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19-155 Statcomm Inc., Fire Suppression Testing and Maintenance at City Facilities CITY OF
PUBLIC WORKS CONTRACT
$60,000 OR LESS
CUPERTINO
1. PARTIES
This public works contract("Contract") is made and entered into on
("Effective Date")by and between the City of Cupertino,a municipal corporation("City"), and
Statcomm Inc. ,a Corporation
("Contractor") for fire suppression testing and maintenance at City facilities
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 June 30,2020
("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$56,540.00
{"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 Fire Suppression Testing&Mafutenance at City Facilities
Public Works Contract$60,000/Rev.Jan.02,2019
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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 j
according to the highest standards and best practices in the industry.
i
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 16 , 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 Fire Suppression Testing & Maintenance at City Facilities
Public Works Contract$60,000/Rev.Jan.02,20-1
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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 20 %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-RE,PORT
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;HVAC 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.
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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 i
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 9241.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.
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Public Works Contrad$60,000 Nov.Jan,02,2019
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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
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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 htto://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
("DITV,).
(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 violation.
(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 will not be tolerated.
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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 1090 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"financial 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, j
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. l�
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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 1,Class H, or Class lI1 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
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Public Works Contract$60,000/Rev.An.02,2019
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(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) lnstall 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 offsite in lawful manner;
(d) After breaking old pavement, remove debris to avoid contact with rainfall/runoff;
(e) Maintain a clean work area by removing trasb, 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 Fire Suppression Testing & Maintenance at City Facilities
Public Works Contmct$60,000/Rev.Jan.02,2019
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17. PROJECT COORDINATION
City Project Manager. City assigns Rudy Lomas 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 Karl Blum
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 101/)o 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 wilt be entitled to reasonable attorney fees and costs.
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Pubfic Works Contract$60,000/Rev.Jan.02,2019
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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
This 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/PARTIAL 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.
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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
All 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: To Contractor:
10300 Torre Avenue, Cupertino CA 95014 statcam,n Inc.
Attention: Ken T-&- Attention: Karl Blum
Copy to: Carl Valdez Copy to:
Email: kent@cupertino.org Email: kblum(@,,statcomm.com
30. VALIDITY OF CONTRACT
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.
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Public Works Contract$60,000/Rev.Jan. 02,2019
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IN WITNESS WHEREOF,the parties have caused this Contract to be executed as of the Execution
Date first above written.
CONTRACTOR Statcomm Inc. CITY OF CUPERTINO,
Corporation
a Municipal Corporation
,/
tv. l/i s•. IQ. w• .� 12e�►�2 Lam'
Title:CFO Title: Director of Public Works
Signature Date: U/ �•
g Signature Date: ��' ,I� 1
APPROVED AS TO FORM:
By: �i Av
HEATHER M.MINNER
Cupertino City Attorney
ATTEST:
By:
GRACE SCHMIDT,City C erk r7 f 7 mil`
i
Public works Project Fire Suppression Testing & Maintenance at City Facilities
Public Works Contract$60,000/Rev.Jan.02, 20f9
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AMENDMENT TO EXHIBIT A OF THE AGREEMENT
BETWEEN THE CITY OF CUPERTINO AND
STATCOMM INC.. FOR FIRE SUPPRESSION TESTING
AND MAINTENANCE AT CITY FACILTIES
This Amendment to Exhibit A of the Agreement between the City of Cupertino and
Statcomm Inc., for reference dated 4/9/2019, is by and between the CITY OF CUPERTINO, a
municipal corporation (hereinafter "City") and Statcomm Inc., a Corporation("Consultant") whose
address is 939-C San Rafael Avenue, Mountain View, CA and is made with reference to the
following:
RECITALS:
A. On 4/9/2019, an agreement was entered into by and between City and Consultant
(hereinafter"Agreement") for fire suppression testing and maintenance at City facilities. The
Agreement will expire on 6/30/2020.
B. The Agreement and the Amendment to Exhibit A are collectively referred to as the
"Agreement" unless otherwise indicated.
C. City and Consultant desire to modify the Agreement on the terms and conditions set
forth herein.
NOW, THEREFORE, it is mutually agreed by and between and undersigned parties as
follows:
1. Exhibit A is amended to add the following provision: To the extent that any term, clause, or
provision of this Exhibit A conflicts with any other term, clause, or provision of the contract
("Contract Terms") the Contract Terms shall prevail and be controlling.
2. Except as expressly modified herein, all other terms and covenants set forth in the
Agreement shall remain the same and shall be in full force and effect.
IN WITNESS WHEREOF, the parties hereto have caused this modification of
Agreement to be executed.
CONSqLTANT RECOMMEND OR APP OVAL
�l
BYE
Title © Title
APPROVED AS TO FORM
City Attorney
City Clerk
rE_-X--H-I B IT - A
A CO MM-1-N C
Engineering - Installation • Service
Fire Systems & Life Safety
Test & Inspection Agreement
This agreement is entered into this day of , 2018 by and between Statcomm Inc.; hereinafter referred
to as"Company", and, City of Cupertino hereinafter referred to as"Customer".
1. DESCRIPTION OF SERVICES PROVIDED:
Company agrees to provide the following testing and inspection services as hereinafter set forth for Customer and located at:
CUSTOMER CONTACT INFORMATION:
Customer: City of Cupertino
Address: 10555 Mary Ave.
City, State,Zip: Cupertino, CA 95014 Phone: 408.777.3111
Contact: Rudy Lomas Email: rudyl@cupertino.org
CUSTOMER INSPECTION LOCATION(S)(if different than above):
Customer: City of Cupertino Proposal/Contract 18761
Address: 10555 Mary Ave.
City, State,Zip: Cupertino, CA 95014 Phone: 40&777.3111
Contact: Rudy Lomas Email: rudyl@cupertmo.orq
1.1. Test&Inspection Services adhere to NFPA 72 Fire Alarm;2013 Edition&NFPA 25 Fire Sprinkler;2011 Edition&2013 Edition.
1.2. This contract is Prevailing Wage rates for 2018- Q19
1.3. Reference:The City of Cupertino-PO
1.4. Location Pricing on Page 7.
1.5.ADVISORY:UNION APPRENTICE PROGRAM-As we are required to contact the union directly for their option to assign/
dispatch Union Apprentice Program participant for our scheduled testing, if applicable the cost per hour that we must
pay the union is $28.00 and Statcomm will add 20% for Administration and Accounting processing (will be invoiced
separately from PO invoicing).
1.6.ADVISORY:PROPRIETARY SYSTEM PROGRAMMING -Due to the highly proprietary nature of this fire control panel, it is
necessary to advise you that initial programming or repairs of the fire control panel may require enlisting the original
vendor's authorized service personnel. The coordination of the two companies will be the responsibility of the property
manager. Statcomm costs will be based upon time and materials,estimated to be approximately$600.00.
NFPA-72 Fire Alarm System & NFPA 25 Fire Sprinkler System Test & Inspections
This will approve both NFPA 72&NFPA 25 T&Is being performed concurrently.
NFPA 72: Fire Alarm System Test& Inspection Semi-Annual Test and Inspection
NFPA 25 CA Ed, Ch. 5: Fire Sprinkler Systems Annual Test, Quarterly Inspection
Annual Cost for Concurrent Prevailing Wage NFPA 72 & NFPA 25 Test & Inspection: $21,540.00
ignature for approval D�te
2. PAYMENT AND TERMS:
2.1.Customer agrees to pay to Company, its agents or assigns,for the Test and Inspection Service listed in Section 1.1,
for the initial term of 12 months,the sum of the approved and signed Option in section 1.1 (page 1 of Agreement),
payable Quarterly in advance.This Agreement shall be in force for a period of one year. Unless either party notifies the
other in writing of its intention to terminate this Agreement,not less than ninety(90)days prior to termination,this
agreement will auto-renew.
2.2 Customer authorizes Company to perform up to $TP7_ of corrections during the inspection without further
authorization. It is understood that this does not obligate Company to perform corrections during the inspection and
return trips may be required.
T&I Service Agreement Contract: City of Cupertino-7.10.2018-Proposal/Contract: Initials
California Contractor License:675521
Statcomm Inc. •939-C San Rafael Avenue•Mountain View, CA 94043•Phone:650.988.9508•Fax:650-988-9509
Page 1 of 8
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"All-
3. DEFINITIONS
EXHI _ IT -
3.1. "Inspection" is a visual examination of a system or portion thereof to verify that it appears to be undamaged and in operation
condition.
3.2. "Test"is a procedure used to determine the status of a system as intended by conducting periodic physical checks on water-
based fire protection systems such as waterflow tests, fire pump tests, alarm tests, and trip tests of dry pipe, pre-action,or deluge
valves. These tests follow up on the original acceptance tests at intervals specified by NFPA 25.
3.3."Maintenance"is worked performed to keep fire system equipment operable or to make repairs.
3.4. "Owner" is the owner of the property or the occupant, management firm, or managing individual that has received authority
from the owner for the inspection,testing,and maintenance of the fire protection system.
3.5. "NFPA 25" is the Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems (2011
California edition)published by the National Fire Protection Association.
3.6."NFPA 72"is the Standard for the Inspection,Testing,and Maintenance of Fire Alarm Systems(2010 edition)published by the
National Fire Protection Association.
3.7. "NFPA 80" is the Standard for the Inspection, Testing, and Maintenance of Fire Doors and Other Opening Protective's (2010
edition)published by the National Fire Protection Association.
3.8. "NFPA 101" is the Standard for the Inspection,Testing, and Maintenance of Life Safety Systems (2010 edition) published by
the National Fire Protection Association.
3.9. "Authority Having Jurisdiction" is an organization, office, or individual responsible for enforcing the requirements of NFPA
Code or for approving procedures.
3.10."Deficiency"is a condition where a system component appears to be damaged, not in operating condition, or the application
is not within its designed limits or application.
3.11. "Work" is the inspections, tests, and maintenance as required by NFPA code or Authority Having Jurisdiction and as limited
by the scope of the contract.
3.12. "Force Majeure Events" include fire, flood, earthquake, water, mend, lightning, transportation disruptions, vandalism, neglect
or misuse, acts of War or Terrorism;electrical work, UPS or other power supplies, external equipment or accessories furnished by
Company,unless specifically included in this Agreement,and any other acts outside the reasonable control of Company.
4. SCOPE OF WORK
Company agrees to provide Customer with fire and life safety system testing services as described below. Such testing will be on a
quarterly, semi-annual and annual basis,as indicated in Section 1.1, at the Inspection Locations listed in this Agreement. Company is
not guaranteeing the sufficiency of any fire or life safety system nor is it undertaking to repair or replace any deficient equipment or
work uncovered during the testing process, as further described below. The Company is not responsible for any additional tests or
inspections that may be required by code beyond the tests and inspections listed in Section 1.1. Customer acknowledges that tests or
inspections not required or enforced by Authority Having Jurisdiction may still be required by code and electing not to perform these
tests or inspections may subject Customer to additional liability. Any repair or replacement or services outside the scope of this
Agreement will be subject to a separate agreement between Customer and Company.
4.1. SYSTEM TESTING AND INSPECTION SERVICES: This Agreement provides for periodic tests and inspections as specified
in Section 1.1 of Customer's life safety systems as recommended by the latest NFPA standard adopted in California, in
accordance with manufacturers'recommendations. Company is responsible for providing documentation related to the completion
of each test included in this Agreement. Test documentation will describe any defective, malfunctioning or inoperable devices,
functions or other system programmed features. Accessible Duct Smoke Detectors will be cleaned annually. All other smoke
detectors will be cleaned on an"As Needed"basis,as determined by Company in its reasonable judgment.
4.1.1. NFPA 25:The test and inspection of the wet fire sprinkler system is specifically limited to those items listed below:
4.1.1.1.INSPECTIONS:
4.1.1.1.1. Fire sprinklers,pipe,fittings,hangers and bracing from the floor level
4.1.1.1.2. System control valves,system check valves and alarm valves(all external)
4.1.1.1.3. Pressure gauges
4.1.1.1.4. Hydraulic data name plate
4.1.1.1.5.Spare sprinkler cabinet
4.1.1.1.6.Fire department connection
4.1.1.1.7.Alarm bell
4.1.1.1.8. Backflow devices
4.1.1.2.TESTS:
4,1.1.2.1. Main drain
4.1.1.2.2.Water flow alarm
4.1.12.3.Control valve electric supervision(tamper switch)
4.1.1.2.4. Backflow device forward flow test
4.2. EXCLUSIONS: This Agreement does not provide for the repair or replacement of any inoperable, malfunctioning, damaged
equipment or missing parts or incorrectly installed equipment uncovered during the testing process, including but not limited to:
4.2.1. Repair, replacement or repetitive service calls caused by the use of unauthorized materials or equipment or repairs by
unauthorized persons;
Initials �` �✓
T&I Service Agreement Contract: City of Cupertino-7.10.2018-Proposal 1 Contract: 18761
California Contractor License:675521
Statcomm Inc. •939-C San Rafael Avenue•Mountain View,CA 94043•Phone:650.988.9508"Fax:650-988-9509
Page 2 of 8
•� 4.2.2. Repair of damage or increase in testing time caused by use of the equipment for purposes other than for which the
equipment was engineered designed and intended;
4.2.3. Repair of damage or increase in testing time caused by Force Majeure Events,as defined above;
4.2.4.Increase in test or inspection time not caused by Company;
4.2.5. Re-testing of unavailable units or
4.2.6.Re-testing of devices in areas where access is impeded in any manner;
4.2.7. Re-programming or reloading of the system and/or client database for computer based systems;
4.2.8. Replacing components necessarily damaged as a result of testing activity performed in conjunction with this
Agreement,
4.2.9.Testing of any stand-alone smoke detectors, unless specifically stated in Section 1.1 Test and Inspection Services;
4.2.10. Testing conducted after Company' standard business hours, unless specifically stated and agreed to in this
Agreement,
4.2.11. NFPA 25: In addition to the above exclusions, the test and inspection of the wet fire sprinkler system specifically
excludes those items listed below:
LJJ 4.2.11.1. INSPECTIONS:
4.2.11.1.1. Fire sprinklers, pipe, fittings, hanger,and bracing in concealed, locked, secured or otherwise unavailable
spaces. 4.2.11.1-2.Roadway valves
4.2.11.1.3.Buried check valves
4.2.11.1.4.System check and alarm valves(internal)
4.2.11.1.5. Building areas for adequate heat
4.2.11.2.TESTS:
4.2.11.2.1.Sample testing for aged fire sprinklers
4.2.11.2.2.Backflow device performance test(s)except for forward flow test
4.2.11.3. MAINTENANCE:
4.2.11-3.1. Corrective or preventative actions including repairs, adjustments, or modifications to correct deficiencies
unless specifically included in the scope of contract
5. OTHER CHARGES_ Company's then current "Time and Materials" rates and work order terms and conditions will apply to any
service requested by Customer which falls outside the scope of this Agreement.
6. HOURS OF OPERATION: Hours for standard business rate testing and inspecting are Monday through Thursday from 8:30 am to
4:30 pm local time. "After-hours" testing is available for an extra charge. "After-hours" is defined as Monday through Thursday from
5:00 am to 8:30 am and 4:30 pm to 8:30 pm, Friday and Saturday,8:00 am to 4:30 pm.
7. RECORDS:The Owner shall provide access to original system commissioning documents including maintenance manuals, material
test certificates, certified fire pump curves, and as-built drawings. The Owner further agrees to provide any and all copies of
inspections and tests performed on the fire sprinkler system post commissioning within the guidelines of NFPA 25, 72, 80, 101,
California Building Code, California Fire Code and all other regulatory agencies. If these documents and records are not available,the
Owner shall hold Company harmless for all exclusions, omissions, and damage to the system that may result from the lack of
information contained within such documents.
The Owner acknowledges that the tests and inspections performed pursuant to this Agreement are not intended to reveal design or
installation deficiencies. The tests and inspections are to verify that the system appears to be in operating condition and system
components appear to be undamaged.
8. PRICE ADJUSTMENTS AND CHANGES: Company reserves the right to modify the prices in this Agreement upon sixty (60) days
prior written notice to Customer. In the event Customer does not agree to such price change, Customer may terminate this Agreement
upon ninety (90) days prior written notice to Company. Any type of equipment, testing or inspections not covered by this Agreement
may be added to this Agreement at Company then current rates, or at such rates as may be mutually agreed upon. In the event that
Customer takes any action to change the overall total count of devices associated with Customer's fire life safety system, Company
reserves the right to immediately recalculate any monetary impact that such changes may have on this Agreement, and will propose
any changes in an Amendment to this Agreement to the Customer. Such actions that may have an impact on total device count may
include,but are not limited to;tenant improvements, changes in Customer's floor plan or building layout, addition or removal of physical
building from Customer's ownership.
9. PAYMENT AND TAXES: Payment terms are NET 30 upon receipt of invoice.
10. BREACH OR DEFAULT: If Customer materially breaches the Agreement, becomes insolvent, or makes an assignment for the
benefit of creditors, then in addition to damages or any other remedies provided by law. Company may refuse to continue testing or
inspecting the equipment or may furnish service on a C.O.D. "Per-Call" basis at Company' then prevailing"Time and Materials" rate;
and Customer shall pay Company's costs and expenses of collection, including reasonable attorney's fees. Company reserves the
right to reschedule service when, in Company opinion, site conditions represent a hazard to the safety or health of any Company
employee. Customer shall be immediately informed in writing whenever such a condition exists.
11.TERMINATION: Each party may for any reason terminate this Agreement upon ninety(90)days written notice to the other party. If
equipment has been altered or repaired by Customer or a third party in any way that, in Company' reasonable opinion, affects the
reliability or detracts from the performance of the equipment, Company shalf have the right to terminate this Agreement in whole or
part, upon ten (10) days written notice to its Customer, and its obligation to provide service hereunder shall terminate accordingly.
Either party may immediately terminate this Agreement if the other shall become insolvent or fail to pay its obligations as they arise or
Initials ..✓
T&I Service Agreement Contract: City of Cupertino-7.10.2018-Proposal/Contract: 18761
California Contractor License:675521
Statcomm Inc. •939-C San Rafael Avenue•Mountain View,CA 94043•Phone:650.988.9508•Fax: 650-988-9509
Page 3 of 8
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upon any proceeding being commenced by or against the other under any law providing relief to the other as debtor. Upon termination,
Customer shall immediately pay to Company any amounts accrued and owing to Company as of the effective date of termination.
12. COMPANY AND MANAGEMENT IS NOT AN INSURER; LIMITATION OF LIABILITY: It is understood and agreed: that Company
and Management is not an insurer; that insurance, if any, will be obtained by Customer; that the payments provided for herein are
based solely on the value of the service as set forth herein and are unrelated to the value of Customer's property or the property of
others located on Customer's premises or other areas effected by Work. COMPANY MAKES NO GUARANTY OR WARRANTY,
EXPRESS OR IMPLIED, INCLUDING ANY IMPLIED WARRANTY OF MERCHANTABILITY OR FITNESS FOR PARTICULAR
PURPOSE THAT FIRE SPRINKLER SYSTEM CAN WITHSTAND HYDRO-TESTING OR ANY OTHER TESTS PERFORMED.
CUSTOMER ACKNOWLEDGES THAT ALL DAMAGES TO THE PROPERTY OF OTHERS WILL BE THE RESPONSIBILITY OF
CUSTOMER AND THAT HE IS NOT ENTERING INTO THIS AGREEMENT WITH THE EXPECTATION THAT COMPANY WILL
INCUR OR REIMBURSE CUSTOMER OR ANY OTHER PERSON FOR LOSSES CAUSED BY WORK. COMPANY SHALL NOT BE
LIABLE FOR CONSEQUENTIAL DAMAGES. IN NO EVENT SHALL COMPANY BE HELD TO BE AN INSURER. Customer
understands and agrees that Company's liability shall be limited to a sum equal to the amount of the contract price; that this limited
amount shall be the sole and exclusive measure of damages for any claim against Company; and that the provisions of this Section
shall apply if loss or damage, irrespective of cause or origin, results directly or indirectly to persons or property from performance or
non-performance of the obligations imposed by this Agreement, or from negligence, active or otherwise, of Company, its agents,
servants assigns or employees. CUSTOMER ACKNOWLEDGES THAT THIS LIMITATION OF LIABILITY PROVISION IS A
SUBSTANTIAL PART OF THE CONSIDERATION FOR THE WORK TO BE PERFORMED BY COMPANY
BY PLACING HIS INITIALS AT THE BOTTOM OF THIS PAGE, CUSTOMER ACKNOWLEDGES THAT HE HAS DISCUSSED THIS �.
PROVISION REGARDING LIQUIDATED DAMAGES AND LIMITED LIABILITY WITH CUSTOMER'S AGENT AND HAS AGREED TO
THE AMOUNT SET FORTH HEREIN.
13. THIRD PARTY NOTIFICATION: In the event any person, not a party to this Agreement, shall make any claim or file any lawsuit
against Company for any reason relating to Company's performance of its obligations under this Agreement, Customer agrees to
defend,indemnify and hold Company harmless from any and all claims and lawsuits, including the payment of all damages, expenses,
costs,and attorney's fee, unless such claim results in a determination of intentional conduct or sole negligence on the part of Company
or its employees.
14. PURCHASE ORDERS: It is understood and agreed by and between the parties hereto, that if there is any conflict between this
Agreement and Customer's purchase order, or any other document,this Agreement will govern, whether such purchase order or other
document is prior or subsequent to this Agreement.
15.ARBITRATION AND ATTORNEYS FEES: Disputes, controversies, or claims arising out of or relating to this contract shall first be
submitted to non-binding arbitration in accordance with the applicable rules of the American Arbitration Association then in effect. In
the event of arbitration or litigation relating to the subject matter of this Agreement, the non-prevailing party shall reimburse the
prevailing party for all reasonable attorney fees and costs resulting therefrom.
16. INVALID PROVISIONS: In the event any of the terms or provisions of this Agreement shall be declared to be invalid or inoperative,
all of the remaining terms and provisions shall remain in full force and effect.
17. ENTIRE INTEGRATED AGREEMENT, MODIFICATION; ALTERATIONS;WAIVER: This writing is intended by the parties hereto
as a final expression of their agreement and as a complete and exclusive statement of their terms thereof.This Agreement supersedes
all prior representations, understandings or agreements of the parties and the parties rely only upon.
18.This agreement is made in and shall be governed by the laws of the State of California.
Company Accepted By:
Authorized Signature Authorized Signature
William R Wood � /� T 5e
Printed Name V Printed Name
CFO
Title Title
Otte I I I Date
THIS AGREEMENT SHALL NOT BE BINDING UPON COMPANY UNLESS APPROVED IN WRITING BY AN OFFICER OF COMPANY. INTHE
EVENT OF NON-APPROVAL, THE SOLE LIABILITY OF COMPANY SHALL BE TO REFUND TO SUBSCRIBER THE AMOUNT THAT HAS BEEN
PAID TO THE COMPANY BY SUBSCRIBER UPON THE SIGNING OF THE AGREEMENT.PURCHASER REPRESENTS AND WARRANTS TO THE
SELLER THAT PURCHASER HAS READ ALL THE TERMS AND CONDITIONS HEREIN AND ALL THE TERMS AND CONDITIONS WHICH ARE
PRINTED ON THE DOCUMENTS ATTACHED TO THIS AGREEMENT BEFORE EXCECUTING THIS AGREEMENT.
�✓
T&I Service Agreement Contract: City of Cupertino-7.102018-Proposal 1 Contract: 18761 Initials
California Contractor License:675521
Statcomm Inc. •939-C San Rafael Avenue•Mountain View,CA 94043•Phone: 650.988.9508•Fax: 650-988-9509
Page 4 of 8
EXI-11 -BIT "All
UPON RETURN OF THIS AGREEMENT for any new HOA type property requiring security passage,the authorized person
herein, must provide keys, FOBS, access codes, and/or access cards to Statcomm. This information is required within [2]
two weeks of receipt of approved contract[s].
The approved contract will not be processed internally, and no T&I schedule will be created until all necessary access
devices and information are received by Statcomm.
Please address the package as follows:
Statcomm Warehouse
939 San Rafael Ave.
Mountain View, CA 94043
The information below must also be filled out so there is no confusion at our end as to what items were sent.
Below is the access information for the newly contracted property
As the authorized manager/owner/board member for this property, as of i P12) 1 have provided
the following information or have shipped the following access devices which will allow Statcomm technicians access to all
areas of said property. By doing so I ensure the Statcomm Inspection &Test Department(ITD)has keys and/or access
information in advance of any scheduled performance of service.This effort will alleviate last minute issues concerning the
scheduled service and return visits to access areas required for tests or inspections.
Access Device Type Access Devices Open Access Codes
❑ Keys ❑ Entry to Building
❑ FOB ❑ Mechanical Room
❑ Access Cards ❑ Electrical Room
❑ Lock Box ❑ Storage Room
❑ Tele Entry System ❑ Roof Access
❑ Not Applicable ❑ Riser Room
❑ Other(specify) ❑ Fire Panel Room
❑ Auto Gate
❑ Pedestrian Gate
T&I Service Agreement Contract: City of Cupertino-7.10.2018-Proposal/Contract: 18761 Initials_-4 4V
California Contractor License:675521
Statcomm Inc. •939-C San Rafael Avenue•Mountain View,CA 94043•Phone:650.988.9508•Fax: 650-988-9509
Page 5 of 8
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AS BUILDS: PLANS &DEVICE COUNTS Bi
( -
ADVISORY: Due to the absence or availability of AS BUILDS or detailed plans for this property being available
prior to the site assessment and proposal process, there is a potential that additional devices exist on premise
which need to be included in this Test & Inspection [T&I] in order to complete the inspection and certify the
system. Should such devices be uncovered during one of our scheduled Annual / Semi NFPA 72 Fire Alarm,
Annual / Quarterly NFPA 25 Fire Sprinkler or NFPA 25-5YR Test & Inspections, Statcomm will adjust the
relevant invoice in accordance with the total number of devices and / or time and materials required to
complete NFPA T&I requirements.
UNION APPRENTICE PROGRAM
ADVISORY: As we are required to contact the union directly for their option to assign / dispatch Union
Apprentice Program participant for our scheduled testing, if applicable the cost per hour that we must pay the
union is $28.00 and Statcomm will add 20% for Administration and Accounting processing (will be invoiced
separately from PO invoicing).
ELEVATOR I FIRE ALARM TESTING
ADVISORY: Per NFPA code, it is required that Elevator Recall must be tested annually. A trained and
certified technician specializing in Elevator Recall testing must perform this service. It is the responsibility of
the property manager to coordinate the elevator vendor to schedule this service in concert with the fire alarm
testing. If same day scheduling proves to be inconvenient, this task will be excluded from this service,
Statcomm is available on a time & materials basis to accommodate a reschedule with the other vendor, if
necessary.
ADVISORY: If elevator recall smoke or heat detectors are connected to the fire alarm control panel, it is
management or owner's responsibility to provide elevator reset keys or elevator control personnel to be
available prior to testing of devices. If keys or elevator personnel not available during performance of the
scheduled annual fire alarm system(s) testing and inspection, the devices will not be tested and thus noted as
a deficiency (unable to test) in the annual NFPA 72 testing and inspection report. Statcomm is not financially
responsible in the event elevator service personnel are required or dispatched as the result of the scheduled
annual testing of devices connected to the fire alarm system that in turn initiate elevator to recall.
ADVISORY: System smoke detectors will only be tested during the annual fire alarm system testing/inspection
as long as we are provided necessary keys and have the capability of restoring the elevator to operation.
Otherwise, testing of the elevator recall smoke and/or heat detectors will require participation of the elevator
service company, performed independently and invoiced separately.
DUCT DETECTOR/ SMOKE DAMPER/ FIRE ALARM TESTING
ADVISORY: Per NFPA code, duct detectors /smoke dampers are connected to the fire alarm system and are
required to be tested annually. A trained and certified technician specializing in duct detector/ smoke damper
testing must perform this service. It is the responsibility of the property manager to coordinate the HVAC
vendor to schedule this service in concert with the fire alarm testing. If same day scheduling proves to be
inconvenient, this task will be excluded from this service. Statcomm is available on a time & materials basis to
accommodate a reschedule with the other vendor, if necessary.
Initials
T&I Service Agreement Contract: City of Cupertino-7 10.2018-Proposal/Contract: 18761
California Contractor License:675521
Statcomm Inc. -939-C San Rafael Avenue•Mountain View,CA 94043-Phone: 650.988.9508-Fax:650-988-9509
Page 6 of 8
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EXHIBIT "N'
Scope of Work
NFPA 72: Fire Alarm System Test& Inspection
• Performed: Annual/Semi Annual
o Common Area & Commercial In-Unit testing will be scheduled during weekdays, Monday -Thursday
between normal service hours of 7:30AM -4:OOPM.
o Notice Postings:
• Management, if required, to post advisory notices in common areas one (1] week prior to the
Annual service. Statcomm will provide notice template via email to property manager.
• Semi operational testing of FACP to include panel maintenance & battery load testing, subpanels, power
supplies & repeaters. Testing of fire sprinkler water flow switches. Inspection and verification of panels,
annunciators, connectors& audible devices.
• Annual Common Area operational testing of all fire system equipment and devices, including but not
limited to: fire alarm control panels, pull stations, smoke detectors, heat detectors, water flow devices,
tamper devices, annunciators, auxiliary power supplies, elevator recall, EVAC systems, duct detectors,
and smoke dampers.
• Annual Fire Door testing of operation and full closure of doors, and automatic closing device [magnetic
locks] reset.
• Annual / Semi-Annual fire alarm system certification / deficiency report, maintaining required records of
service as prescribed.
NFPA 25: Fire Sprinkler Test & Inspection
• Performed: Annual /Quarterly
o Common Area testing will be scheduled during weekdays, Monday - Thursday between normal
service hours of 7:30AM -4:OOPM.
o Notice Postings:
o Management, if required, to post advisory notices in common areas one [1] week prior to the
Annual service. Statcomm will provide notice template via email to property manager.
• Annual / Quarterly inspections of all accessible fire sprinkler risers, control valves, alarm valves,
waterflow devices, valve supervisory devices, supervisory signal devices, gauges (wet-pipe systems),
hydraulic nameplate, fire department connections.
• Annual Sprinkler Head Inspection
• Annual main drain, water-flow alarm, and control valve test
• Annual / Quarterly NFPA 25 inspection reports composed; submitted and / or made available to the
Authority Having Jurisdiction [AHJ].
Initials
T&I Service Agreement Contract:City of Cupertino-7.10.2018-Proposal/Contract: 18761
California Contractor License:675521
Statcomm Inc. •939-C San Rafael Avenue•Mountain View,CA 94043-Phone:650.988.9508•Fax.650-988-9509
Page 7 of 8
Individual Pricing Per Location
Location NFPA 72 Fire Alarm NFPA 25 Fire Sprinkler Total
City Hall of Cupertino $2,407.50 $ 510.00 $2,917.50
Community Hall $2,407.50 $ 510.00 $2,917.50
Cupertino Library $2,677.50 $ 195.00 $2,872.50
Environment Ed. Ctr. $2,137.50 $ 510.00 $2,647.50
Quinlan Community Ctr. $2,002.50 $510.00 $2,512.50
Senior Center $2,677.50 $ 510.00 $3,187.50
Service Yard $1,192.50 $510.00 $1,702.00
Sports Center $2,272.50 $ 510.00 $2,782.50
$17,775.00 $3,765.00 $21,540.00
T&I Service Agreement Contract: City of Cupertino-7.10.2018-Proposal/Contract: 18761 Initials
California Contractor License:675521
Statcomm Inc.•939-C San Rafael Avenue•Mountain View, CA 94043•Phone:650.988.9508•Fax:650-988-9509
Page 8 of 8
PUBLIC WORKS CONSTRUCTION CONTRACTS
Small Projects - $60,000
Insurance Requirements; Exhibit B
Contractor shall procure and maintain for the duration of the contract,and for five 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 LD41T OF INSURANCE
Coverage shall be at least as broad as:
1. 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,
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
aggregate limit applies, either the general aggregate limit shall apply separately to this preject/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 0104 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.
3. Workers' Compensation: As required by the State of California, with Statutory Limits, and
Employer'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,
duly authorized by the DIR.
❑ N/A if box checked(Contractor provides written verification it has no employees).
4. Professional Liability with limits no less than$1,000,000 per occurrence or claim,and$2,000,000 aggregate.
N/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
limits equal to the completed value of the project and no coinsurance penalty provisions.
RT N/A if box checked(Project does not involve construction or improvements/installations to property).
Insurance Requirements for Construction Contracts-$60,000 Version:Jan. 2019
1
6. Contractors'Pollution Legal Liability and/or Asbestos Legal Liability and/or Errors and Omissions with limits
no less an$1,000,000 per occurrence or claim,and$2,000,000 policy aggregate.
N/A if box checked (Project does not involve environmental hazards).
If Contractor maintains broader coverage and/or higher limits than the minimums shown above,City requires and
shall be entitled to the broader coverage and/or higher limits maintained by the contractor. Any available insurance
proceeds in excess of the specified minimum limits of insurance and coverage shall be available to the City.
Self-Insured Retentions 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 behalf
of Contractor including materials, parts, or equipment furnished. Endorsement of CGL coverage shall be at least as
broad as ISO Form CG 20 10 11 85 or if not available,through the addition of both CG 20 10,CG 20 26,CG 20 33,
or CG 20 38;and CG 20 37 if a later edition is used.
Primary Coverage
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 0413 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 which 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,alteration,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 Requirements for Construction Contracts-$60,000 Version:Jan.2019
2
Waiver of Subrogation
Each required policy must include an endorsement providing that the carrier agrees to waive any right of subrogation
it may have against City.Contractor agrees to waive rights of subrogation which any insurer of Contractor may acquire
from Contractor by virtue of the payment of any loss. Contractor agrees to obtain any endorsement that may be
necessary to affect this waiver of subrogation.The Workers' Compensation policy shall be endorsed with a waiver of
subrogation in favor of the City for all work performed by the Contractor, its employees, agents and subcontractors.
Acceptability of Insurers
Insurance must be issued by insurers acceptable to City 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 Coverage
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 1 of all required insurance policies, including endorsements,required by these specifications,at any time.
Subcontractors 1
Contractor shall require and verify that all subcontractors maintain insurance meeting all the requirements stated
herein, and Contractor shall ensure that City is an additional 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
1
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 Circumstances
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-$60,000 Version:Jan.2019
3
STATC-1 OP ID:Z1
ACORD DATE(MM/DD/YYY`/)
CERTIFICATE OF LIABILITY INSURANCE 07/11/2019
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER CO
NTACT
Mercedes Pedroza
Bozzuto&Associates Insurance N
34 S.Second St WCNo Ell:800-989-8712 a/c,No):408-429-8460
Campbell,CA 95008 E-MAIL
Linda Ellis SS:mercedesp@dbinsurance.com
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:Cypress Insurance Company 10855
INSURED Stateomm,Inc. INSURER B:Everest Indemnity Insurance Cc V 10851
939C San Rafael Ave.
Mountain View,CA 94043 INSURER C:Indian Harbor Insurance Co X V 36940
INSURER D:Ohio Security Insurance Co A J 24082
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR TYPE OF INSURANCE D UBR POLICY EFF POLICY EXP
LTR 1 D POLICY NUMBER MMIDD/YY MM/DD/YYYY LIMITS ''/
B X COMMERCIAL GENERAL LIABILITY CH OCCURRENCE $ 1,000,00 �y
CLAIMS-MADE T OCCUR X X 1GL005784-181 j 08/15/2018 10/01/2019 DAMA ET R T
PREMISES Ea occurrence $ 100,000
MED EXP(Any one person) $ 5,00
PERSONAL&ADV INJURY $ 1,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00
POLICY I JEC LOC PRODUCTS-COMP/OP AGG $ 2,000,00
PRO-
OTHER: $
OMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY C Ea $
accident
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
$
UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ ,5,000,00
B X EXCESS LIAB CLAIMS-MADE 51CCO02025-181 08/15/2018 10/01/2019 AGGREGATE $ 5,000,00
DED I X I RETENTION$ 10,000 $
WORKERS COMPENSATION PER I OTH-
AND EMPLOYERS'LIABILITY STATUTE ER /
A ANY PROPRIETOR/PARTNER/EXECUTIVE YIN
N X STWC928968 10/01/2018 10/01/2019 E.L.EACH ACCIDENT $ 1,000,00 V/
OFFICER/MEMBER EXCLUDED? ❑N/A
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000
If yes,describe under
DESCRIPTION OF OPERATIONS below .L.DISEASE-POLICY LIMIT $ 1,000,00
C Pollution/Prof. PECO05036901 08/15/2018 10/01/2019 mit 1,000,00
D Property BKS56535161 10/01/2018 10/01/2019 PP/Ded 278,681/1
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
The City of Cupertino, its City Council, officers, officials, employees,
agents, servants and volunteers are included as an additional insured on
General Liability policy per the attached endorsements. General Liability
policy is primary and non-contributory per the attached endorsement. Waiver
of Subrogation apply to General Liability and Workers Compensation *Cont'd*
CERTIFICATE HOLDER CANCELLATION
CITYOFR
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
CI Of Cupertino THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City p ACCORDANCE WITH THE POLICY PROVISIONS.
10556 Mary Ave.
Cupertino,CA 95014
AUTHORIZED REPRESENTATIVE
©1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
NOTEPAD. HOLDER CODE CITYOFR STATC-1 PAGE 2
INSURED'S NAME Statcomm, Inc. OP ID:Z1 Date 07/11/2019
policies per the attached endorsements.
Policy Number: 5 L005784-181 it
COMMERCIAL GENERAL LIABILITY
EGG 20 599 05 09
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
ADDITIONAL INSURED - OWNERS, LESSEES OR
CONTRACTORS -AUTOMATIC STATUS WHEN REQUIRED
IN WRITTEN CONTRACT OR AGREEMENT WITH YOU -
INCLUDING COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
A. Section II —Who Is An Insured is amended to D. With respect to the insurance afforded to an
include as an additional insured any person or additional insured, the following additional exclu-
organization for whom you are performing opera- sions apply:
tions, but only when you and such person or or- This insurance does not apply to:
ganization have agreed in writing in a contract or
agreement prior to the commencement of such 1. "Bodily injury", "property damage" or"personal
operations that such person or organization be and advertising injury" arising out of any act or
added as an additional insured on your policy. omission of an additional insured or any of its
Such person or organization is an additional in- employees.
sured only with respect to liability for "bodily in- 2. "Bodily injury", "property damage" or"personal
jury", "property damage" or "personal and adver- and advertising injury" arising out of the ren-
tising injury" but only to the extent caused, in dering of, or the failure to render, any archi-
whole or in part, by: tectural, engineering or surveying services,
1. Your acts or omissions; or including:
2. The acts or omissions of those acting on your (a) The preparing, approving, or failing to
behalf; prepare or approve, maps, shop drawings,
in the performance of "your work" for an addi- opinions, reports, surveys, field orders,change orders or drawings and specifica-
tional insured. tions; or
B. The insurance afforded to an additional insured (b) Supervisory, inspection, architectural or
shall only include the insurance required by the engineering activities.
terms of the written agreement and shall not be
broader than the coverage provided within the 3. "Bodily injury", "property damage"or"personal
terms of the Coverage Part. and advertising injury" arising out of any con-
C. The Limits of Insurance afforded to an additional struction projects that are part of a consoli-
datedinsured shall be the lesser of the following: (wrap-up) insurance program. This ex-
insured also applies to any:
1. The Limits of Insurance required by the writ- (a) Work or operations performed; or
ten agreement between the parties; or
2. The Limits of Insurance provided by this Cov-
erage Part. in connection with such wrap-up construction
projects, regardless of whether they are per-
formed or furnished at the location of the
wrap-up construction project or anywhere
else.
ECG 20 599 05 09 Copyright, Everest Reinsurance Company 2009 Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc.,used
with its permission.
Policy Number: 1GL005784-181
\ COMMERCIAL GENERAL LIABILITY
ECG 24 520 08 05
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AMENDMENT - OTHER INSURANCE
(PRIMARY NONCONTRIBUTORY)
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
Condition 4. Other Insurance of SECTION IV (2) Any other primary insurance available to
COMMERCIAL GENERAL LIABILITY CONDITIONS you covering liability for damages arising
is replaced by the following: out of the premises or operations, or the
a. Primary Insurance products and completed operations, for
which you have been added as an addi-
This insurance is primary except when b. be- tional insured by attachment of an en-
low applies. If this insurance is primary, our ob- dorsement.
ligations are not affected unless any of the
other insurance is also primary. When this insurance is excess,we will have no
. Then, we will
share with all that other insurance by the duty under Coverages A or B to defend the in-
method described in c. below, except that we sured against any"suit" if any other insurer has
will not seek contribution from any party with a duty to defend the insured against that "suit".
whom you have agreed in a written contract or If no other insurer defends, we will undertake
agreement that this insurance will be primary to do so, but we will be entitled to the insured's
and noncontributory, if the written contract or rights against all those other insurers.
agreement was made prior to the subject "oc- When this insurance is excess over other in-
currence" or offense_ surance, we will pay only our share of the
b. Excess Insurance amount of the loss, if any, that exceeds the
sum of:
This insurance is excess over:
(1) The total amount that all such other insur-
(1) Any of the other insurance, whether pri- ance would pay for the loss in the absence
mary, excess, contingent or on any other of this insurance; and
basis: (2) The total of all deductible and self-insured
(a) That is Fire, Extended Coverage, amounts under all that other insurance.
Builder's Risk, Installation Risk or simi-
larcoverage for"your work'; We will share the remaining loss, if any, with
any other insurance that is not described in this
(b) That is Fire insurance for premises Excess Insurance provision and was not
rented to you or temporarily occupied by bought specifically to apply in excess of the
you with permission of the owner; Limits of Insurance shown in the Declarations
(c) That is insurance purchased by you to of this Coverage Part.
cover your liability as a tenant for"prop- c. Method Of Sharing
erty damage" to premises rented to you
or temporarily occupied by you with If all of the other insurance permits contribu-
permission of the owner; or tion by equal shares, we will follow this method
also. Under this approach each insurer con-
(d) If the loss arises out of the maintenance tributes equal arnounts until it has paid its ap-
or use of aircraft, "autos" or watercraft plicable limit of insurance or none of the loss
to the extent not subject to Exclusion g. remains, whichever comes first.
of Section I — Coverage A — Bodily In-
jury And Property Damage Liability.
ECG 24 520 08 05 Includes copyrighted material of Insurance Services Office, Page 1 of 2 ❑
Inc., with its permission.
If any of the other insurance does not
permit contribution by equal shares, we
will contribute by limits. Under this
method, each insurer's share is based
on the ratio of its applicable limit of in-
surance to the total applicable limits of
insurance of all insurers.
ECG 24 520 08 05 Includes copyrighted material of Insurance Services Office, Inc. Page 2 of 2 ❑
Used with its permission.
Policy Number: 51t7-
5784-181
COMMERCIAL GENERAL LIABILITY
EGG 24 522 04 02
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name of Person or Organization:
BLANKET WHERE REQUIRED BY CONTRACT
(If no entry appears above, information required to complete this endorsement will be shown in the Declarations
as applicable to this endorsement.)
The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV —
COMMERCIAL GENERAL LIABILITY CONDITIONS)is amended by the addition of the following;
We waive any right of recovery we may have against the person or organization shown in the Schedule above
because of payments we make for injury or damage arising out of your operations or "your work" done under a
written agreement that requires you to waive your rights of recovery. The written agreement must be made prior
to the date of the "occurrence". This waiver applies only to the person or organization shown in the Schedule
above.
ECG 24 522 04 02 Includes copyrighted material of Insurance Services Office, Page 1 of 1 El
Inc.,with its permission.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WCS9 0410B
(Ed.944)
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA
BLANKET BASIS
We have the right to recover our payments from anyone liable for an injury covered by this po|iny. We will not enforce
our right against the person nrorganization named in the Schedule. (This agreement applies only to the extent that you
perform work under written contract that requires you to obtain this agreement from us.)
The additional premium for this endorsement shall be 2% of the total manual premium otherwise due on such
remuneration. The minimum premium for this endorsement is $350.
This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule.
SCHEDULE
BLANKET WAIVER '
Person/Organization B|ankotVVoivor—Any person or organization for whom the Named Insured has
agreed by written contract to furnish this waiver.
Job Description Waiver Premium
All CAOperations 3970.00
This endorsement changes the policy mwhich it is attached and is effective on the date issued vn|oon vmomviov stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective 1001/2018 Policy No. Endorsement No.
|naumo ct Premium$
Insurance Company Cypress Insurance Company
Countersigned by
mCgon41oB
0 F
,4co OR CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY)
0 711 1/2 01 9
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 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 NAME: Mark Chapman
RateF rrn State Farm HONK E 408-370-7100 AAIC No 408 370-7009
Mark Chapman,Agent E-MAIL�� s: mark@markchapmaninsurance.com
.;
250 E Hamilton Ave,Ste B INSURERS AFFORDING COVERAGE NAIC#
Campbell,Ca.95008 INSURERA: State Farm Mutual Automobile Insurance Company 25178
INSURED
INSURER B
Statcomm Inc. INSURER C:
939-C San Rafael Ave. INSURER D:
Mountain View,Ca.94043 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
ILTR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
POLICY NUMBER MMIDD MMIDDIYYYY LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
CLAIMS-MADE OCCUR DAMAGE TO RENTED
PREMISES Ea occurrence $
MED EXP(Any one person) $
PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $
POLICY❑PRO- ❑
JECT LOC PRODUCTS-COMP/OPAGG $
OTHER: S
AUTOMOBILE LIABILITY Y Y Y COMBINED SINGLE LIMIT S 1,000,000
Ea accident
ANY AUTO 224 1457-A06-05A 07/06/2019 07/06/20201 DILY INJURY(Per person) S
OWNED SCHEDULED ti P BODILY INJURY(Per accident)AUTOS ONLY AUTOS ( ) S
HIRED NON-OWNED PROPERTY DAMAGE S
AUTOS ONLY AUTOS ONLY Per accident
$
UMBRELLA LIAR OCCUR EACH OCCURRENCE S
EXCESS LIAB CLAIMS-MADE AGGREGATE $ _
DED I I RETENTIONS S
WORKERS COMPENSATION JPER OTH-
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT S
OFFICERIMEMBER EXCLUDED? ❑ NIA —
IMandatory in NH) E.L.DISEASE-EA EMPLOYE $
It yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
City of Cupertino ACCORDANCE WITH THE POLICY PROVISIONS.
10555 Mary Ave.
Cupertino,CA AUTHORIZED REP SENTATNEn�
95014 f`///j/�//J/l
©1988-201 A ORD CORPORATION. All rights reserved.
ACORD 25(2016103) The ACORD name and logo are registered marks of AC
10014B6 132949.12 03-16-2016
StateFarm State Farm Mutual Automobile Insurance Company R 87971-3-B MUTL VOL FLEET
�. PO Box 853922 DECLARATIONS PAGE
Riohardson, TX 75085-3922
NAMED INSURED
05-3152-3 B A POLICY NUMBER 2241457-AO6-05J
STA000001 0065 POLICY PERIOD JUL 06 2019 to JUL 06 2020
939 SAN RAFAEL AVESTE C NN 12:01 A.M.Standard Time
39 FA
MOUNTAIN VIEW CA 94043-1941 STATE FARM PAYMENT PLAN NUMBER
0389516502
AGENT
II.(���tllllllitl'iI�II'IIIIII�IIIIIi���IIE�"'�I�'IIII�IIIII� MARK CHAPMAN
$ 250 E HAMILTON AVE STE B
I— CAMPBELL,CA 95008-0231
IA O
PHONE:(408)370-7100 or (408)370-6439
DO NOT PAY PREMIUMS SHOWN ON THIS PAGE.
IF AN AMOUNT IS DUE,THEN A SEPARATE STATEMENT IS ENCLOSED.
YOUR CAR
Replaced policy number 2241457-051.
SEE VEHICLE SCHEDULE
Agent: MARK CHAPMAN
Telephone:(408)370-7100
00001{/85• See Reverse Side Prepared JUL 09 2019 3152-BOO
M8XON (t�25t -2002(otoOzilcl (o1a0254c)
This policy is issued by State Farm Mutual Automobile Insurance Company.
MUTUAL CONDITIONS
1. Membership.While this policy is in force,the first insured shown on the Declarations Page is
entitled to vote at all meetings of members and to receive dividends the Board of Directors In
its discretion may declare in accordance with reasonable classifications and groupings of
policyholders established by such Board.
2. No Contingent Liability. This policy Is non-assessable.
3. Annual Meeting. The annual meeting of the members of the company shall be held at its
home office at Bloomington, Illinois,on the second Monday of June at the hour of 10:00 A.M.,
unless the Board of Directors shall elect to change the time and place of such meeting, in
which case, but not otherwise, due notice shall be mailed each member at the address
disclosed in this policy at least 10 days prior thereto.
In Witness Whereof, the State Farm Mutual Automobile Insurance Company has caused this
policy to be signed by its President and Secretary at Bloomington, Illinois.
Secretary President
IMPORTANT NOTICE:
California law requires us to provide you with information for filing complaints with the State Insurance
Department regarding the coverage and service provided under this policy.
Your agent's name and contact information are provided on the front of this document.Another option is to
reach out by mail or phone directly to:
State Farm®Executive Customer Service
PO Box 2320
Bloomington IL 61702
Phone#1-800-STATEFARM(1-800-782.8332)
Department of Insurance complaints should be filed only after you and State Farm or your agent or other
company representative have failed to reach a satietactory agreement on a problem.
California Department of Insurance
Consumer Services Division
300 south Spring Street
Los Angeles,CA 90013
Phone#1-800-027-HELP(4357)or visit www.insurancs.ca.gov/01-consumers
NOTICE
We are required to furnish you with the following intormation: -- -
1. An automobile liability insurance company may cancel a policy before the end of the current policy
period for reasons described in the provision titled Cancellation which is located in the General Terms
section of your policy(refer to the Contents in the beginning of your policyfor the page number).
2. An automobile liability insurance company may increase the premium or refuse to renew the policy for
any of the following reasons:
a. Accident involvement by an insured,and whether an insured is at fault in the accident.
b. A change in,or an addition of,an insured vehicle.
c. A change in,araddition of,an insured under the policy.
d. A change in the location of ga raging of an insured vehicle.
e. A change in the use of the insured vehicle.
f. Convictions for violating any provision of the Vehicle Code orthe Penal Code relating to the
operation of a motor vehicle.
g.The payment made by an insurer due to a claim filed by an insured or a third party,
An automobile liability insurance company may increase the premium or refuse to renew the policy for
reasons that are not listed above but which are lawful and not unfairly discriminatory.
eto
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900Z-OL-bO woesov) a 0909-LSL
BONDN 14LM06
Premium:Included in Performance Bond
Payment Bond
The City of Cupertino("City")and STATCOMM INC. ("Contractor")have entered into
a contract, dated April 9 ,21319 ("Contract")for work on the
< Fire suppression testing and maintenance at City facilities n Project("Project"). The Contract
is incorporated by reference into this Payment Bond('Bond").
1_ General. Under this Bond, Contractor as principal and The Ohio casualty Insurance Company
its surety("Surety"), are bound to City as obligee in an amount not less than
$ 56,540 under California Civil Coda sections 9550, et seq.
2. Surety's Obligation, If Contractor or any of its Subcontractors fails to pay any of the
persons named in California Civil Code section 9100 amounts due under the
Unemployment Insurance Cods with respect to work or tabor 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 and its
Subcontractors, under California Unemployment Insurance Code section 13020,with
respect to the work and labor,then Surety will pay for the same.
3. Beneficiaries. This Bond inures to the benefit of any of the.persons named in California
Civil Code section 9100,so as to give a right of action to those persons or their assigns In
any suit brought upon this Bond. Contractor must promptly provide a copy of this Bond
upon raquest by any person with legal rights under this Bond.
4. Duration. If Contractor promptly makes payment of all sums for all labor, materials,and
equipment furnished for use in the performance of the Work required by the Contract,in i
conformance with the time requirements set forth in the Contract and as required by
California law, Surety's obligations under this Bond will be null and void. Otherwise,
Surety's obligations will remain in full force and effect,
5. Waivers. Surety waives any requirement to be notified of alterations to the Contract or
extensions of time,for performance of the Work under the Contract. Surety waives the
provisions of Civil Code sections 2819 and 2845_ City waives requirement of a new bond
for any supplemental contract under Civil Code section 9550. Any notice to Surety may be
given in the manner specified in the Contract and delivered or transmitted to Surety as
follows:
Attn: Liberty Mutual
Address: Treai BIVd ate
City/State/Zip: Walnut Creek
Phone:
Fax:
Email: DanieLLivsey li rtv,mutua.cum
6. Law and Venuo. This Bond will be govemed by Califomia law, and any dispute pursuant
to this Bond will be venued in the Superior Court of Santa Clara County in which the Project
is located, and no other place. Surety will be responsible for City's attorneys'fees and
costs in any action to enforce the provisions of this Bond.
Fire Suppression Testing&Maintenance at City Facilities PAYMENT BOND
Page 1
T. Law and Venue. This Bond will be governed by California law,and any dispute pursuant to this
Bond will be venued in the Superior Court for Santa Clara County in which the Project is located,
and no other place. Surety will be responsible for City's attorneys'fees and costs in any action to
enforcelhe provisions of this Bond.
0. Effective Date;Execution.This Bond is entered into and effective on August IS
20 19 .
SURETY: The Ohio Casualty Insurance Company
Business Name
Jennifer Mullins,VP ~
Namw7ftle[print] = I
(Acknowledgment with Notary Seal for Surety and Surety's Bower of Attorney must be attached.) r
CONTRACTOR: STATCOMM INC
Business Name
William R Wood,Chief Financial Officer
Name/Title
i
i
I
st f
Namerritle
END OF PERFORMANCE BOND
Fire Suppression Testing&Maintenance at City Facilities PERFORMANCE BOND
Page 4 i
Thia Power of Attorney limits the acts of those named herein,and they have no authority to
bind the Company except in the manner and to the extent herein stated.
Liberty Liberty Mutual Insurance Company
Mutual. The Ohio Casualty Insurance Company Certificate No:8200746-976216
SURETYWest American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duty organized under the laws of the State of New Hampshire,that
Liberty Mutual Insurance Company is a corporation duly organized under fie laws of the State of Massachusetts,and Wast American Insurance Company is a corporation duly organized
under the laws of the State of Indiana(herein collectively called the'Companies'},pursuant to and by authority herein sat forth,does hereby name,oonskdar and appoint Andrea
Hering,Jennifer Mullins
all of the city of Cam rbeil state of California each individually 0 there be more than one named,its true and lawful abmeyin fact to make,
execute,seal,acknowledge and deliver,for and on its behalf ins surety and as its ad and deed,any and all underte"s,bonds,recognixences and other surely obligations,in pursuance
of these presents and shall be as binding upon the Companies as if they have been duly signed by the president and attested by the secretary of the Companies in their own proper
p Sons.
IN WITNESS WHEREOF,this Power of Attorney has been sub scn1 d by an a ihorized officer or official of the Companies and the Corporate seals of the Corpanies have been affixed
thereto this 20th day of March 2019
Liberty Mutual Insurance Company
►Hsu �yar INs& ►Natrq The Ohio Casualty Insurance Company
�`�cA*POir+�`fc+ �J�o*1OR+rP�ty �! oN O R*r 0 West American Insurance Company
4 1912 0 s 1919 o ` 1991 4 (��j
rlkw' w4l—z"' o ;AA rsa�+a ,!� �h01ANt ♦D; !
8/7 * Fe* �yl By:
c David M.Carey,Assistant Secretary =3
m State of PENNSYLVANIA -0
3 County of MONTGOWRY
ca
to to On this 20th day of March , 2019 before me personally appeared David M.Carey,who acknowledged himself to be the Assistant Secretary of U 0
o 2 Company75 w' Casudlty Company,and Wast American Insurance Liberty al Insurance c>
tv Company,and that he,as such,being auUxxized so to do,execute the foregoing instrument for the purposes e
a`) a therein contained by signing on behalf of the corporations by himself as a duly authorized officer. w
IN WITNESS WFiER---OF,I have hereunto subscribed my name and affixed my notarial seal at Dung of Prussia,PennnsyHania,on the day and year fast above written. m E
CL
C.� A PR$ CZ)
Ey�otrw rF COMMONWEALTH OFPEMSYLVANIA Lh
Notarial Soot
Teresa
a,Notary
ile
UpxMaroTwp..MonhereryCounty to
By: � to
a MyCwmawanExpiros FM"2B,2021 '
ereaa PaSlella.No"Public-M~..i'anmxyf is Aseoomiom or uorarres 03 W
tm to a qRY P rL p
ca Lo
N This Power of Attorney is mode and executed pursuant to and by authority of the following Bylaws and Authorizations of The Ohio Casualty Insurance Company,Liberty Mutual
ECompany,
.2 Insurance Coy,and West American Insurance Company which resdutions are now in full force and affect reading as forows: --
L 4i ARTICLE IV-OFFICERS:Section 12.Power of Attorney.
o M Any officer or other official of the Corporation authorized for that purpose in writing by the Chairman or the President,and subod to such limitation as the Chairman or the
President may prescribe,shall appoint such attorneys-in-faci,as may be necessary to ad in behalf of the Corporation to make,exwAe,seal,acknowledge and deliver as surety 0 eD
any and an undertakings,bonds,recorizari:es and other surety obbptkxz,Such attorneys in fart subject to the limitations set forth in their respective powers of attorney,shall i°hN
have fun power to bind the Corporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.When so executed,such—°Q
instruments shall be as binding as If signed by the President and attested to by the Secretary.Any power or authority granted to any representative or attomey4n4acf under the €M
provisions of this article may be revoked at any time by the Board,the Chairman,the President or by the officer or officers granting such power or authority. E 6
a
ARTICLE XIII-Execution of Contracts:Section 5.Surety Bonds and Undertakings. 81
Any officer of the Company authorized for that purpose in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe,H
shall appoint such attomeysan-fact,as may be mwassary to ad in behalf of the Company to make,execute,seal,acknowledge and deliver as surety any all all undedaio ngs,
bonds,reeogni ances and other surety obligations.Such atthmeys-in-fad subject to the limitations set forth in their respective powers of attorney,shall have U power to bind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.When so executed such instruments shall be as binding as if
signed by the president and attested by the secretary.
Certificate of Dasignation-The President of the Company,acting purauartt to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to
fact as may be neo scary to ad on behalf of the Cam to make,execute,searl,ado aizanc such otomeys-i y
Company nowtetFge and deliver as surety any and all undertakings,bonds,rerxhgrnizar►ces and other surety
obigabons.
Authorization-By unanimous consent of The Companys Board of Directors,the Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
C TVmy,wherever appearing upon a Certified copy of any power of attorney issued by the Company In connection with surety bonds,shall be valid and binding upon the company with
the same force and effect as Ifhol*manually affixed.
1,Renee C.Llewellyn,the undersigned.Assistant Secretary,The Ohlo Casualty Insurance Company,Liberty Mutual Insurance Company,and West American Insurance Company do
hereby certify that the original paver of mtm%y of which fha foregoing is a full,true and correct copy of the Pourer of Attorney executed by said Companies,is in full force and effect and
has not been revoked.
IN TESTIMONY WHEREOF,I have harecmto set my hand and affixed the seals of said Companies this 1-5, day of 44(Cy ,--=-/
!` %HSU� SY 1N$v %%Stu;
,y14'oArL'a4�Ro
*1912M � gx1918 o u 1991 a ct+
By:
e C.Llewellyn,Assistant Secreltary
LMS•12873 LMIC WC WAIC Mub Co_002016
CALIFORNIA ALL- PURPOSE
CERTIFICATE OF 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 Santa Clara }
On August 15th 2019 _ before me, Andrea M. Hering, N_ota Public
in g,
re name am e o .o cer
personally appeared Jennifer Mullins
who proved to me on the basis of satisfactory evidence to be the person(a)whose
name(-•) is re subscribed to the within instrument and acknowledged to me that
he Fr�te they executed the same in his1 ,Ye their authorized capacity(ies), and that by
his e (their signature(s) on the instrument the person(e), 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.
ANDREA M.HEA RING
WITNESS my hand and official seal. Notary Publie•Califorrda
z Santa Clara County z
z Commission#2151039
Nl Comm.Ez ins MU,2020
Notary Public Signature 49 (Notary Public Seal)
INSTRUCTIONS FOR COMPLETFNG TFUS FORM
ADDITIONAL OPTIONAL INFURMATIt7N
This form complies with current California statues regarding notary wording and,
DESCRIPTION OF THE ATTACHED DOCUMENT if needed,should be completed and attached to the document..lcknowledgmems
fram other states may be completed far documents being sent to that state so long
as the wording does not require the Califotztta notary to violate California notary
law.
(Me or description ofaitached document) • State and County information must be the State and County where the document
signers)personally appeared before the notary public for acknowledgment.
• Date of notarization must be the date that the signer(s)personally appeared which
(Title a description of attached document oonlintted) must also be the same date the acknowledgment is completed.
• The notary public must print his or her name as it appears within his or her
Number of Pages Document Date commission followed by a comma and then your title(notary public).
• Print the name(s) of document signer(s) who personally appear at the time of
notarization_
CAPACITY CLAIMED BY THE SIGNER • Indicate the correct singular or plural forms by crossing off incorrect forms(i.e.
❑ Individual(S) 4e/she/*e),-is Jere)or circling the correct forms.Failure to correctly indicate this
information may lead to rejection of document recording.
❑ Corporate Officer • The notary seal impression must be clear and photographically reproducible,
Impression must not cover text or lines. If seal impression smudges,re-seal if a
( It a sufficient area permits,otherw se complete a different acknowledgment form.
❑ Partner(s)s) • Signature of the notary public must match the signature on file with the office of
the county clerk.
❑ Attomey-in-Fact fi Additional information is not required but could help to ensure this
❑ Trustee(s) acknowledgment is not misused or attached to a different document.
❑ other 9 Indicate title or type ofattached document,number of pages and date.
Indicate the capacity claimed by the signer. If the claimed capacity is a
corporate officer,indicate the title(i.e.CEO,CFO,Secretary).
2CJ 15 Version www.NotaryClasses-Corn 800-873.9865 Securely attach this document to the signed document with a staple,
CALIFORNIA ACKNOWLEDGMENT CIVIL CODE $1189
FAry public ar other officer completing this certificate verifies only the identity of the individual who signed the document
ch this certificate is attached,and not the truthfulness,accuracy,or validity of that document.
State of California
County of SANTA CLARA
On August 19, 2019 before me, U HPaclrick, Natary Prthlic
Date Here Insert Name and Title of the Officer
personally appeared Wiliam R_ Wand
Name(s)of Signer(s)
who proved tome an the basis of satisfactory evidence to be the person(,&)whose name(s)islaoe subscribed
to the within instrument and acknowledged to me that he it executed the same in hisAhookheio
authorized capacity(ies),and that by his/fierOkkeir signature(e)on the instrument the personM, or the entity
upon behalf of which the personM acted, executed the instrument.
I certify under PENALTY OF PERJURY under the
M.FIEADRICK laws of the State of California that the foregoing
Comm.No.214M paragraph is true and correct.
NWARY PUBLIC-CAtFORM
6ANTACIARACOLINTY y
MY Comm. Feb.9,ICZt WITNESS m hand and official seat.
Ploce!Votary Seal andlor Stamp Above Signature of Notary Public
OPTIONAL
Completing this information can deter alteration of the document or
fraudulent reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Document Date: Number of Pages:
Signer(s) Other Than Named Above:
Capacity(les) Claimed by Signer(s)
Signer's Name: Signer's Name-
0 Corporate Officer—Title(s): ❑Corporate Officer—Title(s):
0 Partner— GI Limited 0 General ❑ Partner-- 0 Limited 0 General
❑ Individual ❑ Attorney in Fact ❑ Individual ❑ Attorney in Fact
o Trustee d Guardian or Conservator ❑ Trustee 0 Guardian or Conservator
❑ Other: ❑ Other:
Signer is Representing: Signer is Representing:
kf�tl3AY{y�-i�i4ki��!k?i�i��!nb47SSA'h`i�S!tdi{�N:PW:�'tSH�:�%'Na9�ir734}Fi4ik?e3i{�fStfNk?a"e4'!a�.�PH4Hr'}�a5��;,k�^4i!r's=i}�:��'�.'ytit�jr-t4)iF+.Phi.":P#:!�.'�s:.�?�'+isa!4�_�_Yr`S
s2018 National Notary Association
BOND4 14LOW506
Premium $1,131
Performance Bond
The City of Cupertino("City')and STATCOMM INC. ("Contractor') have entered into a
contract,dated_ April 9.20 19 ('Contract')for work on the
Fire suppression testing and maintenance at City facilities >Project("Project'). The Contract Is
incorporated by reference into this Performance Bond('Bond').
1. General, Under this Bond,Contractor as Principal and The Ohio Casualty Insurance Company its
surety('Surety), are bound to City as obligee for an amount not less than$56.540
®y executing this Bond. Contractor and Surety bind themselves and their respective heirs,
executors, administrators,successors and assigns,jointly and severally,to the provisions of this
Bond.
2. Surety's Obligations;Waiver. If Contractor fully performs its obligations under the Contract,
including its warranty obligations under the Contract, Surety's obligations under this Bond will
become null and void upon recordation of the notice of completion, provided Contractor has timely
provided a warranty bond as required under the Contract. Surety waives any requirement to be
notified of and further consents to any alterations to the Contract made under the applicable
provisions of the Contract Documents, including changes to the scope of Work or extensions of
time for performance of Work under the Contract. Surety waives the provisions of Civil Code
sections 2819 and 2845.
3. Application of Contract Balance.Upon making a demand on this Bond,City will make the
Contract Balance available to Surety for completion of the Work under the Contract. For purposes
of this provision, the Contract Balance is defined as the total amount payable by City to Contractot
as the Contract Price minus amounts already paid to Contractor, and minus any liquidated
damages, credits,or backcharges to which City is entitled under the terms of the Contract
4. Contractor Default. Upon written notification from City that Contractor is in default under Article 13
of the Contract General Conditions,time being of the essence, Surety must act within the time
specified in Article 13 to remedy the default through one of the following courses of action:
4.1 Arrange for completion of the Work under the Contract by Contractor,with City's consent,
but only if Contractor is in default solely due to its financial inability to complete the Work;
4.2 Arrange for completion of the Work under the Contract by a qualified contractor
acceptable to City, and secured by performance and payment bonds issued by an admitted surety
as required by the Contract Documents, at Surety's expense;or
4.3 Waive its right to complete the Work under the Contract and reimburse City the amount
of City's costs to have the remaining Work completed.
S. Surety Default. if Surety defaults on its obligaflons under the Bond, City will be entitled to recover
all costs it incurs due to Surety's default, including legal,design professional,or delay costs_
6. Notice. Any notice to Surety may be given in the manner specified in the Contract and delivered or
transmitted to Surety as follows:
Aftn' Liberty Mutual
Address: 1340 Treat Blvd Ste 400
Cityl8t WZ!p: Walnut creek CA 94597
Phone: 925-278-0158
Fax: — ----- -
Email: LDaniel.Livsey@libertymutual,com
Fire Suppression Vesting &Maintenance at City Facilities PERFORMANCE BOND
Page 3
7. Effective Date;Execution. This Bond is entered into and is effective on August 15
2019,
SURETY: The Ohio casualty Insurance Company
Business Name
Jennifer Mullins,VP
Name/Title
(Acknowledgment with Surety's Notary Sea[and Surety's Power of Attorney must be attached,)
i
f
i
CONTRACTOR: STATCOMM INC.
Business Name i
William R-Wood,Chief Financial Officer
NarnoM le
i
SI !
NamelTitle
END OF PAYMENT BOND
Fire Suppression Testing&Maintenance at City Facilities PAYMENT BOND
Page 2
This Power of Attomey limb the acts of those named herein,and they have no authority to
bind the Company except in the manner and to the extent herein stated.
Liberty Liberty Mutual Insurance Company
Mutual. The Ohio Casualty Insurance Company Certificate No:8200746-976216
SURETY West American Insurance Company
POWER OF ATTORNEY
KNOWN ALL PERSONS BY THESE PRESENTS:That The Ohio Casualty Insurance Company is a corporation duly organized under the laws of the State of New Hampshire,that
Liberty Mutual Insurance Company is a corporation duly organized under the laws of the State of Massachusetts,and West American Insurance Company is a corporation duly organized
under the laws of the State of Indiana(herein collectively called the'Companies'},pursuant to and by authority herein set forth,does hereby name,constihde and appoint, Andrea
Hering,Jennifer Mullins
all of the city of Campbell state Of California each individually if there be more than one named,its true and lawto!allomsy4n-fact to make,
execute,seal,adutowlAs and deliver,for and on its behalf as surety and as its act and deed any and all uridertakirgs,bonds,recognizences and other surety obligations,in pursuance
d these presents and shall be as binding upon fire Companies as if they have been duty signed by the president and attested by the secretary of the Companies in their own proper
persons. ,
IN WITNESS WHEREOF,this Power of Attorney has been subscribed by an authorized officer or official of the Companies and the corporate seals of the Companies have been affixed
thereto this 20th day of March 2019
Liberty Mutual Insurance Company
♦Karr �r irlte° INsuy� The Ohio Casualty Insurance Company
,�a* a4, ac, +, a °+s,,sty �pq°OR., in West American Insurance Company
4, m fs M
r 191 c c1919 e s 1991 ,cf�yM�
�a
ou �y7 : t� �y1 „ r �,k * > By: to
David M.Carey,Assistant Secretary
Slate of PENNSYLVANIA
0= County of MONTGOMERY ss
v N On this 20th day of March 2019 before me personally appeared David M.Carey,who ackmWedged himself to be the Assistant Secretary of liberty Mutual Insurance o
O� Company' Th� aw Caity Company,and Walt American insuranoa fpnpany,and that he,as such,being authorized so to do,execute to foregoing instrument for the purposes—
> therein oontaLiad by sigxing on behalf of the corparatims by himself as a duly authorized officer. LLt
c IN WITNESS WHEREOF,t have hereunto subscribed my name and affixed my notarial seal at ICrng of Prussia,Pennsylvania,an the day and year first above written, d
":'rn a PAs o
G
O N �4��',5�olily�'T4`t COMMONWEALTH OF PENNSYLVANIA
Notarial Seal �y
rt1 O OF lie ese P3SIeaa.Nalary Pthlbc
O d UPWMena)Tun..Monw--yCandy By: m
C a} My Commissim Expires Mar(h 2a.M 3,E
ase
M3yxao- er Pastella,Notary Public �co
Vl '4FN Y"�L` Men w,Penroylkarua Amrimmn of Naladea it CA
CID
YL`
d) This Power of Attorney i3 made and executed pursuant to and by authority of the following Bylaws and Authorizations of The Ohio Casualty Insurance Company,Liberty Mutual-a'
p G Insurance Company,and West American Insurance Company which reedutions are now in full force and effect reading as follows: o a4i
�i ARTICLE IV-OFFICERS:Section 12.Power of Mornay.
o Any officer or other official of the Corporabori authorized for that purpose in writing by the Chairman or the President,and subject to such limitation as the Chairman or the -
zr President may prescribe,shall appoint such attorneys in lad as may be necessary to act in behalf of the Corporation to make,exaatte,seat edcnowledge and deliver as surety >c3
any and all undertakings,bonds,moognizenoas and other surety obligations.Such attorneys-in-fact,subject to the limitations set forth in their respective powers of attorney,shall$N
have full power to bind fire Crxporation by their signature and execution of any such instruments and to attach thereto the seal of the Corporation.When so executed,such c?
u instruments shall be as binding as if signed by the President and attested to by the Secretary.Any power or authority granted to any representative or atlomeymin-fact under the
provisions of this article may be revolted et any time by the Board,the Chairman,the President or by the offroer or officars granting such power or authority. E Go
ARTICLE Mil-Execution of Contracts:Section S.Surety Bonds and Undertakings. r
Any officer of the Company auttaized for that piapme in writing by the chairman or the president,and subject to such limitations as the chairman or the president may prescribe, o
shall appoint such attorneys-in-fact,as may be necessary to act in behalf of the Company to make,exeaAe,seal,acknowledge and deliver as surety arty and all undertakings,
bonds,rec ognizanees and other surety obligations.Such attomeys-In-fact subject to the limitations set forth in their respective powers of attorney,shall have full power to hind the
Company by their signature and execution of any such instruments and to attach thereto the seal of the Company.When so executed such instruments shall be as binding as'If
signed by the president and attested by the secretary,
Certificate of Designation-The President of the Company,acting pursuant to the Bylaws of the Company,authorizes David M.Carey,Assistant Secretary to appoint such attomeys-in-
fad as may be necessary to ad on behalf of the Company to make,execute,seal,acknowledge and deliver as surety any and all undertakings,bonds,recogri¢ances and other surety
Dbligatkx"-
Authorlxation-By unanimous consent of the Company's Board of Directors,ffie Company consents that facsimile or mechanically reproduced signature of any assistant secretary of the
Company.Wherever appearing upon a cartified copy of any power of attorney issued by the Company in connection with Surety bonds,shall be valid and binding upon the Company with
the same force and effect as though manually affixed.
I,Renee C.Llewellyn,the undersigned,Assistant Secretary,The Ohio Casualty Inshuance Company,Liberty Mutual Insurance Company,and West American Insurance Company do
hereby carMy that the original power of aM—y of vAich foe foregoing is a full,true and owed cwpy of the Power of Attorney executed by said Companies,is in full force and offed and
has not been revoked.
IN TESTIMONY WHEREOF,I have 1vx xMW sat my hard and affixed tie seals of said Companies this � - day of �, +
sr+au tv urs % SUR
JoaR°,T,r�A °mJ a►oR'rt+ ICU
t.3�o�o�'Pb m
1912 4n `1919 n 1991
~d►y�Actwr+��Ja y°�`H�xr+i�a� Y,t Ioux* �b By Renee C.Llewellyn,Assistant Secretary
1 * 1~ y1 * T•� 3M * AN
LMS-12673 LMIC OaCIC WMC Muni C°06"g1B
CALIFORNIA ALL- PURPOSE
CERTIFICATE OF 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 Santa Clara }
On August 15th 2019 before me, Andrea M. Herin , Notary Public ,
personally appeared Jennifer Mullins
who proved to me on the basis of satisfactory evidence to be the person(G) whose
name(-9-) Is re subscribed to the within instrument and acknowledged to me that
he they executed the same in his he their authorized capacity(ies), and that by
his 1e 'their signature(s) on the instrument the person(, or the entity upon behalf of
which the person(e) 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.
ANDREA M.HERING
WITNESS my hand and official seal. Notary Putilic-calnornla
Santa Clara county
Z Commission#2151039
jlam�Comm.Ex ires Ala 25,2020 y
Notary Public Signature (Notary Public Seal)
ADDITIONAL OPTIONAL iNF�RMATIQN INSTRUCTIONS FOR COMPLETING THIS FORM
This form complies with current California statutes regarding notary wording and,
DESCRIPTION OF THE ATTACHED DOCUMENT ifneeded,should be completed and attached to the document.Ackwwtedgments
from other states may be completed far documents being sent to that state so long
as the wording does not require the California notary to violate California notary
law.
(Titleordescription ofabOed document) • State and County inforntatiun must be the State and County where the document
signer(s)personally appeared before the notary public for acknowledgment.
- Date of notarization must be the date that the signer(s)personally appeared which
(Tide or description of attached document continued) must also be the same date the acknowledgment is completed.
The notary public must print his or her name as it appears within his or her
Number of Pages Document Date commission followed by a comma and then your title(notary public).
- print the name(s) of document signer(s) who personally appear at the time of
notarization.
CAPACITY CLAIMED BY THE SIGNER - indicate the correct singular or plural forms by crossing off incorrect forms(ix.
Wshel0w)r is/are)or circling the correct forms.Failure to correctly indicate this
❑ Individual(s) information may lead to rejection ofdocument recording.
❑ Corporate Officer s The notary seal impression must be clear and photographically reproducible.
Impression must not cover text or lines. If seal impression smudges,re-seal if a
sufficient area permits,otherwise complete a different acknowledgment form.
❑ Partner(s) • Signature of the notary public must match the signature on file with the office of
the county clerk.
❑ Attomey-in-Fact 0 Additional information is not required but could help to ensure this
® Trustee(s) acknowledgment is not misused or attached to a different document.
Other ;- Indicate title or type of attached document,number of pages and date.
® 0 indicate the capacity claimed by the signer. If the claimed Capacity is a
corporate officer,indicate the title(i.e.CEO,CFO,Secretary).
2015 Version wvAv NotaryClasses.cont 800-873-9865 Securely attach this document to the signed document with a staple.
CALIFORNIA ACKNOWLEDGMENT CIVIL CODE g 1189
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 SANTA CLARA
On August 19, 2019 before me, M Hea riCk,N.(ar Prrhlir.
Date Here Insert Name and Title of the Officer
personally appeared Mil"am R- Mod
Nome(s)of Signer(s)
who proved to me on the basis of satisfactory evidence to be the persons)whose name(*) is/aie subscribed
to the within instrument and acknowledged to me that heAs%%*ey executed the same in his4knio *-
authorized capacity(ies),and that by his/herfO+eir signature(M on the instrument the personM, or the entity
upon behalf of which the person(s)acted,executed the instrument.
I certify under PENALTY OF PERJURY under the
Y.HEAGRICA(
laws of the State of California that the foregoing
rg& CO�Mn �f paragraph is true and correct.
EA
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VXTACLOAC>!titrrr 4 WITNESS my hand and official seal.
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Signatur tJ���
Place Notary Seal and/or Stomp Above Signature of Notary Public
OPTIONAL
Completing this information can deter alteration of the document or
frauduient reattachment of this form to an unintended document.
Description of Attached Document
Title or Type of Document:
Documentpate: NumberofPages:
Signer(s) Other Than Named Above:
Capaeity(ies) Claimed by Signer(s)
Signer's Name: Signer's Name:
❑ Corporate Officer—Title(s): ❑Corporate Officer—Title(s):
❑ Partner— o Limited d General Q Partner— ❑ Limited ❑ General
❑ Individual ❑ Attorney in Fact ❑ Individual ❑ Attorney in Fact
❑ Trustee © Guardian or Conservator ❑ Trustee ❑ Guardian or Conservator
o Other: ❑ Other:
Signer is Representing: Signer is Representing:
2018 National Notary Association
Exhibit
Labor Code Requirements
1. The following prevailing wage provisions apply to this Agreement.
1.1 In General. For purposes of California labor law,this is a public works contract
subject to the provisions of Part 7 of Division 2 of the California Labor Code
(Sections 1720 et seq.). In accordance with Labor Code Section 1771,Contractor
and all subcontractors shall pay not less than current prevailing wage rates as
determined by the California Department of Industrial Relations C'DIR')to all
workers employed on this project as applicable. In accordance with Labor Code
Section 1815,Contractor and all subcontractors shall pay all workers employed
on this project 1 %the basic rate of pay for work performed in excess specified
hour limitations. The work performed pursuant to this Agreement is subject to
compliance monitoring and enforcement by the Department of Industrial
Relations.
1.2 Registration. Contractor and all subcontractors are not qualified to bid on or be
lasted in a bid proposal,subject to the requirements of section 4104 of the
California Public Contract Code,and shall not engage in the performance of any
work under this Agreement,unless currently registered and qualified to perform
public work pursuant to section 1725.5 of the California Labor Code. Contractor
represents and warrants that it is registered and qualified to perform public work I
pursuant to section 1725.5 of the Labor Code and will provide its DIR registration
number,along with the registration numbers of any subcontractors as required,to
the City.
1.3 Posting. Contractor shall post at the job site the determination of the DIR
director of the prevailing rate of per diem wages together with all job notices that
are required by regulations of the DIR.
1.4 Reporting. Contractor and any subcontractors shall keep accurate payroll records
in accordance with Section 1776 of the Labor Code and shall furnish the payroll
records directly to the Labor Commissioner in accordance with the law.
1.5 Report on Prevailing Nate of Wages. The City has obtained the general
prevailing rate of per diem wages in the vicinity of the project for each type of
worker needed,a copy of which is on file at the City of Cupertino City Hall,and
shall be made available to any interested party upon request.
1.6 Employment of Apprentices. Contractor's attention is directed to the provisions
in Sections 1777.5 and 1777.6 of the Labor Code concerning the employment of
apprentices by the Contractor or any subcontractor. It shall be the responsibility
of the Contractor to effectuate compliance on the part of itself and any
subcontractors with the requirements of said sections in the employment of i
apprentices. Information relative to apprenticeship standards,wage schedules,
and other requirements may be obtained from the Director of Industrial Relations,
ex-officio the Administrator of Apprenticeship,San Francisco,California, or from'
the Division of Apprenticeship Standards and its branch offices.
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1.7 Penalties. Contractor's attention is directed to provisions in Labor Code Sections
1775 and 1813. In accordance with Labor Code Section 1775,Contractor and
subcontractors may be subject to penalties for Contractor's and subcontractors'
failure to pay prevailing wage rates. In accordance with Labor Code Section
1813, Contractor or subcontractors may be subject to penalties for Contractor's or
subcontractors' failure to pay overtime pay rates for hours worked by workers
employed on this project in excess specified hour limitations.
do9W2.1
Statcomm Inc.
Fire Suppression Testing & Maintenance at City Facilities
Proposal Amount $ 21,540.00
Description Provide fire suppression preventive maintenance & repairs.
Account# various City facilities
Proposal Amount $ 35,000.00
Description Corrective repair allowance & bond costs.
Account# varies
Allowance Amount
Description
Account#
Unforeseeables/Extras
SUBTOTAL $ 56,540.00
Contingency $ 5,000.00
CONTRACT TOTAL $ 61,540.00
PW Supervisor Ken Tanase
Carl Valdez-Superintendent Date
