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20-064 Trip Stop Sidewalk Repair, Inc., 2019 Sidewalk Repair ProjectPublic Works Project:
Public Works Contract $60,000 /Rev. April 2020
Page 1 of 12
PUBLIC WORKS CONTRACT
$60,000 OR LESS
1.PARTIES
This public works contract (“Contract”) is made by and between the City of Cupertino (“City”), and
, a
(“Contractor”) for
and is effective on the last date signed below (“Effective Date”).
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. Contractor further agrees to carry out its work in compliance with
the City’s Shelter In Place and Social Distancing Requirements, attached here and incorporated as
Exhibit A-A.
3.TIME FOR COMPLETION
3.1 Term. This Contract begins on the Effective Date and ends on
(“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. The Director of Public Works
may authorize the extension of the Contract Time by up to sixty (60) calendar days through a written
amendment to this Agreement, provided such extension does not include additional contract funds.
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 $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 $
Trip Stop Sidewalk Repair Inc.Corporation
2019 Sidewalk Repair Project
October 1, 2020
250.00
50,000
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Public Works Contract $60,000 /Rev. April 2020
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(“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
any incidental costs incurred. Contractor will be paid ninety-five percent (95%) of the undisputed
amounts billed within thirty (30) days after City receives a properly submitted invoice. Any retained
amounts will be included with Contractor’s final payment within sixty (60) days of City’s acceptance of
the Work as complete.
5.INDEPENDENT CONTRACTOR
5.1 Status. Contractor is an independent contractor and not an employee of City. Contractor is
solely responsible for the means and methods of performing the Work and for the persons under this
employment. Contractor is not entitled to worker’s compensation or any other City benefits.
5.2 Contractor’s Qualifications. Contractor warrants on behalf of itself and its subcontractors that they
have the qualifications and skills to perform the Work in a competent and professional manner and according
to the highest standards and best practices in the industry.
5.3 Permits and Licenses. Contractor warrants on behalf of itself and its subcontractors that they are
properly licensed, registered, and/or certified to perform the Work as required by law, and have procured
a City Business License, if required by the Cupertino Municipal Code. Contractor shall possess a
California Contractor’s License in good standing for the following classification(s):
, 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 Benefits and Taxes. Contractor is solely responsible for the payment of
employment taxes incurred under this Agreement and any similar federal or state taxes. Contractor and
any of its employees, agents, and subcontractors shall not have any claim under this Agreement or
otherwise against City for seniority, vacation time, vacation pay, sick leave, personal time off,
overtime, health insurance, medical care, hospital care, insurance benefits, social security, disability,
unemployment, workers compensation or employee benefits of any kind. Contractor shall be solely
liable for and obligated to pay directly all applicable taxes, fees, contributions, or charges applicable to
Contractor’s business including, but not limited to, federal and state income taxes. City shall have no
obligation whatsoever to pay or withhold any taxes or benefits on behalf of Contractor. Should any
court, arbitrator, or administrative authority, including but not limited to the California Public
Employees Retirement System (PERS), the Internal Revenue Service or the State Employment
Development Division, determine that Contractor, or any of its employees, agents, or subcontractors, is
an employee for any purpose, then Contractor agrees to a reduction in amounts payable under this
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Agreement, or to promptly remint to City any payments due by the City as a result of such
determination, so that the City’s total expenses under this Agreement are not greater than they would
have been had the determination not been made.
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.
8.PUBLICITY / SIGNS
Any publicity generated by Contractor for the Project during the Contract Time, and for one (1) 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 % 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 the Public Contract Code. 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 fifteen (15)
days after City accepts the Work if the Contract involves work by subcontractors.
10.RECORDS AND DAILY REPORTS
10.1 Contractor must maintain daily reports of the Work and submit them to City upon request and at
completion of Project. The reports must describe the Work and specific tasks performed, the number of
50
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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 (4) years from the date of City’s final payment.
11.INDEMNIFICATION
11.1 To the fullest extent allowed by law, and except for losses caused by the sole and active
negligence or willful misconduct of City personnel, Contractor shall indemnify, defend, and hold
harmless City, its City Council, boards and commissions, officers, officials, employees, agents, servants,
volunteers and consultants (“Indemnitees”), through legal counsel acceptable to City, from and against
any and all liability, damages, claims, stop notices, actions, causes of action, demands, charges, losses
and expenses (including attorney fees, legal costs, and expenses related to litigation and dispute
resolution proceedings), of every nature arising directly or indirectly from this Contract or in any manner
relating to any of the following:
(a) Breach of contract, obligations, representations or warranties;
(b) Performance or nonperformance of the Work or of any obligations under the Contract by
Contractor, its employees, agents, servants, subcontractors or subcontractors;
(c) Payment or nonpayment by Contractor or its subcontractors or sub-subcontractors for Work
performed on or off the Project Site; and
(d) Personal injury, property damage, or economic loss resulting from the work or performance of
Contractor or its subcontractors or sub-subcontractors.
11.2 Contractor must pay the costs City incurs in enforcing this provision. Contractor must accept a
tender of defense upon receiving notice from City of a third-party claim, in accordance with California
Public Contract Code Section 9201. At City’s request, Contractor will assist City in the defense of a
claim, dispute, or lawsuit arising out of this Contract.
11.3 Contractor’s duties under this entire Section 11 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.
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11.5 Contractor agrees to obtain executed indemnity agreements with provisions identical to those
set forth here in this Section 11 from each and every subcontractor, or any other person or entity
involved by, for, with, or on behalf of Contractor in the performance of this Agreement. Failure of
City to monitor compliance with these requirements imposes no additional obligations on City and
will in no way act as a waiver of any rights hereunder.
11.6 This Section 11 shall survive termination of the Contract.
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.
13.COMPLIANCE WITH LAWS
13.1 General Laws. Contractor shall comply with all laws and regulations applicable to this Contract.
Contractor will promptly notify City of changes in the law or other conditions that may affect the Project
or Contractor’s ability to perform. Contractor is responsible for verifying the employment status of
employees performing the Work, as required by the Immigration Reform and Control Act
13.2 Labor Laws.
(a) The following provisions apply to contracts of $1,000 or more:
(i)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 (“DIR”) to all
workers employed on this project. In accordance with Labor Code Section 1815,
Contractor and all subcontractors shall pay all workers employed on this project 1
½ the basic rate of pay for work performed in excess specified hour limitations.
The work performed pursuant to this Contract is subject to compliance monitoring
and enforcement by the Department of Industrial Relations.
(ii)Registration. Contractor and all subcontractors shall not engage in the
performance of any work under this Contract 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 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.
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(iii)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.
(iv)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.
(v)Report on Prevailing Rate 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.
(vi)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 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.
(vii)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.
(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 $
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 the provisions of Section 3700 of the Labor Code which require 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 of 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.
150.00
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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 nor do they 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 Title 2 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 (7) calendar days after written notice from City. If Contractor fails to do so, City may in its
sole discretion and without prior notice, purchase bonds at Contractor’s expense, deduct the cost from
payments due Contractor, or terminate the Contract. City will not execute the Contract nor issue the NTP
until the required bonds are submitted.
15.UTILITIES, TRENCHING, AND EXCAVATION
15.1 Contractor must call the Underground Service Alert (“USA”) 811 hotline and request marking of
utility locations before digging or commencing Work. For underground service alerts for street lighting
and traffic signal conduits, City’s Service Center must be called at (408) 777-3269. Government Code
Section 4215 requires Contractor to notify City and Utility in writing if it discovers utilities or utility
facilities not identified in the Contract.
15.2 Pursuant to Government Code Section 7104, Contractor must stop work, notify City in writing,
and wait for instructions if one of the conditions below is found at the worksite. City will work with
Contractor to amend the Contract or issue a change order if the discovered conditions materially change
the Work/Performance, Contract Time or Contract Price.
(a) Material believed to be hazardous waste under Health and Safety Code Section 25117, and
which requires removal to a Class I, Class II, or Class III disposal site pursuant to law;
(b) Subsurface or latent physical conditions at the Project worksite differing from those
indicated by information about the worksite made available to Contractor; and
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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) Install storm drain inlet protection devices such as sand bag barriers, filter fabric fences, and
block and gravel filters at all drain inlets impacted by construction. During the annual rainy
season, October 15 through June 15, storm drain inlets impacted by construction work must be
filter-protected from onsite de-watering activities and saw-cutting activities. Shovel or vacuum
saw-cut slurry and remove from the Work site;
(b) Cover exposed piles of soil or construction material with plastic sheeting. Store all construction
materials in containers;
(c) Sweep and remove all materials from paved surfaces that drain to streets, gutters and storm
drains prior to rain and at the end of each work day. When the Work is completed, wash the
streets, collect and dispose of the wash water 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 trash, litter, and debris at the end of each work day
and when Work is completed. Clean up any leaks, drips, and other spills as they occur.
16.2 These requirements must be used in conjunction with the California Stormwater Quality
Association and California Best Management Practices Municipal and Construction Handbooks, local
program guidance materials from municipalities, and any other applicable documents on stormwater
quality controls for construction. Contractor’s failure to comply with this Section will result in the
issuance of noncompliance notices, citations, Work stop orders and regulatory fines.
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17.PROJECT COORDINATION
City Project Manager. City assigns 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
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 ten percent (10%) of the total time expended in performing the
Work.
18.2 City may terminate the Contract for cause or without cause at any time. Contractor will be paid for
satisfactory Work rendered through the termination date and will be given reasonable time to close out the
Work.
18.3 Final payment will not be made until Contractor delivers the Work and provides records
documenting the Work, products and deliverables completed. Nothing in the Section below is intended to
delay, abridge or bar City’s right under this Section.
19.GOVERNING LAW, VENUE AND DISPUTE RESOLUTION
This Contract is governed by the laws of State of California. Venue for any legal action shall be the
Superior Court of the County of Santa Clara, California. The dispute resolution procedures of Public
Contract Code Section 20104, et seq., incorporated here by reference, apply to this Contract and
Contractor is required to continue the Work pending resolution of any dispute. Prior to filing a lawsuit,
Contractor must comply with the claim filing requirements of the California Government Code. If the
Parties elect arbitration, the arbitrator’s award must be supported by law and substantial evidence and
include detailed written findings of law and fact.
20.ATTORNEY FEES
If City initiates legal action, files a complaint or cross-complaint, or pursues arbitration, appeal, or
other proceedings to enforce its rights or a judgment in connection with this Contract, the prevailing
party will be entitled to reasonable attorney fees and costs.
Jo Anne Johnson
Alex Bolghand
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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.
24.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.
25.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 there is any inconsistency between any
term, clause, or provision of the main Contract and any term, clause, or provision of the attachments or
exhibits thereto, the terms of the main Contract shall prevail and be controlling.
26.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.
27.SURVIVAL
The contract provisions which by their nature should survive the Contract or Completion of Project,
including without limitation all provisions regarding 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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28.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.
29.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.
30.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.
31.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 (5th) 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:
Attention:
Email:
To Contractor:
Attention:
Email:
32.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.
Copy to:Copy to:
10300 Torre Ave., Cupertino CA 95014 Trip Stop Sidewalk Repairs, Inc.
1424 East 3rd Ave
Alex Bolghand
alex@tripstoppers.com
Jo Anne Johnson
pwinvoices@cupertino.org
joannej@cupertino.org
2019 Sidewalk Repair Project
Heather M. Minner
Roger S. Lee
Jun 22, 2020
Jun 22, 2020
EXHIBIT A
SCOPE OF SERVICES
CONCRETE SHAVING
The City of Cupertino is requesting costs proposals for concrete shaving services to supplement
the City's Sidewalk Repair Program at locations throughout the City.
The Project Inspector will provide locations throughout the City with varying service needs,
lengths and heights. See Attachment A for location list. Work will be released in phases such
that work will begin in June 2020 and continue through October 2020. As each phase is
completed the Project Manager and contractor will compile additional locations as needed for
shaving. The scope of services shall include, but is not limited to work similar to that
presented below.
1) The contractor will provide all labor and equipment to shave concrete off-sets that
are between 3/8" and 1". Any sidewalk less than 2" thick shall not be considered for
shaving.
2) All concrete locations shall be ground or shaved so as to provide a smooth transition
between concrete slabs. The shaved areas shall be uniform, smooth, contain minimal
grooving and be straight at the backline with little or no scarring of the adjacent
concrete. ADA requirements of 8:1 slope will be provided in addition to a non-slip
finish.
3) Contractor will provide concrete dust control by use of high efficiency vacuum
attachment secured to the port of the shaving machine.
4) Locations to be shaved will be provided by the Project Inspector as needed.
Contractor shall not shave any locations without prior approval from Project Inspector.
5) Existing temporary asphalt ramps shall be removed at no extra charge and disposed
of by Contractor Personnel All shaving residue shall be collected, removed and
disposed of by Contractor at no additional charge. Adherence to all clean water
regulations is required.
Work shall be paid per inch foot not to exceed $50,000.00. An inch foot is calculated by
measuring the average height of the sidewalk off-set and multiplying the average height by the
length of the cut. Example: A 4-foot wide sidewalk that has a 1 inch rise on one side and
tapers to a half inch rise on the other is calculated as follows:
1+.5 X 4 = 3 inch feet
2
ATTACHMENT A -LOCATION LIST
STREET HOUSE NUMBER ZONE
BREWER AVE 10405 1
BREWER AVE 10488 1
CASTINE AVE 10550 1
METEOR DR 21397 1
METEOR DR 21427 1
METEOR DR 21478 1
ALVES AVE/NEAR YMCA 20803 2
BANDLEY DR 10475 2
BEARDON DR 10227 2
DE ANZA BLVDNALLEY GREEN DR 10591 2
N STELLING RD 10510 2
STEVENS CREEK BLVD/ON BANDLEY DR SIDE 20745 2
VALLEY GREEN DR 20725 2
VALLEY GREEN DR 20740 2
HOLLYOAK DR 21486 3
WOODLARK WAY 7949 3
NOVEMBER DR 917 4
RAINBOW DR 7941 5
RAINBOW DR 8005 5
SUNDERLAND DR 7954 5
DERBYSHIRE 1111 6
S STELLING RD 1161 6
LINDY LN 21661 7
REGNART RD 21541 7
REGNART RD 21602 7
ASTER LN 1285 8
ASTER LN 1471 8
ASTER LN 1455 8
ASTER LN 1495 8
ASTER LN 1544 8
ASTER LN 1568 8
ASTER LN 1594 8
GALWAY 1697 8
JAMESTOWN DR 1450 8
JAMESTOWN DR 1463 8
JAMESTOWN DR 1474 8
JAMESTOWN DR 1475 8
JAM ES TOWN DR 1486 8
JAM ES TOWN DR 1487 8
JAMESTOWN DR 1510 8
JAMESTOWN DR 1522 8
JAMESTOWN DR 1534 8
JAMESTOWN DR 1566 8
JAMESTOWN DR 1567 8
JAMESTOWN DR 1574 8
JAMESTOWN DR 1646 8
JAMESTOWN DR 1658 8
NEWCASTLE DR 7525 8
NEWCASTLE DR 7526 8
NEWCASTLE DR 7558 8
NEWCASTLE DR 7543 8
NORMANDY WAY 7567 8
NORMANDY WAY 7610 8
Page 1
SIDEWALK REPAIR
Trip Hazard Removal Proiect Proposal
City of Cupertino
June 12, 2020
Trip Stop Sidewalk Repair would like to submit a proposal for the Trip Hazard Removal
Project, for your approval. Our price per inch foot is, $28.50
As part of this proposal, please find our company information and references.
I want to assure you that if we are awarded this project, no one will do a better job for
you than we will. Our company runs on zero complaints, and our crew is specially trained on
how to work with residents, homeowners, and pedestrians. If I can provide any more
information for you, please feel free to reach out at any time. We look forward to working with
you on this project.
Best Regards,
Alex Bolghand
Trip Stop Sidewalk Repair Inc.
(650) 863-STOP (7867)
lnfo@tripstoppers.com
1424 East 3rd Ave.
San Mateo, CA 94401
www.tripstoppers.com
Trip Stop Sidewalk Repair Inc.
1424 East 3rd Ave.
San Mateo, CA 94401
CSL #: 987713
DIR#: 1000019535
Principal Contact Information:
Alex Bolghand
(650)863-7867 (Office)
(650)403-0202 (Fax)
Alex@Tripstoppers.com
Trip Stop Sidewalk Repair Inc
(650) 863-STOP (7867)
lnfo@tripstoppers.com
SIDEWALK REPAIR
1424 East 3rd Ave.
San Mateo, CA 94401
www.tripstoppers.com
Revised: June 5, 2020 – Public Works Contracts
1
Exhibit A-A – SHELTER IN PLACE AND SOCIAL DISTANCING REQUIREMENTS
A. Health Laws Acknowledged. It is acknowledged that Consultant’s/Contractor’s
(“Contractor”) duty to comply with Laws, as defined in Section 13 of the Contract/Agreement
(“Contract”), includes immediate compliance by Contractor and its subcontractors with the
restrictions on travel and the Social Distancing Requirements set forth in the most recent health
order issued by the County of Santa Clara Health Department in response to the COVID-19
pandemic, and any subsequent amendments or superseding orders thereto (the “Health
Order”), and any other local, state, or federal laws that have been or may be enacted in
response to the COVID-19 pandemic (collectively, “Health Laws”).
B. Health Order Compliance. Contractor shall comply with any restrictions on travel and social
distancing requirements in the Health Order when preforming work under this Contract. If a
scope of work item, notice to proceed, or work order under this Contract specifies work that
cannot be performed in compliance with the Health Order or other Health Laws, Contractor
shall refrain from conducting the work and immediately inform the City.
C. Individuals at High Risk of Severe Illness. Nothing in this Contract shall be interpreted to
require any person at high risk of severe illness from COVID-19 to leave their residence to
perform work under the Contract. Contractor will inform the City if other arrangements for the
work must be made, and City will do so, with no penalty to Contractor, although Contractor will
not be compensated for work performed by the City or third parties. Information from the
Center for Disease Control ("CDC") on "high risk" categories is available at the CDC's website at:
https://www.cdc.gov/coronavirus/2019-ncov/specific-groups/people-at-higher-risk.html.
D. Health Order Requirements and Best Practices. Contractor will immediately undertake all
appropriate measures to ensure compliance with the Social Distancing Requirements in the
Health Order by all individuals on any project site or work area performing work under this
Contract, including Contractor's or any subcontractor's workers, employees, representatives,
vendors, or suppliers (collectively, "workers"), and shall maintain these measures for as long as
required by the Health Order or other Health Laws. In particular, Contractor must comply with
the provisions of Appendix B-1 or B-2 (attached hereto) to the Health Order, as applicable.
Further, as long as required by the operative Health Order including Appendix B-1 or B-2, or
other Health Laws, these measures shall include, but are not limited to, the following best
practices:
1. Information. Inform all workers of the Social Distancing Requirements and these best
practices, including any updates or modifications, and require compliance as a condition
to being present on the project site or work area.
2. Sick Workers. Prohibit any individuals who have been tentatively or conclusively
diagnosed with COVID-19 or who have any symptoms of illness, including the following,
from entering or remaining on the project site or work area: fever, cough, shortness of
Revised: June 5, 2020 – Public Works Contracts
2
breath, sore throat, body aches, chills, sudden loss of smell or taste or other flu-like
symptoms. Encourage sick workers to get immediate medical attention.
a. Daily Screening. A supervisor must ask the following questions of each worker
before the worker is permitted to enter the project site or work area each day,
and a worker who responds "yes" to any one of the following questions must be
asked to leave immediately and will not be permitted back on the project site or
work area until cleared based on meeting the applicable requirements set forth
in the CDC's Interim Guidance on Discontinuation of Home Isolation for Persons
with COVID-19 (https://www.cdc.gov/coronavirus/2019-ncov/hcp/disposition-in-
home-patients.html):
(1) Have you had any of the following symptoms within the past 14 days:
fever, cough, shortness of breath, sore throat, body aches, chills, sudden
loss or smell or taste, or any other flu-like symptoms?
(2) Have you or anyone in your household been in contact with a person
that has been diagnosed with, has symptoms of, or is being tested for
COVID-19?
(3) Have you been medically directed to self-quarantine due to possible
exposure to COVID-19?
3. Signage/Posters. In compliance with the Health Order, post a Social Distancing
Protocol, substantially in the form attached to the Health Order as Appendix A, at all
project site or work area entry points, and in other areas where they are likely to be
seen (e.g., project trailers, sanitary facilities, break areas). The Social Distancing Protocol
must explain how Contractor is achieving compliance with social distancing
requirements. Resources for this purpose are available from the CDC at:
https://www.cdc.gov/coronavirus/2019-ncov/community/guidance-business-
response.html A copy of the Social Distancing Protocol must also be provided to each
employee performing work at the project site or work area.
4. Sanitary Facilities. Ensure adequate handwashing and/or hand-sanitizing facilities are
available at all times and encourage frequent handwashing and/or hand-sanitizing
throughout the day as specified below. Portable sanitary facilities must be serviced and
cleaned on a daily basis. Provide hand sanitizer in or around all toilet facilities and
common areas, including project trailers.
a. Handwashing. Wash hands using soap and water for at least 20 seconds.
b. Hand-sanitizer. Use a hand sanitizer that contains at least 60-95% alcohol
when handwashing is not immediately available.
Revised: June 5, 2020 – Public Works Contracts
3
c. Paper Products. Ensure that toilet paper, tissues, and paper towels are
available as appropriate, with designated receptacles for disposal.
5. Distancing. Prohibit workers from being less than six feet apart, unless and only to
the extent that would compromise worker safety or violate safety Laws for specific
operations. Prohibit handshaking or any physical contact among workers, with the sole
and limited exception of any physical contact required for worker safety or to comply
with safety Laws. Avoid sharing tools to the extent possible. Require workers to provide
their own transportation where possible and to avoid having more than two workers in
a vehicle.
6. Groups/Meetings/Site Access. Avoid any group gatherings of 10 or more people. Use
electronic alternatives to in person meetings, e.g., conference calls, video-conferencing,
etc., to the greatest extent possible. Limit access to the project site or any work area to
workers who are necessary to perform the work at that time. Allow non-essential
personnel to work from home to the extent possible. Avoid all non-essential travel. Do
not stack trades if possible.
7. Frequent Cleaning. Provide for regular and appropriate cleaning of all high touch
surfaces at a project site or work area, including, but not limited to, shared tools or
equipment, doorknobs and handles, toolboxes, sanitary facilities, common break areas,
keypads, touch screens, project trailer surfaces and equipment, light or power switches,
workstations, countertops, break areas, and the like. Clean and/or disinfect any reusable
items or equipment. Clean surfaces of shared vehicles, including steering wheels, gear
shifts, handles, instrument panels, etc. Ensure that cleaning products are used correctly
and safely, and avoid cleaning techniques, such as use of pressurized air or water sprays,
that may generate bioaerosols.
8. Personal Protective Equipment. When workers cannot avoid close proximity or
physical contact, e.g., based on applicable safety laws, or are otherwise at risk for
exposure to COVID-19, ensure that the affected workers are provided with appropriate
personal protective equipment ("PPE"), which may include disposable gloves and/or
other PPE. Instruct workers to wash or sanitize hands after removing gloves or other
PPE. Ensure that all personal protective equipment is disposed of properly.
9. Water and Food. Prohibit shared or communal food or common water coolers.
Provide individual water bottles for workers or instruct workers to bring their own.
10. Enforcement. Immediately eject any worker who fails or refuses to comply with the
Health Laws, Social Distancing Requirements, or these best practices from the project
site until or unless the Project Manager issues a written authorization for the worker to
return, subject to full compliance.
Revised: June 5, 2020 – Public Works Contracts
4
F. Proof of Compliance. If Contractor is subject to Appendix B-1 of the Health Order, Contractor
must provide to the City the name and contact information for its designated site-specific
COVID-19 supervisor(s). If Contractor is subject to Appendix B-2 of the Health Order, Contractor
must provide to the City a copy of its Site-Specific Health and Safety Plan. Any changes to the
COVID-19 supervisor or the Site-Specific Health and Safety Plan must be reported to the City
immediately.
E. Oversight. In other to ensure that all workers comply with the Social Distancing
Requirements to the extent possible, Contractor shall designate a named individual to have
primary responsibility for implementation and enforcement of the Social Distancing
Requirements and these best practices, and to serve as the primary point of contact with the
City in this regard. Contractor shall promptly inform the City of the name of this individual.
F. Changed Requirements. It is understood and acknowledged that circumstances pertaining to
the COVID-19 pandemic are evolving rapidly and that new local, state, or federal requirements
may modify the requirements under this Exhibit. Contractor agrees to work cooperatively with
the City to implement new or changed requirements as quickly as possible.
G. Subcontracts. Contractor shall include the terms of this Exhibit in all subcontracts and
require any agents, subcontractors, or subconsultants to comply with its provisions.
Attachments to Exhibit A-A
Appendix B-1 to June 5, 2020 Health Order
Appendix B-2 to June 5, 2020 Health Order
1228578.4
Appendix B-1
(Effective June 5, 2020)
1
Small Construction Project Safety Protocol
1. Any construction project meeting any of the following specifications is subject to this Small
Construction Project Safety Protocol (“SCP Protocol”), including public works projects unless
otherwise specified by the Health Officer:
a. For residential projects, any single-family, multi-family, senior, student, or other residential
construction, renovation, or remodel project consisting of 10 units or less. This SCP Protocol
does not apply to construction projects where a person is performing construction on their
current residence either alone or solely with members of their own household.
b. For commercial projects, any construction, renovation, or tenant improvement project
consisting of 20,000 square feet of floor area or less.
c. For mixed-use projects, any project that meets both of the specifications in subsection 1.a and
1.b.
d. All other construction projects not subject to the Large Construction Project Safety Protocol
set forth in Appendix B-2.
2. The following restrictions and requirements must be in place at all construction job sites subject to
this SCP Protocol:
a. Comply with all applicable and current laws and regulations including but not limited to
OSHA and Cal-OSHA. If there is any conflict, difference, or discrepancy between or among
applicable laws and regulations and/or this SCP Protocol, the stricter standard shall apply.
b. Designate a site-specific COVID-19 supervisor or supervisors to enforce this guidance. A
designated COVID-19 supervisor must be present on the construction site at all times during
construction activities. A COVID-19 supervisor may be an on-site worker who is designated
to serve in this role.
c. The COVID-19 supervisor must review this SCP Protocol with all workers and visitors to the
construction site.
d. Establish a daily screening protocol for arriving staff to ensure that potentially infected staff
do not enter the construction site. If workers leave the jobsite and return the same day,
establish a cleaning and decontamination protocol prior to entry and exit of the jobsite. Post
the daily screening protocol at all entrances and exits to the jobsite. More information on
screening can be found online at: https://www.cdc.gov/coronavirus/2019-
ncov/community/index.html.
e. Practice social distancing by maintaining a minimum six-foot distance between workers at all
times, except as strictly necessary to carry out a task associated with the construction project.
Appendix B-1
(Effective June 5, 2020)
2
f. Where construction work occurs within an occupied residential unit, separate work areas
must be sealed off from the remainder of the unit with physical barriers such as plastic
sheeting or closed doors sealed with tape to the extent feasible. If possible, workers must
access the work area from an alternative entry/exit door to the entry/exit door used by
residents. Available windows and exhaust fans must be used to ventilate the work area. If
residents have access to the work area between workdays, the work area must be cleaned and
sanitized at the beginning and at the end of workdays. Every effort must be taken to
minimize contact between workers and residents, including maintaining a minimum of six
feet of social distancing at all times.
g. Where construction work occurs within common areas of an occupied residential or
commercial building or a mixed-use building in use by on-site employees or residents,
separate work areas must be sealed off from the rest of the common areas with physical
barriers such as plastic sheeting or closed doors sealed with tape to the extent feasible. If
possible, workers must access the work area from an alternative building entry/exit door to
the building entry/exit door used by residents or other users of the building. Every effort must
be taken to minimize contact between worker and building residents and users, including
maintaining a minimum of six feet of social distancing at all times.
h. Prohibit gatherings of any size on the jobsite, including gatherings for breaks or eating,
except for meetings regarding compliance with this protocol or as strictly necessary to carry
out a task associated with the construction project.
i. Cal-OSHA requires employers to provide water, which should be provided in single-serve
containers. Sharing of any of any food or beverage is strictly prohibited and if sharing is
observed, the worker must be sent home for the day.
j. Provide personal protective equipment (PPE) specifically for use in construction, including
gloves, goggles, face shields, and face coverings as appropriate for the activity being
performed. At no time may a contractor secure or use medical-grade PPE unless required
due to the medical nature of a jobsite. Face coverings must be worn in compliance with the
April 17, 2020 Guidance from the County of Santa Clara Public Health Department,
available at: https://www.sccgov.org/sites/covid19/Pages/learn-what-to-do.aspx#howto.
k. Strictly control “choke points” and “high-risk areas” where workers are unable to maintain
six-foot social distancing and prohibit or limit use to ensure that six-foot distance can easily
be maintained between individuals.
l. Minimize interactions and maintain social distancing with all site visitors, including delivery
workers, design professional and other project consultants, government agency
representatives, including building and fire inspectors, and residents at residential
construction sites.
m. Stagger trades as necessary to reduce density and allow for easy maintenance of minimum
six-foot separation.
Appendix B-1
(Effective June 5, 2020)
3
n. Discourage workers from using others’ desks, work tools, and equipment. If more than one
worker uses these items, the items must be cleaned and disinfected with disinfectants that are
effective against COVID-19 in between use by each new worker. Prohibit sharing of PPE.
o. If hand washing facilities are not available at the jobsite, place portable wash stations or hand
sanitizers that are effective against COVID-19 at entrances to the jobsite and in multiple
locations dispersed throughout the jobsite as warranted.
p. Clean and sanitize any hand washing facilities, portable wash stations, jobsite restroom areas,
or other enclosed spaces daily with disinfectants that are effective against COVID-19.
Frequently clean and disinfect all high touch areas, including entry and exit areas, high traffic
areas, rest rooms, hand washing areas, high touch surfaces, tools, and equipment
q. Maintain a daily attendance log of all workers and visitors that includes contact information,
including name, phone number, address, and email.
r. Post a notice in an area visible to all workers and visitors instructing workers and visitors to
do the following:
i. Do not touch your face with unwashed hands or with gloves.
ii. Frequently wash your hands with soap and water for at least 20 seconds or use hand
sanitizer with at least 60% alcohol.
iii. Clean and disinfect frequently touched objects and surfaces such as work stations,
keyboards, telephones, handrails, machines, shared tools, elevator control buttons,
and doorknobs.
iv. Cover your mouth and nose when coughing or sneezing, or cough or sneeze into the
crook of your arm at your elbow/sleeve.
v. Do not enter the jobsite if you have a fever, cough, or other COVID-19 symptoms. If
you feel sick, or have been exposed to anyone who is sick, stay at home.
vi. Constantly observe your work distances in relation to other staff. Maintain the
recommended minimum six feet at all times when not wearing the necessary PPE for
working in close proximity to another person.
vii. Do not carpool to and from the jobsite with anyone except members of your own
household unit, or as necessary for workers who have no alternative means of
transportation.
viii. Do not share phones or PPE.
s. In the event of a confirmed case of COVID-19 at any jobsite, the following must take place:
i. Immediately remove the infected individual from the jobsite with directions to seek medical
care.
ii. Each location the infected worker was at must be decontaminated and sanitized by an outside
vendor certified in hazmat clean ups, and work in these locations must cease until
decontamination and sanitization is complete.
iii. The County Public Health Department must be notified immediately by both telephone (by
calling 408.885.4214) and by email (by sending an email to coronavirus@phd.sccgov.org).
Any requirements specified by the County health officials must be completed, including full
compliance with any tracing efforts by the County.
Appendix B-2
(Effective June 5, 2020)
1
Large Construction Project Safety Protocol
1. Any construction project meeting any of the following specifications is subject to this
Large Construction Project Safety Protocol (“LCP Protocol”), including public works
projects unless otherwise specified by the Health Officer:
a. For residential construction projects, any single-family, multi-family, senior,
student, or other residential construction, renovation, or remodel project consisting
of more than 10 units.
b. For commercial construction projects, any construction, renovation, or tenant
improvement project consisting of more than 20,000 square feet of floor area.
c. For construction of Essential Infrastructure, as defined in section 16.c of the Order,
any project that requires 20 or more workers at the jobsite at any one time.
2. The following restrictions and requirements must be in place at all construction job sites
subject to this LCP Protocol:
a. Comply with all applicable and current laws and regulations including but not
limited to OSHA and Cal-OSHA. If there is any conflict, difference or discrepancy
between or among applicable laws and regulations and/or this LCP Protocol, the
stricter standard will apply.
b. Prepare a new or updated Site-Specific Health and Safety Plan to address COVID-
19-related issues, post the Plan on-site at all entrances and exits, and produce a
copy of the Plan to County governmental authorities upon request. The Plan must
be translated as necessary to ensure that all non-English speaking workers are able
to understand the Plan.
c. Provide personal protective equipment (PPE) specifically for use in construction,
including gloves, goggles, face shields, and face coverings as appropriate for the
activity being performed. At no time may a contractor secure or use medical-grade
PPE, unless required due to the medical nature of a job site. Face coverings must
be worn in compliance with the April 17, 2020 Guidance from the County of Santa
Clara Public Health Department, available at:
https://www.sccgov.org/sites/covid19/Pages/learn-what-to-do.aspx#howto.
d. Ensure that employees are trained in the use of PPE. Maintain and make available
a log of all PPE training provided to employees and monitor all employees to
ensure proper use of the PPE.
e. Prohibit sharing of PPE.
Appendix B-2
(Effective June 5, 2020)
2
f. Implement social distancing requirements including, at minimum:
i. Stagger stop- and start-times for shift schedules to reduce the quantity of
workers at the jobsite at any one time to the extent feasible.
ii. Stagger trade-specific work to minimize the quantity of workers at the
jobsite at any one time.
iii. Require social distancing by maintaining a minimum six-foot distance
between workers at all times, except as strictly necessary to carry out a task
associated with the project.
iv. Prohibit gatherings of any size on the jobsite, except for safety meetings or
as strictly necessary to carry out a task associated with the project.
v. Strictly control “choke points” and “high-risk areas” where workers are
unable to maintain minimum six-foot social distancing and prohibit or limit
use to ensure that minimum six-foot distancing can easily be maintained
between workers.
vi. Minimize interactions and maintain social distancing with all site visitors,
including delivery workers, design professional and other project
consultants, government agency representatives, including building and fire
inspectors, and residents at residential construction sites.
vii. Prohibit workers from using others’ phones or desks. Any work tools or
equipment that must be used by more than one worker must be cleaned with
disinfectants that are effective against COVID-19 before use by a new
worker.
viii. Place wash stations or hand sanitizers that are effective against COVID-19
at entrances to the jobsite and in multiple locations dispersed throughout the
jobsite as warranted.
ix. Maintain a daily attendance log of all workers and visitors that includes
contact information, including name, address, phone number, and email.
x. Post a notice in an area visible to all workers and visitors instructing
workers and visitors to do the following:
1. Do not touch your face with unwashed hands or with gloves.
2. Frequently wash your hands with soap and water for at least 20
seconds or use hand sanitizer with at least 60% alcohol.
3. Clean and disinfect frequently touched objects and surfaces such as
workstations, keyboards, telephones, handrails, machines, shared
tools, elevator control buttons, and doorknobs.
4. Cover your mouth and nose when coughing or sneezing or cough or
sneeze into the crook of your arm at your elbow/sleeve.
5. Do not enter the jobsite if you have a fever, cough, or other COVID-
19 symptoms. If you feel sick, or have been exposed to anyone who
is sick, stay at home.
6. Constantly observe your work distances in relation to other staff.
Maintain the recommended minimum six-feet distancing at all times
when not wearing the necessary PPE for working in close proximity
to another person.
7. Do not share phones or PPE.
Appendix B-2
(Effective June 5, 2020)
3
xi. The notice in section 2.f.x must be translated as necessary to ensure that all
non-English speaking workers are able to understand the notice.
g. Implement cleaning and sanitization practices in accordance with the following:
i. Frequently clean and sanitize, in accordance with CDC guidelines, all high-traffic and
high-touch areas including, at a minimum: meeting areas, jobsite lunch and break
areas, entrances and exits to the jobsite, jobsite trailers, hand-washing areas, tools,
equipment, jobsite restroom areas, stairs, elevators, and lifts.
ii. Establish a cleaning and decontamination protocol prior to entry and exit of the
jobsite and post the protocol at entrances and exits of jobsite.
iii. Supply all personnel performing cleaning and sanitization with proper PPE to prevent
them from contracting COVID-19. Employees must not share PPE.
iv. Establish adequate time in the workday to allow for proper cleaning and
decontamination including prior to starting at or leaving the jobsite for the day.
h. Implement a COVID-19 community spread reduction plan as part of the Site-Specific Health
and Safety Plan that includes, at minimum, the following restrictions and requirements:
i. Prohibit all carpooling to and from the jobsite except by workers living within the
same household unit, or as necessary for workers who have no alternative means of
transportation.
ii. Cal-OSHA requires employers to provide water, which should be provided in single-
serve containers. Prohibit any sharing of any food or beverage and if sharing is
observed, the worker must be sent home for the day.
iii. Prohibit use of microwaves, water coolers, and other similar shared equipment.
i. Assign a COVID-19 Safety Compliance Officer (SCO) to the jobsite and ensure the SCO’s
name is posted on the Site-Specific Health and Safety Plan. The SCO must:
i. Ensure implementation of all recommended safety and sanitation requirements
regarding the COVID-19 virus at the jobsite.
ii. Compile daily written verification that each jobsite is compliant with the components
of this LCP Protocol. Each written verification form must be copied, stored, and
made immediately available upon request by any County official.
iii. Establish a daily screening protocol for arriving staff, to ensure that potentially
infected staff do not enter the construction site. If workers leave the jobsite and
return the same day, establish a cleaning and decontamination protocol prior to entry
and exit of the jobsite. Post the daily screening protocol at all entrances and exit to
the jobsite. More information on screening can be found online
at: https://www.cdc.gov/coronavirus/2019-ncov/community/index.html.
iv. Conduct daily briefings in person or by teleconference that must cover the following
topics:
1. New jobsite rules and pre-job site travel restrictions for the prevention of
COVID-19 community spread.
2. Review of sanitation and hygiene procedures.
3. Solicitation of worker feedback on improving safety and sanitation.
4. Coordination of construction site daily cleaning/sanitation requirements.
5. Conveying updated information regarding COVID-19.
Appendix B-2
(Effective June 5, 2020)
4
6. Emergency protocols in the event of an exposure or suspected exposure to
COVID-19.
v. Develop and ensure implementation of a remediation plan to address any non-
compliance with this LCP Protocol and post remediation plan at entrance and exit of
jobsite during remediation period. The remediation plan must be translated as
necessary to ensure that all non-English speaking workers are able to understand the
document.
vi. The SCO must not permit any construction activity to continue without bringing such
activity into compliance with these requirements.
vii. Report repeated non-compliance with this LCP Protocol to the appropriate jobsite
supervisors and a designated County official.
j. Assign a COVID-19 Third-Party Jobsite Safety Accountability Supervisor (JSAS) for the
jobsite, who at a minimum holds an OSHA-30 certificate and first-aid training within the past
two years, who must be trained in the protocols herein and verify compliance, including by
visual inspection and random interviews with workers, with this LCP Protocol.
i. Within seven calendar days of each jobsite visit, the JSAS must complete a written
assessment identifying any failure to comply with this LCP Protocol. The written
assessment must be copied, stored, and, upon request by the County, sent to a
designated County official.
ii. If the JSAS discovers that a jobsite is not in compliance with this LCP Protocol, the
JSAS must work with the SCO to develop and implement a remediation plan.
iii. The JSAS must coordinate with the SCO to prohibit continuation of any work activity
not in compliance with rules stated herein until addressed and the continuing work is
compliant.
iv. The remediation plan must be sent to a designated County official within five
calendar days of the JSAS’s discovery of the failure to comply.
k. In the event of a confirmed case of COVID-19 at any jobsite, the following must take place:
i. Immediately remove the infected individual from the jobsite with directions to seek
medical care.
ii. Each location the infected worker was at must be decontaminated and sanitized by an
outside vendor certified in hazmat clean ups, and work in these locations must cease
until decontamination and sanitization is complete.
iii. The County Public Health Department must be notified immediately by both
telephone (by calling 408.885.4214) and by email (by sending an email to
coronavirus@phd.sccgov.org). Any requirements specified by the County health
officials must be completed, including full compliance with any tracing efforts by the
County.
l. Where construction work occurs within an occupied residential unit, any separate work area
must be sealed off from the remainder of the unit with physical barriers such as plastic
sheeting or closed doors sealed with tape to the extent feasible. If possible, workers must
access the work area from an alternative entry/exit door to the entry/exit door used by
Appendix B-2
(Effective June 5, 2020)
5
residents. Available windows and exhaust fans must be used to ventilate the work area. If
residents have access to the work area between workdays, the work area must be cleaned and
sanitized at the beginning and at the end of workdays. Every effort must be taken to
minimize contact between workers and residents, including maintaining a minimum of six
feet of social distancing at all times.
m. Where construction work occurs within common areas of an occupied residential or
commercial building or a mixed-use building in use by on-site employees or residents, any
separate work area must be sealed off from the rest of the common areas with physical
barriers such as plastic sheeting or closed doors sealed with tape to the extent feasible. If
possible, workers must access the work area from an alternative building entry/exit door to
the building entry/exit door used by residents or other users of the building. Every effort
must be taken to minimize contact between worker and building residents and users,
including maintaining a minimum of six feet of social distancing at all times.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
INSURER(S) AFFORDING COVERAGE
INSURER F :
INSURER E :
INSURER D :
INSURER C :
INSURER B :
INSURER A :
NAIC #
NAME:CONTACT
(A/C, No):FAX
E-MAILADDRESS:
PRODUCER
(A/C, No, Ext):PHONE
INSURED
REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
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).
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.
OTHER:
(Per accident)
(Ea accident)
$
$
N / A
SUBR
WVD
ADDL
INSD
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.
$
$
$
$PROPERTY DAMAGE
BODILY INJURY (Per accident)
BODILY INJURY (Per person)
COMBINED SINGLE LIMIT
AUTOS ONLY
AUTOSAUTOS ONLY NON-OWNED
SCHEDULEDOWNED
ANY AUTO
AUTOMOBILE LIABILITY
Y / N
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
DESCRIPTION OF OPERATIONS below
If yes, describe under
ANY PROPRIETOR/PARTNER/EXECUTIVE
$
$
$
E.L. DISEASE - POLICY LIMIT
E.L. DISEASE - EA EMPLOYEE
E.L. EACH ACCIDENT
EROTH-STATUTEPER
LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
EXCESS LIAB
UMBRELLA LIAB $EACH OCCURRENCE
$AGGREGATE
$
OCCUR
CLAIMS-MADE
DED RETENTION $
$PRODUCTS - COMP/OP AGG
$GENERAL AGGREGATE
$PERSONAL & ADV INJURY
$MED EXP (Any one person)
$EACH OCCURRENCE
DAMAGE TO RENTED $PREMISES (Ea occurrence)
COMMERCIAL GENERAL LIABILITY
CLAIMS-MADE OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-JECT LOC
CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
CANCELLATION
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
CERTIFICATE HOLDER
The ACORD name and logo are registered marks of ACORD
HIRED
AUTOS ONLY
5/22/2020
Bone, Robertson & McBride, Inc.
1255 Treat Blvd.
Suite 100A
Walnut Creek CA 94597
Tonya Taylor-Long
925-674-1000 925-674-0188
certificates@brmins.com
AmGuard Insurance Company 42390
TRIPS-1 Security National Insurance Co 19879Trip Stop Sidewalk Repair Inc.
1424 East 3rd Ave.
San Mateo CA 94401
James River Ins Co 12203
Crum & Forster Speciality Ins
453954837
C X 1,000,000
X 100,000
5,000
1,000,000
2,000,000
X
Y Y 001013430 3/30/2020 3/30/2021
2,000,000
A 1,000,000
X
X X
Y ALAU111090 3/30/2020 3/30/2021
C X 2,000,000
X
001013860 3/30/2020 3/30/2021
2,000,000
OVER GL
B XYSWC12845173/30/2020 3/30/2021
1,000,000
1,000,000
1,000,000
D Contractors Pollution Liability
Errors & Omissions
PKC109660 3/30/2020 3/30/2021 General Aggregate
Each Occurrence
2,000,000
1,000,000
General Liability & Auto Liability Blanket Additional Insured endorsement applies. General Liability, Auto Liability & Workers Compensation Blanket Waiver of
Subrogation applies. All blanket endorsements apply only when required per written contract or written agreement executed prior to an occurrence. Please see
attached "disclosure" page.
City of Cupertino its City Council, boards and commissions, officers, employees, and volunteers are included as additional insured with respects to general
liability. Per project aggregate limits applies. Waiver of subrogation applies on the General Liability, Auto Liability and Workers Compensation policies.
City of Cupertino
10300 Torre Ave
Cupertino CA 95014
A+, XI
A-, XV
A, XI
A, XIII
Information Regarding Certificate of Insurance – Revised – 11/2019
INFORMATION REGARDING THIS CERTIFICATE OF INSURANCE
We have been instructed by the “First Named Insured” to issue a Certificate of Insurance only for
those policy numbers listed on the reverse side of this form. This Certificate is issued “as a matter
of information only” and does not supersede any Insurance Company cancellations,
exclusions or limitations and is not a contract between you and any Named Insureds or Bone,
Robertson & McBride, Inc. (The Certificate Holder is warned that it is not entitled to rely on
the Certificate itself for insurance coverage). Please note that if listed below and unless it is
indicated to the contrary on the reverse side of this form, all the following items apply to your interest
(if any);
1. Certificate does not state you are an additional insured on the General Liability policy (if any).*
2. Certificate does not state you are an additional insured on the Auto Policy (if any).*
3. Certificate does not state you are an additional insured on the Property Portion of the policy (if
any).*
4. Certificate does not state you are an additional insured on the Excess/Umbrella Liability policy
(if any).*
5. Certificate does not state you are a loss payee on any of the mentioned policies (if any).*
6. Certificate does not state there is a waiver of Subrogation on the Workers’ Compensation,
General Liability, Auto, Property or Inland Marine Policy(s), or any policy, in your favor (if any).*
7. Certificate does not state there is any primary insurance coverage and/or a separate per
project aggregate amount in your favor, (if any).*
8. Cancellation for non-payment of monies due to keep any policy(s) in force shall be 10 days.
9. As respects the Workers Compensation policy (if any), the insured has a continuous option to
include or exclude certain individuals for coverage.
10. In the event of any cancellation or modification of the policies described on the reverse side of
this form, you will not be notified of any changes by Bone, Robertson & McBride, Inc.
11. Bone, Robertson & McBride, Inc., has issued this Certificate “as a matter of information only”
and does not state, warrant or guarantee that any terms and conditions of the policy(s) listed
on the reverse side of this form, conform to the Contract requirements between you and the
named insured(s). Further, Bone, Robertson & McBride, Inc., disclaims any contractual
relationship with you, including this “as a matter of information only” Certificate. You are not
entitled to rely on the Certificate itself for Insurance Coverage.
The Insurance Limits shown on the reverse side are only Policy Limits that were in force
at the inception of such policy(s) and may have been reduced by claims and
occurrences and expenses. Any such reductions have not been stated on the reverse
side of this form.
*IMPORTANT! If such status were to be stated on the reverse side of this form; for such
potential coverage to be valid, one of the conditions requires that prior to the
“Occurrence” a written Contract between the Parties must have been in effect requiring
such status and for the specific task(s) to be performed and is not contrary to public
policy.
COMMERCIAL AUTO
BA 99 02 09 08
%A 99 02 09 08 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1
BLANKET WAIVER OF SUBROGATION
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply
unless modified by the endorsement.
SECTION IV - BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer Of Rights Of
Recovery Against Others To Us is amended by adding the following:
We waive any right of recovery we may have against any person or organization with whom you have a
written contract that requires such waiver because of payments we make for damages under this
Coverage Form.
POLICY NUMBER: ALAU111090
COMMERCIAL AUTO
BA 99 04 06 18
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
BA 99 04 06 18 Includes copyrighted material of Insurance Services Office, Inc., with its permission.Page 1 of 1
ADDITIONAL INSURED WHEN REQUIRED BY CONTRACT
This endorsement modifies insurance provided under the following:
BUSINESS AUTO COVERAGE FORM
With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless
modified by the endorsement.
This provision does not apply in regard to any ownership, maintenance or use of the additional insured’s “autos.”
Additional Insured When Required by Contract
(1)Paragraph A.1. – WHO IS AN INSURED –
of Section II – Liability Coverage is
amended to add:
d.When you have agreed, in a written
contract or written agreement, that a
person or organization be added as an
additional insured on your business auto
policy, such person or organization is an
“insured”, but only to the extent such
person or organization is liable for
“bodily injury” or “property damage”
caused by the conduct of an “insured”
under paragraphs a. or b. of Who Is An
Insured with regard to the ownership,
maintenance or use of a covered “auto.”
The insurance afforded to any such
additional insured applies only if the
“bodily injury” or “property damage”
occurs:
(1)During the policy period, and
(2)Subsequent to the execution of such
written contract, and
(3)Prior to the expiration of the period
of time that the written contract
requires such insurance be provided
to the additional insured.
(2) How Limits Apply
If you have agreed in a written contract
or written agreement that another
person or organization be added as an
additional insured on your policy, the
most we will pay on behalf of such
additional insured is the lesser of:
(a)The limits of insurance specified in
the written contract or written
agreement; or
(b)The Limits of Insurance shown in
the Declarations.
Such amount shall be a part of and not
in addition to Limits of Insurance shown
in the Declarations and described in this
Section.
(3) Additional Insureds Other Insurance
If we cover a claim or “suit” under this
Coverage Part that may also be covered
by other insurance available to an
additional insured, such additional
insured must submit such claim or “suit”
to the other insurer for defense and
indemnity.
However, this provision does not apply
to the extent that you have agreed in a
written contract or written agreement
that the insurance is primary and non-
contributory with the additional insured’s
own insurance.
(4) Duties in The Event Of Accident, Claim,
Suit or Loss
If another person or organization is
added as an additional insured on your
policy, the additional insured shall be
required to comply with the provisions in
A. Loss Conditions 2. – Duties In The
Event Of Accident, Claim, Suit Or
Loss – of SECTION IV – BUSINESS
AUTO CONDITIONS, in the same
manner as the Named Insured.
POLICY NUMBER: ALAU111090
POLICY NUMBER: 00101343-0 COMMERCIAL GENERAL LIABILITY
CG 20 10 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 o
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – SCHEDULED PERSON OR
ORGANIZATION
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s): Location(s) Of Covered Operations
Where required by written contract or written agreement
All operations of the Named Insureds
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
A. Section II – Who Is An Insured is amended to
include as an additional insured the person(s) or
organization(s) shown in the Schedule, but only
with respect to liability for "bodily injury", "property
damage" or "personal and advertising injury"
caused, in whole or in part, by:
1. Your acts or omissions; or
2. The acts or omissions of those acting on your
behalf;
in the performance of your ongoing operations for
the additional insured(s) at the location(s) desig-
nated above.
B. With respect to the insurance afforded to these
additional insureds, the following additional exclu-
sions apply:
This insurance does not apply to "bodily injury" or
"property damage" occurring after:
1. All work, including materials, parts or equip-
ment furnished in connection with such work,
on the project (other than service, maintenance
or repairs) to be performed by or on behalf of
the additional insured(s) at the location of the
covered operations has been completed; or
2. That portion of "your work" out of which the
injury or damage arises has been put to its in-
tended use by any person or organization oth-
er than another contractor or subcontractor
engaged in performing operations for a princi-
pal as a part of the same project.
POLICY NUMBER: 00101343-0 COMMERCIAL GENERAL LIABILITY
CG 20 37 07 04
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 o
ADDITIONAL INSURED – OWNERS, LESSEES OR
CONTRACTORS – COMPLETED OPERATIONS
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Name Of Additional Insured Person(s)
Or Organization(s):
Location And Description Of Completed Opera-
tions
Where required by written contract or written
agreement
All operations of the Named Insureds
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
Section II – Who Is An Insured is amended to include
as an additional insured the person(s) or organiza-
tion(s) shown in the Schedule, but only with respect to
liability for "bodily injury" or "property damage" caused,
in whole or in part, by "your work" at the location desig-
nated and described in the schedule of this endorse-
ment performed for that additional insured and included
in the "products-completed operations hazard".
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AP5031US 04-10 Page 1 of 1
PRIMARY AND NON CONTRIBUTORY
ENDORSEMENT
This endorsement modifies insurance provided under the following:
ALL COVERAGE PARTS
Name Of Additional Insured Person(s)
Or Organization(s):
If no entry appears above, this endorsement applies to all Additional Insureds covered under
this policy.
Any coverage provided to an Additional Insured under this policy shall be excess over any other
valid and collectible insurance available to such Additional Insured whether primary, excess,
contingent or on any other basis unless a written contract or written agreement specifically
requires that this insurance apply on a primary and noncontributory basis.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
POLICY NUMBER: 00101343-0
POLICY NUMBER: 00101343-0 COMMERCIAL GENERAL LIABILITY
CG 24 04 05 09
CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 o
WAIVER OF TRANSFER OF RIGHTS OF RECOVERY
AGAINST OTHERS TO US
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART
SCHEDULE
Name Of Person Or Organization:
Where required by written contract or written agreement
Information required to complete this Schedule, if not shown above, will be shown in the Declarations.
The following is added to Paragraph 8. Transfer Of
Rights Of Recovery Against Others To Us of
Section IV – Conditions:
We waive any right of recovery we may have against
the person or organization shown in the Schedule
above because of payments we make for injury or
damage arising out of your ongoing operations or
"your work" done under a contract with that person
or organization and included in the "products-
completed operations hazard". This waiver applies
only to the person or organization shown in the
Schedule above.
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
AP5012US 12-03 Page 1 of 1
POLICY LIMITATION – AMENDED AGGREGATE
LIMITS OF INSURANCE PER PROJECT
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
CONTRACTORS COMBINED LIABILITY POLICY
SECTION III – LIMITS OF INSURANCE - The General Aggregate Limit applies separately to
each “Project” of the Named Insured.
Notwithstanding the application of the General Aggregate Limit to each “Project” of the
Named Insured, under no circumstances will we pay more than $5,000,000 for all claims
under this policy that are subject to the General Aggregate limit.
For the purpose of this endorsement, the following definition is added:
“Project” means all work done by you or on your behalf, away from premises owned or
rented to you, to complete an individual bid or negotiated contract to provide services for
a specified period of time. Multiple jobs, work orders, purchase orders, or work done at
multiple “locations” under one contract are not separate “projects” within the meaning of
this coverage.
ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED.
POLICY NUMBER: 00101343-0
WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA
We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right
against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under
a written contract that requires you to obtain this agreement from us.)
You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work
described in the Schedule.
The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such
remuneration.
WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06
(Ed. 04-84)
Schedule
Person or Organization Job Description
Any person or organization as required by written contract.
This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated.
(The information below is required only when this endorsement is issued subsequent to preparation of the policy.)
Endorsement Effective 3/30/2020 Policy No. SWC1284517 Endorsement No. 0
Insured Trip Stop Sidewalk Repair, Inc. Premium $ 34,062
Insurance Company Security National Insurance Company
Countersigned by
WC 04 03 06
(Ed. 04-84)
Trip Stop Agreement with City of Cupertino for
2019 Sidewalk Repair Project
Final Audit Report 2020-06-22
Created:2020-06-15
By:Julia Kinst (juliak@cupertino.org)
Status:Signed
Transaction ID:CBJCHBCAABAAQI4S96JQjxjauRVcD2JXw7jtiPm00RsL
"Trip Stop Agreement with City of Cupertino for 2019 Sidewalk R
epair Project" History
Document created by Julia Kinst (juliak@cupertino.org)
2020-06-15 - 8:14:49 PM GMT- IP address: 64.178.242.15
Document emailed to Araceli Alejandre (aracelia@cupertino.org) for approval
2020-06-15 - 8:26:43 PM GMT
Document approved by Araceli Alejandre (aracelia@cupertino.org)
Approval Date: 2020-06-16 - 6:44:51 PM GMT - Time Source: server- IP address: 24.23.184.82
Document emailed to Heather M. Minner (minner@smwlaw.com) for signature
2020-06-16 - 6:44:55 PM GMT
Email viewed by Heather M. Minner (minner@smwlaw.com)
2020-06-20 - 11:02:58 PM GMT- IP address: 45.41.142.81
Document e-signed by Heather M. Minner (minner@smwlaw.com)
Signature Date: 2020-06-20 - 11:03:22 PM GMT - Time Source: server- IP address: 52.39.49.65
Document emailed to Roger S. Lee (rogerl@cupertino.org) for signature
2020-06-20 - 11:03:25 PM GMT
Email viewed by Roger S. Lee (rogerl@cupertino.org)
2020-06-22 - 2:29:32 PM GMT- IP address: 104.47.46.254
Document e-signed by Roger S. Lee (rogerl@cupertino.org)
Signature Date: 2020-06-22 - 2:30:15 PM GMT - Time Source: server- IP address: 67.164.104.249
Document emailed to Kirsten Squarcia (kirstens@cupertino.org) for signature
2020-06-22 - 2:30:18 PM GMT
Email viewed by Kirsten Squarcia (kirstens@cupertino.org)
2020-06-22 - 3:33:38 PM GMT- IP address: 104.47.44.254
Document e-signed by Kirsten Squarcia (kirstens@cupertino.org)
Signature Date: 2020-06-22 - 3:33:49 PM GMT - Time Source: server- IP address: 148.64.105.190
Signed document emailed to Heather M. Minner (minner@smwlaw.com), Araceli Alejandre
(aracelia@cupertino.org), Roger S. Lee (rogerl@cupertino.org), Kirsten Squarcia (kirstens@cupertino.org), and
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