operation of law or otherwise, without prior written consent of City. Any attempt to do so will be null and void. Any changes related to the financial control or business nature of Contractor as a legal entity is considered an assignment of the Contract and subject to City approval, which shall not be unreasonably withheld. Control means fifty percent (50%) or more of the voting power of the business entity. This Contract is binding on Contractor, its heirs, successors and permitted assigns Public Works Project Quinlan Community Center -Drinking Fountain Replacements Public Works Contract $45,000 /Rev. May 22, 2018 Page 2 of 11 8. PUBLICITY/ SIGNS Any publicity generated by Contractor for the Project during the Contract Time, and for one year thereafter must credit City contributions to the Project. The words "City of Cupertino" must be displayed in all pieces of publicity, flyers, press releases, posters, brochures, interviews, public service announcements and newspaper articles. No signs may be posted or displayed on or about City property , except signage required by law or this Contract, without prior written approval from the City. 9. SUBCONTRACTORS 9.1 Contractor must perform all the Work with its own forces, except that Contractor may hire qualified subcontractors to perform up to 25 % of the Work, provided that each subcontractor is required by contract to be bound by the provisions of this Contract. Contractor must provide City with written proof of compliance with this provision upon request. 9.2 City may reject any subcontractor of any tier and bar a subcontractor from performing Work on the Project, if City in its sole discretion determines that subcontractor's Work falls short of the requirements of this Contract or constitutes grounds for rejection under Public Contract Code Section 4107. If City rejects a subcontractor, Contractor at its own expense must perform the subcontractor's Work or hire a new subcontractor that is acceptable to City. A Notice of Completion must be recorded within 15 days after City accepts the Work if the Contract involves work by subcontractors. 10. RECORDS AND DAILY REPORTS 10.1 Contractor must maintain daily reports of the Work and submit them to City upon request and at completion of Project. The reports must describe the Work and specific tasks performed, the number of workers, the hours, the equipment, the weather conditions, and any circumstances affecting performance. City will have ownership of the reports, but Contractor will be permitted to retain copies. 10.2 If applicable, Contractor must keep a separate set of as-built drawings showing changes and updates to the Scope of Work or the original drawings as changes occur. Actual locations to scale must be identified for all major components of the Work, including mechanical, electrical and plumbing work; HV AC systems; utilities and utility connections; and any other components City determines should be included in the final drawings of the Project. Deviations from the original drawings must be shown in detail, and the location of all main runs, piping, conduit, ductwork, and drain lines must be shown by dimension and elevation. 10.3 Contractor must maintain complete and accurate accounting records of its Work, in accordance with generally accepted accounting principles, which must be available for City review and audit, kept separate from other records, and maintained for four years from the date of City's final payment. Public Works Project Quinlan Community Center -Drinking Fountain Replacements Public Works Contract $45,000/Rev. May 22, 2018 Page 3 of 11 11. INDEMNIFICATION 11.1 To the fullest extent allowed by law, and except for losses caused by the sole and active negligence or willful misconduct of City personnel, Contractor shall indemnify, defend, and hold harmless City, its City Council, boards and commissions, officers, officials, employees, agents , servants, volunteers and consultants ("Indemnitees"), through legal counsel acceptable to City, from and against any and all liability, damages , claims, stop notices, actions, causes of action , demands, charges, losses and expenses (including attorney fees, legal costs and expenses related to litigation and dispute resolution proceedings), of every nature arising directly or indirectly from this Contract or in any manner relating to any of the following: (a) Breach of contract, obligations, representations or warranties; (b) Performance or nonperformance of the Work or of any obligations under the Contract by Contractor, its employees, agents, servants, subcontractors or subcontractors; ( c) Payment or nonpayment by Contractor or its subcontractors or sub-subcontractors for Work performed on or off the Project Site; and (d) Personal injury , property damage, or economic loss resulting from the work or performance of Contractor or its subcontractors or sub-subcontractors. 11.2 Contractor must pay the costs City incurs in enforcing this provision. Contractor must accept a tender of defense upon receiving notice from City of a third-party claim, in accordance with California Public Contract Code Section 9201. At City's request, Contractor will assist City in the defense of a claim, dispute or lawsuit arising out of this Contract. 11.3 Contractor's duties under this entire Section are not limited to Contract Price, Workers ' Compensation or other employee benefits, or the insurance and bond coverage required in this Contract. Nothing in the Contract shall be construed to give rise to any implied right of indemnity in favor of Contractor against City or any other Indemnitee. 11.4 Contractor's payments may be deducted or offset to cover any money the City lost due to a claim or counterclaim arising out of this Contract, a purchase order or other transaction. 12. INSURANCE Contractor shall comply with the Insurance Requirements, attached and incorporated here as Exhibit B. Contractor must provide satisfactory proof of insurance and maintain it for the Contract Time or longer as required by City. City will not execute the Contract until City has approved receipt of satisfactory certificates of insurance and endorsements evidencing the type, amount, class of operations covered, and the effective and expiration dates of coverage. Failure to comply with this provision may result in City, at its sole discretion and without notice, purchasing insurance at Contractor's expense, deducting the costs from Contractor's compensation, or terminating the Contract. Public Works Project Quinlan Community Center -Drinking Fountain Replacements Public Works Contract $45,000 /Rev . May 22, 2018 Page 4 of 11 13. COMPLIANCE WITH LAWS 13.1 General Laws. Contractor shall comply with all laws and regulations applicable to this Contract. Contractor will promptly notify City of changes in the law or other conditions that may affect the Project or Contractor's ability to perform. Contractor is responsible for verifying the employment status of employees performing the Work, as required by the Immigration Reform and Control Act 13.2 Labor Laws. (a) Contracts of $1,000 or more are subject to the requirements of the California Labor Code, including but not limited to: (i) Prevailing wage laws under Labor Code Section 1775 , which require Contractor to pay prevailing wages applicable in Santa Clara County for each craft, classification , or type of worker needed to perform the Work , including health , pension and vacation. The prevailing wage rates are on file with the City Engineer's office and are available online at http://www.dir.ca.gov/DLSR; (ii) Apprenticeship requirements under Labor Code Section 1777 .5 for Contacts $30,000 or more; (iii) Maintain certified payroll records in accordance with Labor Code Sections 1776 and 1812, and electronically submit them to the Labor Commissioner as required by the regulations of California, Department of Industrial Relations ("DIR"); (iv) Comply with DIR Monitoring, Enforcement and Registration requirements of Labor Code Section 1725.5 . (b) Contractor must compensate workers who are paid less than prevailing wages or required to work more than a legal day's work. Contractor will also be required to pay City a penalty of $ 200.00 per worker for each day of vio lation. (c) As required by Labor Code Section 1861, by signing this Contract Contractor certifies as follows: "I am aware of Labor Code Section 3700 which requires every employer to be insured against liability for workers' compensation or to undertake self-insurance in accordance with the provisions of that code, and I will comply with such provisions before commencing the Work on this Contract." 13.3 Discrimination Laws. Contractor shall not discriminate on the basis of race , religious creed , color, ancestry, national origin, ethnicity, handicap , disability , marital status , pregnancy, age, sex, gender, sexual orientation, gender identity, Acquired-Immune Deficiency Syndrome (AIDS) or any other protected classification. Contractor shall comply with all anti-discrimination laws , including Government Code Sections 12900 and 11135, and Labor Code Sections 1735, 1777 and 3077.5. Consistent with City policy prohibiting harassment and discrimination, Contractor understands that harassment and discrimination directed toward a job applicant, an employee, a City employee, or any other person, by Contractor or Contractor's employees or sub-contractors wi ll not be tolerated. Public Works Project Quinlan Community Center -Drinking Fountain Replacements Public Works Contract $45,000 !Rev. May 22, 2018 Page 5 of 11 13.4 Conflicts of Interest. Contractor, its employees, subcontractors , servants and agents, may not have, maintain or acquire a conflict of interest in relation to this Contract in violation of law , including Government Code section l 090 and Government Code section 81000 and their accompanying regulations. No officer, official , employee, consultant, or other agent of the City ("City Representative") may have, maintain, or acquire a "financia l interest" in the Contract, as that term is defined by state law , or in violation of a City ordinance or policy while serving as a City Representative or for one year thereafter. Contractor, its employees , subcontractors, servants and agents warrant they are not employees of City or have any relationship with City officials, officers or employees that creates a conflict of interest. Contractor may be required to file a conflict of interest form if it makes certain governmental decisions or serves in a staff capacity , as defined in section 18700 of the California Code of Regulations. Contractor agrees to abide by City rules governing gifts to public officials and employees. 13.5 Remedies. Any violation of Section 13 constitutes a material breach and may result in City suspending payments, requiring reimbursement, or terminating the Contract. City reserves all rights and remedies under the law and this Contract, including seeking indemnification. 14. BONDS For contracts of $25,000 or more, Contractor must obtain a payment bond and a performance bond, each in the penal sum of 100% of the Contract Price, using the Bond Forms attached and incorporated here as Exhibit C. Each bond must be issued by a surety admitted in California, with a financial rating from A.M. Best Company of Class A-or higher, or as otherwise acceptable to City. If an issuing surety cancels a bond or becomes insolvent, Contractor must provide a substitute bond from a surety acceptable to City within seven calendar days after written notice from City. If Contractor fails to do so , City may in its sole discretion and without prior notice, purchase bonds at Contractor's expense, deduct the cost from payments due Contractor, or terminate the Contract. City will not execute the Contract nor issue the NTP until the required bonds are submitted. 15. UTILITIES, TRENCHING AND EXCAVATION 15.1 Contractor must call the Underground Service Alert ("USA") 811 hotline and request marking of utility locations before digging or commencing Work. For underground service alerts for street lighting and traffic signal conduits, City's Service Center must be called at (408) 777-3269. Government Code Section 4215 requires Contractor to notify City and Utility in writing if it discovers utilities or utility facilities not identified in the Contract. 15.2 Pursuant to Government Code Section 7104, Contractor must stop work, notify City in writing , and wait for instructions if one of the conditions below is found at the worksite. City will work with Contractor to amend the Contract or issue a change order if the discovered conditions materially change the Work/Performance, Contract Time or Contract Price. (a) Material believed to be hazardous waste under Health and Safety Code Section 25117 , and which requires removal to a Class I, Class II, or Class III disposal site pursuant to law ; (b) Subsurface or latent physical conditions at the Project worksite differing from those indicated by information about the worksite made available to Contractor; and Public Works Project Quinlan Community Center -Drinking Fountain Reolacements Public Works Contract $45,000 /Rev. May 22, 2018 Page 6 of I I (c) Unknown physical conditions at the Project worksite of any unusual nature , materially different from those ordinarily encountered and from those generally recognized as inherent in the character of the Work. 15.3 For contracts $25 ,000 or higher that require excavation or involve trenches five feet or more in depth , Contractor must submit a detailed plan for City approval , per Labor Code Section 6705 prior to commencing work. The plan must show the design of shoring, bracing, sloping and other provisions for worker protection from caving ground and other hazards. The protective system must comply with all Construction Safety Orders. If the plan varies from shoring system standards, it must be prepared by a registered civil or structural engineer. 16. URBAN RUNOFF MANAGEMENT 16.1 All Work must fully comply with federal , state and local laws and regulations concerning storm water management. Contractor must avoid creating excess dust when breaking asphalt or concrete and during excavation and grading. If water is used for dust control, Contractor will use only the amount of water necessary to dampen the dust. Contractor will take all steps necessary to keep wash water out of the streets , gutters and storm drains. Prior to the start of the Work, Contractor will implement erosion and sediment controls to prevent pollution of storm drains , and must upgrade and maintain these controls based on weather conditions or as otherwise required by City. These controls must be in place during the entire Contract Time and must be removed at the end of construction and completion of the Work. Such controls must include , but will not be limited to, the following requirements: (a) Install storm drain inlet protection devices such as sand bag barriers , filter fabric fences, and block and gravel filters at all drain inlets impacted by construction. During the annual rainy season , October 15 through June 15 , storm drain inlets impacted by construction work must be filter-protected from onsite de-watering activities and saw-cutting activities. Shovel or vacuum saw-cut slurry and remove from the Work site; (b) Cover exposed piles of soil or construction material with plastic sheeting. Store all construction materials in containers; ( c) Sweep and remove all materials from paved surfaces that drain to streets , gutters and storm drains prior to rain and at the end of each work day. When the Work is completed, wash the streets, collect and dispose of the wash water off site in lawful manner; (d) After breaking old pavement, remove debris to avoid contact with rainfall/runoff; ( e) Maintain a clean work area by removing trash , litter, and debris at the end of each work day and when Work is completed. Clean up any leaks , drips , and other spills as they occur. 16.2 These requirements must be used in conjunction with the California Stormwater Quality Association and California Best Management Practices Municipal and Construction Handbooks , local program guidance materials from municipalities, and any other applicable documents on stormwater quality controls for construction. Contractor's failure to comply with this Section will result in the issuance of noncompliance notices , citations , Work stop orders and regulatory fines . Public Works Project Quinlan Community Center -Drinking Fountain Replacements Public Works Contract $45 ,000 /Rev . May 22, 2018 Page 7 of 11 17. PROJECT COORDINATION City Project Manager. City assigns Ken Tanase as the City representative for all purposes under this Contract, with authority to require compliance with the Scope of Work. City may substitute Project Managers at any time and without prior notice to Contractor. Contractor Project Manager. Subject to City approval, Contractor assigns Johnny Marez -------------------as its single representative for all purposes under this Contract, with the responsibility to ensure progress with the Work. Contractor's Project Manager is responsible for coordinating and scheduling the Work and must regularly update the City Project Manager about the status and any delays with the Work, consistent with the Scope of Work. Any substitutions must be approved in writing by City. 18. ABANDONMENT AND TERMINATION 18.1 City may abandon or postpone the Project or parts therefor at any time. Contractor will be compensated for satisfactory Work performed through the date of abandonment and will be given reasonable time to close out the Work. With City's pre-approval in writing, the time spent in closing out the Work will be compensated up to 10% of the total time expended in performing the Work. 18.2 City may terminate the Contract for cause or without cause at any time. Contractor will be paid for satisfactory Work rendered through the termination date and will be given reasonable time to close out the Work. 18.3 Final payment will not be made until Contractor delivers the Work and provides records documenting the Work, products and deliverables completed. Nothing in the Section below is intended to delay, abridge or bar City's right under this Section. 19. GOVERNING LAW, VENUE AND DISPUTE RESOLUTION This Contract is governed by the laws of State of California. Venue for any legal action shall be the Superior Court of the County of Santa Clara, California. The dispute resolution procedures of Public Contract Code Section 20104, incorporated here by reference, apply to this Contract and Contractor is required to continue the Work pending resolution of any dispute. Prior to filing a lawsuit, Contractor must comply with the claim filing requirements of the California Government Code. If the Parties elect arbitration, the arbitrator's award must be supported by law and substantial evidence and include detailed written findings of law and fact. 20. ATTORNEY FEES If City initiates legal action, files a complaint or cross-complaint, or pursues arbitration, appeal, or other proceedings to enforce its rights or a judgment in connection with this Contract, the prevailing party will be entitled to reasonable attorney fees and costs. Public Works Project Quinlan Community Center -Drinking Fountain Replacements Public Works Contract $45,000/Rev. May 22, 2018 Page 8 of 11 21. SIGNS/ADVERTISEMENT No signs may be displayed on or about City's property, except signage which is required by law or by the Contract, without City's prior written approval as to size, design and location. 22. THIRD PARTY BENEFICIARIES There are no intended third party beneficiaries of this Contract. 23. WAIVER Neither acceptance of the Work nor payment thereof shall constitute a waiver of any contract provision. City waiver of any breach shall not constitute waiver of another provision or breach . 26. WARRANTY Contractor warrants that materials and equipment used will be new, of good quality, and free from defective workmanship and materials, and that the Work will be free from material defects not intrinsic in the design or materials. All Work, materials and equipment should pass to City free of claims, liens or encumbrances. Contractor warrants the Work and materials for one year from the date of City's acceptance of the Work as complete ("Warranty Period"), except when a longer guarantee is provided by a supplier, manufacturer or is required by this Contract. During the Warranty Period, Contractor will repair or replace any Work defects or materials, including damage that arises from Contractor's Warranty Work, except any wear and tear or damage resulting from improper use or maintenance. 27. ENTIRE CONTRACT Th is Contract and the attachments, documents, and statutes attached, referenced, or expressly incorporated herein, including authorized amendments or change orders constitute the final and complete contract between City and Contractor with respect to the Work and the Project. No oral contract or implied covenant will be enforceable against City. If any attachment or incorporated provisions conflict or are inconsistent with the terms of this Contract, the Contract terms will control. 28. SEVERABILITY IP ARTIAL INVALIDITY If a court finds any term or provision of this Contract to be illegal, invalid or unenforceable, the legal portion of said provision and all other contract provisions will remain in full force and effect. 28. SURVIVAL The contract provisions which by their nature should survive the Contract or Completion of Project, including without limitation all warranties, indemnities, payment obligations, insurance and bonds, shall remain in full force and effect after the Work is completed or Contract ends. Public Works Project Quinlan Community Center -Drinking Fou ntain Replacements Public Works Contract $45,000 /Rev. May 22, 2018 Page 9 of 11 29. INSERTED PROVISIONS Each provision and clause required by law to be inserted in this Contract will be deemed to be included and will be inferred herein. Either party may request an amendment to cure mistaken insertions or omissions of required provisions. 30. CAPTIONS The captions, titles, and headings in this Contract are for convenience only and may not be used in the construction or interpretation of the Contract or for any other purpose. 31. COUNTERPARTS This Contract may be executed in counterparts, each of which is an original and all of which taken together shall form one single document. 20. NOTICES A ll notices, requests, and approvals must be sent in writing to the persons below and will be considered effective on the date of personal delivery, the date confirmed by a reputable overnight delivery service, on the fifth calendar day after deposit in the United States Mail, postage prepaid, registered or certified, or the next business day following electronic submission: To City of Cupertino: 10300 Torre Avenue, Cupertino CA 95014 Attention: Ken Tanase ------------- Copy to: Carl Valdez Email: kent@cupertino.org 30. VALIDITY OF CONTRACT To Contractor: J Marez Ocean Plumbing Attention: Johnny Marez ------------- Copy to: -------------Em ail: oceanplum@msn.com This Contract is valid and enforceable only if (a) it complies with the purchasing and contract provisions of Cupertino Municipal Code Chapters 3.22 and 3.23, (b) is signed by the City Manager or an authorized designee, and (c) is approved for form by the City Attorney's Office. 32. EXECUTION The persons signing below warrant they have the authority to enter into this Contract and to legally bind their respective Parties. If Contractor is a corporation , signatures from two officers of the corporation are required pursuant to California Corporations Code Section 313. Public Works Project Quinlan Community Center -Drinking Fountain Replacements Public Works Contract $45,000 /Rev. May 22, 2018 Page 10 of 11 IN WITNESS WHEREOF, the parties have caused this Co ntract to be executed as of the Execution Date first above written. CONTRACTOR J Marez Ocean Plumbing Sole Proorietorshio/Ind By: ~Nl!4c~ Title: Owner ~ Signature D~~ ?5;;;:- 0~ 1 / zo I 8 CITY OF CUPERTINO, a Municipal Corporation Title: Director of Public Works Signature Date: 6;;/ ( 'f ( ( ~ r 7 APPROVED AS TO FORM: 'f<;!-?!j jJ g -/l '1 -I j ~() v<lrurr ~-g _ }7 -19 Cu 1tino City Attorney l}-,t.,t_J-, on . g 1-. i-3,o r O it) l ~ , w2) Public Works Project Quinlan Community Center -Drinking Fountain Replacements Public Works Contract $45,000 /Rev. May 22, 2018 Page 11 of 11 EXH I BIT 11 A11 PH; 925-597-3227 Plumbing Bid #154 July 22 2018 J.MAREZ / OCEAN PLUMBING CONSTRUCTION 5508 Round Tree Dr #0 Concord, Ca 94521 Calif Lie; #695831 -1994 To; C ity Of Cupertino 10300 Torre Ave Cupertino, Ca 95014 Job; Quinlan Community Center 10185 N Stel!ing Rd Cupe11ino, Ca 95014 Job Description; To remove & replace 2-existing water drinking fountain with 2-new Halsey Taylor HydroBoost, bottle filling station & Single ADA cooler, #1} To perform & provide 2 new Halsey Taylor HydroBoost, bottle filling station & single ADA cooler. #2) To provide & install new modification of existing in -wall plumbing sewer drain & water line to accommodate new water drinking fountain. #3} To perform & provide Sheet rock repairs. #4) To perform & provide all additional plumbing materials in order to completed job. #5) Total Bid Price $8'500.00 Than k's For The Opportunity In Working With You; J. Marez/ Ocean Plumbing Johnny Marez / July 22 2018 PUBLIC WORKS CONSTRUCTION CONTRACTS Small Projects -$45,000 Insurance Requirements: Exhibit B Contractor shall procure and maintain for the duration of the contract, and for jive years following the completion of the Project, insurance against claims for injuries to persons or damages to property which may arise from or in connection with the performance of the work hereunder by Contractor, its agents, representatives, employees or subcontractors. MINIMUM SCOPE AND LIMIT OF INSURANCE Coverage shall be at least as broad as: ~ Commercial General Liability (CGL): Insurance Services Office (ISO) Form CG 00 01 covering CGL on an "occurrence" basis, written on a comprehensive general liability form, and must include coverage for liability ~ arising from Contractor's or Subcontractor's acts or omissions, including Contractor's protected coverage, 'V blanket contractual, products and completed operations, vehicle coverage and employer's non-ownership liability (\.).. coverage , with limits of at least $2,000,000 per occurrence. The CGL policy must protect against any and all ;()'\ ' liability for personal injury, death, property damage or destruction, and personal and advertising injury. If a general ggregate limit applies, either the general aggregate limit shall apply separately to this project/location (ISO CG 25 03 or 25 04) or the general aggregate limit shall be twice the required occurrence limit. a. It shall be a requirement under this agreement that any available insurance proceeds broader than or in excess of the specified minimum insurance coverage requirements and/or limits shall be made available to the Additional Insured and shall be (1) the minimum coverage/limits specified in this agreement; or (2) the broader coverage and maximum limits of coverage of any insurance policy, whichever is greater. b. Additional Insured coverage under Contractor's policy shall be "primary and non-contributory," will not seek contribution from City's insurance/self-insurance, and shall be at least as broad as ISO CG 20 01 04 13 c. The limits of insurance required may be satisfied by a combination of primary and umbrella or excess insurance, provided each policy complies with the requirements set forth in this Contract. Any umbrella or excess insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a primary and non-contributory basis for the benefit of City before the City's own insurance or self-insurance shall be called upon to protect City as a named insured. 2. Automobile Liability: ISO Form CA 00 01 covering any auto (Code 1), or if Contractor has no owned autos, then hired autos (Code 8) and non-owned autos (Code 9), with limit no less than $1,000,000 per accident for bodily injury and property damage. V3. \f~rkers' Compensation: As required by the State of California, with Statutory Limits, and · ~fuployer's Liability Insurance of no less than $1,000,000 per accident for bodily injury or disease, or as otherwise required by statute. If Contractor is self-insured, Contractor must provide a Certificate of Permission to Self-Insure, dul~thorized by the DIR . . Dsi NI A if box checked ( c_ontra_ctor provides written verification it has no employees). 4. Pro~ional Liability with limits no less than $1,000,000 per occurrence or claim, and $2,000,000 aggregate. ~ NI A if box checked (Contract is not design/build). 5. Builder's Risk. Course of Construction insurance utilizing an "All Risk" (Special Perils) coverage form , with limi~ual to the completed value of the project and no coinsurance penalty provisions. ~ NI A if box checked (Project does not involve construction or improvements/installations to property). Insurance Requirements/or Construction Contracts -$45,000 Version: Nov 2017 \/ 6 . Contractors' Pollution Legal Liability and/or Asbestos Legal L iability and/or Errors and Omissions with limits no less than $1,000,000 per occurrence or claim, and $2,000,000 policy aggregate . :gf NIA if bo x checked (Project does not involve environmental hazards). If Contractor maintains broader coverage and/or higher limits than the minimums shown above , City re quires and shall be entitled to the broader coverage and/or higher limits maintained by the contrac tor. Any available insurance proceeds in excess of the specified minimum limits o f insurance and coverage shall be available to the City. Self-Insured Rete1itions. Self-insured retentions must be declared to and approved by City . At City's option , either: (1) Contractor shall cause the insurer to reduce or eliminate self-insured retentions as respects City, its officers, officials, employees, and volunteers; or (2) Contractor shall provide a financial guarantee satisfactory to City guaranteeing payment of losses and related investigations, claim administration , and defense expenses. The policy language shall provide, or be endorsed to provide, that the self-insured retention may be satisfied by either the named insured or the City . OTHER INSURANCE PROVISIONS The insurance policies are to contain, or be endorsed to contain, the following provisions: Additional Insured Status The City of Cupertino, its City Council, officers, officials, employees, agents, servants and volunteers are to be covered as additional insureds on the CGL policy with respect to liability arising out of the Services performed by or on behal f of Contractor including materials, parts, or equipment furnished. Endorsement of CGL coverage shall be at least as broad as ISO Form CG 20 l O 11 85 or if not available, through the addition of both CG 20 l 0, CG 20 26, CG 20 3;3, or CG 20 38; and CG 20 37 if a later edition is used. Primary Co verage For any claims related to this Project, Contractor's insurance coverage shall be "primary and non-contributory" and at least as broad as ISO CG 20 01 04 13 with respect to City, its officers, officials, employees and volunteers, and shall not seek contribution from City's insurance. If the limits of insurance are satisfied in part by Umbrella/Excess Insurance, the Umbrella/Excess Insurance shall contain or be endorsed to contain a provision that such coverage shall also apply on a "primary and non-contributory" basis for the benefit of City. Notice of Cancellation Each insurance policy required shall provide that coverage shall not be canceled, except with notice to the City. Each certificate of insurance must state that the coverage afforded by the policy is in force and will not be reduced, cancelled or allowed to expire without at least 30 days advance written notice to City, unless due to non-payment of premiums, in whic h case ten days advance written notice must be provided to City. Such notice must be sent to City via certified mail and addressed to the attention of the City Manager. Builder's Risk Contractor may submit Builder's Risk insurance in the form of Course of Construction coverage, which shall name the City as a loss payee , as its interest may appear. The Builder's Risk policy must be issued on an occurrence basis, for all-risk coverage on a 100% completed value basis on the insurable portion of the Project, with no coinsurance penalties, and for the benefit of City. If the Project does not involve new or major reconstruction, City may elect, acting in its sole discretion , to accept an Installation Floater policy instead of Builder's Risk. For such projects, the Property installation Floater shall include improvement, remodel , modification, alterat ion, conversion or adjustment to existing buildings, structures, processes, machinery and equipment, and shall provide property damage coverage for any building, structure, machinery or equipment damaged, impaired, broken, or destroyed during the performance of the Work, including during transit, installation, and testing at the City's site. Insurance Require ments for Co nstr uction Co ntracts -$45,000 Version: Nov 2017 2 Wai ver of S ubrogation Each required pol icy must include an endorsement providing that the carrier agrees to waive any right of subrogation it may have again st City. Contractor agrees to waive rights o f subrogation which any insurer of Contractor may acquire 1 I !\,.§"om Co ntractor by virtue of the pa yment of any loss . Contractor agrees to obtain any endorsement that may be I\\ 'l:P'necessa ry to affec t this wa iver of subrogat ion. The Workers' Compensation policy shall be endorsed with a waiver of V subrogation in favor of the City for all work performed by the Contractor, its employees, agents and subcontractors . A ccep tability of Insurers Vb.h-~ g,,-,-5 l ~'/ flP Insurance must be issued by insurers acceptable t ity and licensed to do business in the State of California, and each insurer must have an A.M. Best's financial strength rating of"A" or better and a financial size rating of"VII" or better. Verification of Co verage Contractor shall furnish the City with original certificates and amendatory endorsements, or copies of the applicable insurance language, effecting coverage required by this contract. All certificates and endorsements are to be received and approved by the City before work commences . The City reserves the right to require complete, certified copies of all required insurance policies, including endorsements, required by these specifications, at any time . Subcontracto rs Contractor shall require and verify t hat all subcontractors maintain insurance meeting all the requirements stated herein, and Contractor shall ensure that City is an addit ional insured on insurance required from subcontractors. For CGL coverage subcontractors shall provide coverage with a form at least as broad as CG 20 38 04 13. Surety Bonds As required by Contract and described in the Contract Documents . The Payment and Performance Bonds shall be in a sum equal to the Contract Price . If the Performance Bond provides for a one-year warranty a separate Maintenance Bond is not necessary . If the warranty period specified in the Contract is for longer than one year a Maintenance Bond equal to 10% of the Contract Price is required. Bonds shall be duly executed by a responsible corporate surety, authorized to issue such bonds in the State of California and secured through an authorized agent with an office in California . Special Risks or Circ umstances City reserves the right to modify these requirements, based on the nature of the risk, prior experience, insurer, coverage, or other circumstances. Insurance Requirements for Construction Contracts -$45,000 Version: Nov 201 7 3 ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DDNYYY) ~ 3/8/2018 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(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER CON 1Ai;1 Pac ifi c Pro's In surance NAME : Pacifi c Pro's In surance Age ncy wg~o Extl : 71 4-909-075 5 I FAX {AJC Nol : 5200 Warn er Av e, St e. 102 ~~cf~ss: kim@pacificpr os in s.co m INSURER{S)AFFORDING COVERAGE NAIC # Huntington Beac h CA 92649-40 06 INSURER A: Am Trust Intl Und, Ltd -AAl 780074 I NSURED INSURER B : Natio nal Uni o n fir e In s Co of Pitts 19445 Jo hnny Ma rez INSURER c : lntegon National Insurance Co 29742 DBA: J M arez Ocea n Plumbing INSURERD : 55 08 Ro undtree Dr Apt D INSURERE : Co nco rd CA 945 21-392 1 INSURERF : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED . NOTW ITHSTANDING ANY REQUIREMENT , TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIF ICATE MAY BE ISSUED OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE POLICIES DESCR IBED HEREIN IS SUBJECT TO ALL THE TERMS , EXCLUSIONS AND CONDITIONS OF SUCH POLICIES . LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS . INSR TYPE OF INSURANCE ADDL 'SUBR ,&~lc\%Y~ ~~lt\ii~Yl LIMITS LTR '"'"n l\11/\ffl POLICY NUMBER X COMMERCIAL GENERAL LIABILITY EACH OCCURR ENCE $ 1,000,000 V -D CLAIMS-MADE [Z] OCCUR UAMAGE TO Kt:N I t:U PR EM ISES CE a occu rrence l $ 100,000 -XNl 07 964 500 \/" MED EXP (Any one pe rs on) $ 5,000 A X X 02/07 /2 018 02/07 /201 <jl PERSO NAL & ADV IN JJRY $ 1,000,000 -- GEN 'L AGG RE GATE LI M IT APPLIES PER : G ENERAL AGG RE GATE $ 2,000,000 V fXj PO LI CY D iB,:: OLoc PRO DU CTS -COMP/O P AGG $ 2,000,000 r~ OTHER : $ \ AUTOMOBILE LIABILITY -(E~~~d~~l f lNGLE LI MI T $ 1,000,000 v ' AN Y AUTO ~ODIL Y INJJRY (Per pe rson ) $ -O'M'lED X SC HEDU LED 2006 10210 2 v 02/07 /201 .,... C X X 02/07/2018 BODIL Y INJJRY (Per accident ) $ I AUTOS ONLY -~~i~gv\NED X H IRED PROPERTY DA MAGE $ I AUTO S ONLY ~ AUTO S ON LY CPer acci dent! IY -' / -, UMBRELLA LIAB H OCCUR Ef.CH OCCUR REN CE I $ 2,000,00~ 8 x EXCESS LIAB CLAIM S-MADE EBUOl 5630241 02/07/2018 02/07/201 9 L 'AGGREGATE l $ 2,000,000 J DED I I RETENT ION $ \.. $ / WORKERS COMPENSATION I PER I I OTH- AND EMPLOYERS' LIABILITY STATUTE ER Y/N ANYPROPR IETOR/PARTNER/EXECUTI VE D N/A E.L. EACH ACC IDEN T $ OFF I CERIMEMBER EXC LU DE D? (Mandatory In NH) E.L. DI SEASE -EA EMPLO YEE $ g~;t~:'f5n8~ ~'}do"PER AT IONS be lo w E.L. DISEASE -POL ICY LI M IT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is r equired) V RE: ln sured 's Ope ratio ns in Califo rni a /C ity of Cupertino, including its City Co uncil, boa rd s and co mmi ss io ns, o ffi ce rs, offici als, ag ents, e mploye es, co n sultants and v oluntee rs are additio nal insured w ith res pects t o Ge neral Li ability and Auto. Prim ary Wordin g and Waiv er of Subr oga ti o n applies as pe r the attac hed endo rse ments. "S ubj ect to th e po licy t erm s, ex clu sio ns & co nditio ns·• CERTIFICATE HOLDER CANCELLATION City of Cupertino SHOULD ANY OF TH E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREO F, NOTICE WILL BE DELIVERED IN ken t@cupertino.org ACCORDANCE WITH TH E POLICY PROVISIONS. 10555 Mary Avenue Cupertino CA 95014 AUTHORIZED REPRESENTATIVE Rh o nda Ho lt I @ 1988-2015 ACORD CO RPORATION. All rights re se rved. A CORD 25 (2016/03) The ACORD name a n d logo are registe red marks o f ACORD Total 12 Month Policy Premium $1,157.76 Discounts Applied Policy Level Important Notice Business Experience Package Discount Our Company offers multiple programs in California to eligible insureds. A lower rate or better coverage may be available to you . If you are a member of an association and would like your policy reviewed to assure you are receiving the best possible rate, please contact your agent or our call center at 1-877-468-3466. Additional Policy Information Additional Insured City Of Cupertino 10555 Mary Ave, Cupertino, CA 95014 Tier 8 Disclosure of Possible Additional Charges The amounts below are authorized for use in this state . However, they are only charged if they apply to your policy. Acquisition Expense $20.00 Additional Insured Charge $25.00 Additional Insured Charge -Blanket CA Vehicle Assessment and Fraud Fee $1,000.00 $1 .76 Cancellation Charge Convenience Fee Federal Filing Fee Form E Filing Charge FR Filing Charge Late Charge Nonsufficient Funds Charge $10.00 $5 .00 $50.00 $50.00 $50.00 $10.00 $25.00 Reinstatement Charge -Federal Filing $50.00 Reinstatement Charge -No Federal $20.00 Filing UIIA Fee $50.00 Waiver of Subrogation Waiver of Subrogation -Blanket Forms and Endorsements Endorsement Edition 10141 01012014 10146 01012014 10149 01012014 10150 01012014 10379 01012014 11332 07012014 10039CA (06012014) $25.00 $1,000 .00 ADDITIONAL INSURED COVERAGE HIRED AUTO COVERAGE NON-OWNERSHIP LIABILITY COVERAGE NUCLEAR ENERGY LIABILITY EXCLUSION WAIVER OF SUBROGATION COMMERCIAL AUTO POLICY Authorized Signature lntegon National Insurance Company This Endorsement Applies Only If Form Number 10141 (01012014) Appears on the Declarations Page . THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED All the provisions of this Policy apply except as modified by this endorsement Any coverage afforded under PART A> LIABILITY COVERAGE of this Policy for a covered auto shall also apply to the individual or organization listed on the Declarations Page as an additional insured subject to the following provisions: 1. We will pay compensatory damages for which the additional insured is legally liable due to bodily injury or property damage caused by an accident arising out of the operation of an auto covered under PART A > LIABILITY COVERAGE. We will pay under this endorsement only if those damages arise out of the acts or omissions of an insured as defined under PART A and then only to the extent of that liability. 2. The designation of an additional insured on the Declarations Page shall not increase our limits of liability under PART A of this Policy . 3. We also agree with you that insurance provided by this agreement will be excess insurance over any other applicable insurance, self-insurance or bond . 4. All language in the LIMITS OF LIABILITY section of this Policy referencing a permissive operator is deleted. lntegon National Insurance Company This Endorsement Applies Only If Form Number 10379 (01012014) Appears on the Declarations Page. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF SUBROGATION All /isior.:is-of his P ~licy apply except as modified by this endorsement. P ~llcy No.: 2006102102 This'°eA docs..emer.:i t-is-i~ to: Johnny Marez GENERAL PROVISIONS OUR RIGHT TO RECOVER PAYMENT section will not apply to: City Of Cupertino 10555 Mary Ave Cupertino, CA 95014 Effective: 2/7/2018 (12:01 A.M .) POLICY NUMBER: XN10796~ COMMERCIAL GENERAL LIABILITY NXGL 189 0511 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSUREDS - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following : COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Number: XN107964500 Endorsement Effective: 02/07/18 12:01 a.m. Named Insured: Counter Signed By: JOHNNY MAREZ J MAREZ OCEAN PLUMBING "ry {(t, ;x, ·'\ ,'··~ 'i' ····~"-·" . l_;;;0, . · .. ·. ::j.j . . . ~. . .~ . . SCHEDULE Name of Person or Organization: Any person or organization that the named insured is obligated by virtue of a written contract or Agreement to provide insurance s uch as is afforded by this policy. Location: (If no entry appears above , information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A . Section II -Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liab le for your acts or omiss ions arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the follow ing exclusion is added: 2. Exclusions This insurance does not apply to "bodi ly injury" or "property damage" occurring after: (1) All work, inc luding materials, parts or equipment furnished in connection with such work, on the project (other than services , maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed: or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. The words "you " and "your" refer to the Named Insured shown in the Declarations. NX GL 189 05 11 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission COIVIVERCIAL GENERAL LIABILITY NX GL 189 0511 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. D. The following a-e added to SECTION V -DEANITIONS: ''Your work" means work or operations ~ormed by you or on your behalf, and materials, parts or equipment furnished in connection with such work or operations. E. Toe following a:lditional puviSions appy to any entity that is an insured by the terms of this endorsement: 1. PrimaryWording With respect to the Third Party sho\M1 above, this insurance is primary and non-contril:l.Jting. Any and all other valid aid collectalje insurance available to sud1 Third Party in respect of wok perfonned by you underwritten caitractual agreements with said Third Party fa-loss CO\A3f'ed by this policy, shall in no instance be caisidered as primay, CCrinsurance, a-cootributing inst.ranee. Rather, any such other insurance shall be caisidered excess <JI/er and above the insi..rance i,:rovided by this policy. 2. Waiwr of &Jtroaation If required by written contract a-agreement: We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or darlage arising out of "you work'' done under a contract with that person or organization. NXGL 189 0511 Page 2of2 Includes copyrighted material of lnsurarce Services Office, Ire., with its penniSSion v Poli~O Insured Name: J MAREZ OCEAN PLUMBING COMMERICAL GENERAL LIABILITY CG 20 3707 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Location and Description of Completed Organization(s): Operations CITY OF CUPERTINO, ITS OFFICERS, MISC PLUMBING WORK ON THEIR BUILDINGS - OFFICIALS, AGENTS AND EMPLOYEES, HE IS DOING THE WORK VARIOUS LOCATIONS THROUGHOUT 10555 MARY AVENUE, CUPERTINO CA 95014 CUPERTINO, CA Information required to complete this Schedule, 1f not shown above, will be shown 1n the declarations Section II -Who is an Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only w ith respect to liability for "bodi ly injury" or "Property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard". CG 20 37 07 04 Copyright lso Properties , Inc .. 2004 In sured Page 1 of 1 National General >) Auto, Home & Heal th In surance Policy Number: Named Insured: PO Box 3199 • Wnston Salem , NC 27102-3199 Johnny Marez OBA J MAREZ OCEAN PLUMBING Policy Period: 12:01 A.M. JOHNNY MAREZ OBA J MAREZ OCEAN PLUMBING APTD 5508 ROUNDTREE DR CONCORD CA 94521 2/7/2018 -2/7/2019 Date of Notice: Policy Underwritten By: lntegon National Insurance Company 2/8/2018 24 Hour Claim Reporting: 1-800-468-3466 For Policy Information: 1-877-468-3466 www.MyNatGenPolicy.com Your Agent: Pacific Pro's Insurance Agency 9199 Cockatoo Ave Fountain Valley CA 92649 (714) 909-0755 CA COMMERCIAL VEHICLE DECLARATIONS PAGE Endorsement Effective 2/8/2018 The following changes were made to your policy -Coverage(s) Updated Drivers, Employees and Household Residents #1 Johnny Marez Driver Status License # Owner Driver XXX0180 Lie state CA Date of Birth Gender 6/21/1958 Male Insured Vehicle(s) and Schedule of Coverages Marital Status Driver Pts Single 0 Yrs. Licensed 43 #1 2004 GMC SIERRA C2500 HEAVY DUTY VIN : Usage: Business Radius : 200 Garaging Location: Policy Coverage Level Coverages Provided Bodily Injury/ Property Damage - Combined Single Limit Medical Payments Uninsured/ Underinsured Motorist Combined Single Limit Additional Policy Coverages Hired Auto Non-Ownership Liability 1 GTHC24U64E378836-Use Only G8A425 94521 Schedu ledAuto Limits/Deductibles $1,000,000 Combined Single Limit $1,000 Each Person/ Each Accident $500,000 Combined Single Limit Total for this Vehicle Limits/Deductibles $1,000,000 Combined Single Limit $1 ,000 ,000 Combined Single Limit Combined Vehicle Premium Combined Policy Coverages Premium Acquisition Expense Additional Insured Charge CA Vehicle Assessment and Fraud Fee Total 12 Month Policy Premium 10039CA (06012014) Premium $738.00 $6 .00 $125 .00 $869.00 Premium $128.00 $89.00 $869.00 $217.00 $20.00 $25.00 $1 .76 $1,132.76 Discounts Applied Policy Level Business Experience Package Discount Important Notice Our Company offers multiple programs in California to eligible insureds. A lower rate or better coverage may be available to you. If you are a member of an association and would like your policy reviewed to assure you are receiving the best possible rate, please contact your agent or our call center at 1-877-468-3466. Additional Policy Information Additional Insured City Of Cupertino 10555 Mary Ave, Cupertino, CA 95014 Tier 8 Disclosure of Possible Additional Charges The amounts below are authorized for use in this state . However, they are only charged if they apply to your policy. Acquisition Expense $20.00 Additional Insured Charge $25 .00 Additional Insured Charge -Blanket $1,000 .00 CA Vehicle Assessment and Fraud $1 .76 Fee Cancellation Charge Convenience Fee Federal Filing Fee Form E Filing Charge FR Filing Charge Late Charge Nonsufficient Funds Charge Reinstatement Charge -Federal Filing Reinstatement Charge -No Federal Filing $10.00 $5.00 $50.00 $50.00 $50.00 $10.00 $25.00 $50.00 $20.00 UIIA Fee Waiver of Subrogation Waiver of Subrogation -Blanket Forms and Endorsements Endorsement 10141 10146 10149 10150 Edition 01012014 01012014 01012014 01012014 10039CA (06012014) $50.00 $25.00 $1,000 .00 ADDITIONAL INSURED COVERAGE HIRED AUTO COVERAGE NON-OWNERSHIP LIABILITY COVERAGE NUCLEAR ENERGY LIABILITY EXCLUSION 11332 07012014 COMMERCIAL AUTO POLICY Authorized Signature 10039CA (06012014) lntegon National Insurance Company This Endorsement Applies Only If Form Number 10141 (01012014) Appears on the Declarations Page. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED All the provisions of this Policy apply except as modified by this endorsement. Any coverage afforded under PART A> LIABILITY COVERAGE of this Policy for a covered auto shall also apply to the individual or organization listed on the Declarations Page as an additional insured subject to the following provisions: 1. We will pay compensatory damages for which the additional insured is legally liable due to bodily injury or property damage caused by an accident arising out of the operation of an auto covered under PART A > LIABILITY COVERAGE. We will pay under this endorsement only if those damages arise out of the acts or omissions of an insured as defined under PART A and then only to the extent of that liability. 2. The designation of an additional insured on the Declarations Page shall not increase our limits of liability under PART A of this Policy . 3. We also agree with you that insurance provided by this agreement will be excess insurance over any other applicable insurance, self-insurance or bond. 4. All language in the LIMITS OF LIABILITY section of this Policy referencing a permissive operator is deleted. State of California County of Santa Clara City of Cupertino Contractor/Consultant Affidavit of No Employees I, the undersigned, declare as follows: I am an independent contractor and the owner of ~Ao.re.Z-keo...u ~&rA7iio I wish to enter into a services contract with the City of Cupertfuo. I am fully aware of the provisions of section 3700 of the California Labor Code, which requires every employer to provide Workers' Compensation coverage for employees in accordance with the provisions of that Code. I am also aware that I must provide proof of workers' compensation insurance to the City of Cupertino for any and all employees I may have, pursuant to Section 12 of the City of Cupertino's contract. I hereby certify that I do not have any employees nor will I have any employees working for me or my business during the term of any service contract with the City of Cupertino. I am not required to have Workers' Compensation insurance. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. Executed on this O 'I day of A <A Q-California. SIGNATURE Revised 1.05.18 Declaration of Sole Proprietorship DECLARATION AND ADDENDUM TO ALL CQNTRACTS ENTERED INTO OR BID AWARDED TO: it&t.r,;;z./0£(?:W ~.oj hereinafter "Organization" For the purpose of inducing the City of Cupertino ("City") to enter into any contracts with Organization, or to go forward with any contracts awarded to Organization, I declare as follows: I am the authorized representative of Organization, an independent contractor for the purposes of workers' compensation and labor laws in the State of California. This Organization will hire no employees for work required for any bid awarded or any contract entered into with the City. All work required will be performed personally and solely by me. If the Organization hires employees to perform this contract or any portion thereof, the Organization shall obtain workers' compensation insurance and provide proof of such coverage to the City. If the Organization hires a subcontractor to perform this contract or any portion thereof, and the subcontractor has employees, then the Organization shall require its subcontractor to obtain workers' compensation insurance coverage. In the alternative, the Organization shall obtain workers' compensation insurance coverage on behalf of the subcontractor's employees. This document constitutes a declaration by the Organization against its financial interest, relative to any claims that it may assert under the applicable workers' compensation and/or labor laws against the City relating to any bid awarded or contract entered into with this Organization. The Organization shall defend, indemnify and hold harmless the City from any and all liability, claims, demands, causes of action, charges, damages, injuries, fees including attorney fees, costs and expense that may be asserted or established by any person or entity in the event the Organization hires an employee in violation of this addendum. I agree that this declaration shall constitute an addendum to any bid awarded or any contract entered into with this Organization. I declare under penalty of perjury under the laws of the State of California that the foregoing is true and correct. ~~ QC\ Z.o Ll; ~ ~ s?~~~v -~~~ AUTHORIZED RESPRESENTA TIVE Revised, 01.05.18