HomeMy WebLinkAboutChrisp Company (2) 4r+ y1
ORIGINAL
AGREEMENT
THIS AGREEMENT is made and entered into on the 24 day of October, 2017 by and
between the TOWN OF LOS ALTOS HILLS (hereinafter referred to as "TOWN") and
Chrisp Company (hereinafter referred to as "CONTRACTOR"). In consideration of their
mutual covenants, the parties hereto agree as follows:
1. CONTRACTOR. Shall provide or furnish the following specified services and/or
materials:
1) Repaint curbs in the Town Hall lot and along Fremont
Road & Fremont Pines Lane, as per field meeting.
2) Stencil "Sheriff / EOC Director" on Fremont in from of
Town Hall, as per field meeting.
2. EXHIBITS. The following attached exhibits are hereby incorporated into and made
a part of this Agreement:
Proposal from CONTRACTOR dated 10/24/2017
3. TERMS. The services and/or materials furnished under this Agreement shallI,
commence 10/25/2017 and shall be completed by 11/08/2017, unless terminated
pursuant to Section 5(0.
4. COMPENSATION. For the full performance of this Agreement:
a. TOWN shall pay CONTRACTOR an amount not to exceed two thousand six
hundred dollars and zero cents ($2,600.00) within thirty (30) days following
receipt of invoice and completion/delivery of services/goods as detailed in
Sections 1, 2, and 3 of this Agreement and only upon satisfactory
delivery/completion of goods/services in a manner consistent with
professional/industry standards for the area in which CONTRACTOR operates.
TOWN is not responsible for paying for any work done by CONTRACTOR or any
subcontractor above and beyond the not to exceed amount.
b. Town shall not reimburse for any of CONTRACTOR's costs or expenses to
deliver any services/goods. Town shall not be responsible for any interest or late
charges on any payments from Town to CONTRACTOR.
c. CONTRACTOR is responsible for monitoring its own forces/employees/agents/
subcontractors to ensure delivery of goods/services within the terms of this
Agreement. TOWN will not accept or compensate CONTRACTOR for
incomplete goods/services.
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5. GENERAL TERMS AND CONDITIONS.
a. HOLD HARMLESS. CONTRACTOR agrees to indemnify, defend and hold
harmless the TOWN, its officers, agents and employees from any and all
demands, claims or liability of personal injury (including death) and property
damage of any nature, caused by or arising out of the performance of
CONTRACTOR under this Agreement. With regard to CONTRACTOR'S work
product, CONTRACTOR agrees to indemnify, defend and hold harmless the
TOWN, its officers, agents and employees from any and all demands, claims or
liability of any nature to the extent caused by the negligent performance of
CONTRACTOR under this Agreement.
b. INSURANCE. CONTRACTOR shall file with the TOWN a certificate of
insurance before commencing any services under this Agreement as follows:
i. WORKERS COMPENSATION INSURANCE: Minimum statutory
limits.
ii. COMMERCIAL GENERAL LIABILITY AND PROPERTY DAMAGE
INSURANCE: General Liability and Property Damage Combined.
$1,000,000.00 per occurrence including comprehensive form,
personal injury, broad form personal damage, contractual and
premises/operation, all on an occurrence basis. If an aggregate limit
exists, it shall apply separately or be no less than two (2) times the
occurrence limit.
Hi. AUTOMOBILE INSURANCE: $1,000,000.00 per occurrence.
iv. ERRORS AND OMISSIONS INSURANCE: $1,000,000.00 aggregate.
v. NOTICE OF CANCELLATION: The City requires 30 days written
notice of cancellation. Additionally, the notice statement on the
certificate should not include the wording "endeavor to" or"but failure
to mail such notice shall impose no obligation or liability of any kind
upon the company, its agents or representatives."
vi. CERTIFICATE OF INSURANCE: Prior to commencement of services,
evidence of insurance coverage must be shown by a properly
executed certificate of insurance and it shall name "The Town of Los
Altos Hills, its elective and appointed officers, employees, and
volunteers" as additional insureds.
vii. To prevent delay and ensure compliance with this Agreement, the
insurance certificates and endorsements must be submitted to:
Town of Los Altos Hills
26379 Fremont Road
Los Altos Hills, CA 94022
Town of Los Altos Hills Page 2 of 4
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c. NON-DISCRIMINATION. No discrimination shall be made in the employment of
persons under this Agreement because of the race, color, national origin, age,
ancestry, religion or sex of such person.
d. INTEREST OF CONTRACTOR. It is understood and agreed that this
Agreement is not a contract of employment and does not create an employer-
employee relationship between the TOWN and CONTRACTOR. At all times
CONTRACTOR shall be an independent contractor and CONTRACTOR is not
authorized to bind the TOWN to any contracts or other obligations without the
express written consent of the TOWN. In executing this Agreement,
CONTRACTOR certifies that no one who has or will have any financial interest
under this Agreement is an officer or employee of TOWN.
e. CHANGES. This Agreement shall not be assigned or transferred without
advance written consent of the TOWN. No changes or variations of any kind are
authorized without the written consent of the City Manager. This Agreement may
only be amended by a written instrument signed by both parties.
f. TERMINATION. This Agreement may be terminated by TOWN upon seven (7)
days written notice to CONTRACTOR. Monies owed for work satisfactorily
completed shall be paid to CONTRACTOR within 14 days of termination.
g. RECORDS. All reports, data, maps, models, charts, studies, surveys,
calculations, photographs, memoranda, plans, studies, specifications, records,
files, or any other documents or materials, in electronic or any other form, that
are prepared or obtained pursuant to this Agreement and that relate to the
matters covered hereunder shall be the property of the TOWN. CONTRACTOR
hereby agrees to deliver those documents to the TOWN at any time upon
demand of the TOWN. It is understood and agreed that the documents and
other materials, including but not limited to those described above, prepared
pursuant to this Agreement are prepared specifically for the TOWN and are not
necessarily suitable for any future or other use. Failure by CONTRACTOR to
deliver these documents to the TOWN within a reasonable time period or as
specified by the TOWN shall be a material breach of this Agreement. TOWN
and CONTRACTOR agree that until final approval by TOWN, all data, plans,
specifications, reports and other documents are preliminary drafts not kept by
the TOWN in the ordinary course of business and will not be disclosed to third
parties without prior written consent of both parties. All work products submitted
to the TOWN pursuant to this Agreement shall be deemed a "work for hire.°
Upon submission of any work for hire pursuant to this Agreement, and
acceptance by the TOWN as complete, non-exclusive title to copyright of said
work for hire shall transfer to the TOWN. The compensation recited in Section 4
shall be deemed to be sufficient consideration for said transfer of copyright.
CONTRACTOR retains the right to use any project records, documents and
materials for marketing of their professional services.
Town of Los Altos Hills Page 3 of 4
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h. ENTIRE AGREEMENT. This Agreement represents the entire agreement
between the Parties. Any ambiguities or disputed terms between this Agreement
and any attached Exhibits shall be interpreted according to the language in this
Agreement and not the Exhibits.
6. INVOICING. Send all invoices to the contract coordinator at the address below.
This Agreement shall become effective upon its approval and execution by TOWN. In
witness whereof, the parties have executed this Agreement the day and year first
written above.
CONTRACT COORDINATOR and
representative for TOWN: CONT CTOR:
Allen Chen JJ
Public Works Director e �//�
A
Town of Los Altos Hills By: -" 10/25/17
26379 Fremont Road Signature Date
Los Altos Hills, CA 94022
David Morris, Executive Vice President
Print name,Title
TOWN OF LOS ALTO HILLS:
By: ., / I�I 0
Carl Ca ill,City Manager D= e
Town of Los Altos Hills Page 4 of 4
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ago. peginpatue EXTRA WORK Contractors License No.374600
Fremont Office
DIR Registration No.1000000306
43650 Osgood Rd
A General Engineering
Fremont CA 94539 C-13 Fence,Wire,wood
Phone: (510)656-2840 Fax: (510)656-2397 C-32 Highway Improvement
Quotation
TO: Current Date: 10/24/2017
LOS ALTOS HILLS BidDate: 10/24/2017
26379 FREMONT ROAD JobName: REPAINT CURBS
LOS ALTOS HILLS CA 94022 Location: LOS ALTOS HILLS Bide: 37878 1
Phone:(650)941-7222 Fax: (650)941-3160 Contacte: Job#:
Working Days:
Contact: John Chau
Liquidated Damages
email: jchau@losaltoshills.ca.gov
ITEM NO. DESCRIPTION QUANTITY UNIT UNIT PRICE TOTAL
1 REPAINT CURBS AND STENCIL"SHERIFF/EOC 1 LS 2600.000 $2,600.00
DIR"AS PER FIELD MEET
Subtotal $2,600.00
TOTAL $2,600.00
Signing of this quotation will constitute a legal and binding contract change order to perform extra work as quoted and a
contract change order must be issued to Chrisp company for the agreed amount of work and moneys within 10 days of the
beginning for the work. Non-timely issuance of a contract change order will not relieve general contractor of delayed/late
payment.
Date Approved:
Signed:
Print name and
title:
This quote includes all stipulations found on page 3 QUOTE PREPARED BY John Sales
(510)385-5501
jsalas@chrispco.com
CHRISP COMPANY
Page 1 of 3
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Cfixiop `^Rl'ep 'j41. EXTRA WORK 4 Contractors License No.374600
Fremont Office
DIR Registration No.1000000306
43650 Osgood Rd
A General Engineering
Fremont CA 94539 C-13 Fence,Wire,wood
Phone: (510)656-2840 Fax: (510)656-2397 C-32 Highway Improvement
Quotation
COMMENTS, EXCLUSIONS, AND STIPULATIONS
The following stipulations are hereby incorporated into and made part of the quotation from Chrisp co.
dated October 24, 2017 for the following project
REPAINT CURBS
• NO RETENTION TO BE TAKEN ON CONTRACTS LESS THAN$5000.00
• Chrisp Company reserves the right to withdraw proposal if written acceptance is not received within 30 days of bid
date
• EXCLUDE: Installation or removal of temporary delineation
• Clean, clear and unobstructed access required for Chrisp Co.work
• Final PAY QTYS presented by owner MUST be agreed by Chrisp Co.
• Changeable Message board if required to be provided by General Contractor for Chrisp Co.Use at no Charge to
Chrisp Co.
• EXCLUDE: Removal of Existing Striping 8 Markings
• EXCLUDE: Removal of Existing Pavement Markers
• Parking Area is to be Clear of Debris and Parked Vehicles prior to Chrisp Company Arrival.
• EXCLUDE: Furnishing and Installation of Mast Arm Signs
• EXCLUDE: Red-Lined As-Built Drawings
• Traffic Control INCLUDED for Chrisp Company work ONLY
• After receiving contract 10 working days written notice required prior to scheduling of work
• EXCLUDE: Special Insurance Requirements,(I.e.Railroad Insurance,
• Chrisp Co.will remove contractors short term temporary markers (Floppys)placed for lanelines and centerlines
only(no edgelines or shoulders). No Tape removal.Short Term Temporary markers are to be placed so that striping
may be placed before removal of temporary markers.
• This quotation excludes Primary Liability Insurance greater than$2.000,000.
• This quotation excludes all work associated with the project SWPP and WPCP.
• This quotation excludes installing permanent striping while other operations are in progress on Jobsite.
• This quotation excludes the removal &disposal of hazardous grindings&spoils from jobslte.
• EXCLUDE: Encroachment Permit(If required to be provided at No Cost to Chrisp Company)
• EXCLUDE: ALL Safety Training,Badging, Drug Testing and Orientation(To be paid at time and material Cal-Trans
• Access/and or Accessibility by 1 Ton Vehicle required for Chrisp Company work
• EXCLUDE:Advanced posting of"No Parking"signs
Page 2 of 3
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l.((1WJp __ --_rczszy 61# EXTRA WORK Contractors License No.374600
Fremont Office
DIR Registration No.1000000306
43650 Osgood Rd
A General Engineering
Fremont CA 94539 C-13 Fence,Wire,wood
Phone: (510)656-2840 Fax: (510)656-2397 C-32 Highway Improvement
Quotation
• ALL Bid items shall NOT be adjusted or removed without written I or verbal permission.
• EXCLUDE:Lead Compliance Plan
• Retainage percentage on monthly progress payments to be no greater than the percentage retained by the Owner on
its payment to the Contractor. If Owner reduces the retainage percentages on payments to the Contractor,the
Contractor shall likewise reduce the retainage percentage on payment to Chdsp Company. Full retention to be
released no later than thirty, (30)Days after completion of Chrisp Companys work. Excessive or delinquent
retainage will be subject to the highest interest rate allowed by law.
• Chrisp Company shall be reimbursed the full amount for bonds upon submission to General Contractor. Retention
shall not be held from bond reimbursement.
• THIS QUOTATION IS BASED ON A STANDARD MONDAY THROUGH FRIDAY WORK WEEK.ADDITIONAL COSTS WILL
OCCUR FOR WORK PERFORMED ON WEEKENDS
• CHRISP COMPANY WILL USE EXISTING EMPLOYEE POOL TO PERFORM ALL WORK ON THIS PROJECT.IF THERE
ARE ANY HIRING GOALS FOR THIS PROJECT THIS WILL BE EXCLUDED
Page 3 of 3
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Taxpayer Identification Number(TIN)
Enter your TIN N the appropriate box The TIN provided must match the name given on Une 1 to avoid seas eewlry mmnber
backup wMholdng.For Individuals.this Is your social seamy number(S8M.However,fora resident
Alen,sole proprietor,or disregarded entity,see the Part I Instructions or.page 3.For other entitle;It Is -
your employer idntlhiceedn number(EIN)If you do not have a naMer,see How to get a TIN on page 3. or
Note.N the account Is In more than one name,see the than on page filer guidelines on vbose Employer WMnutbn mention
^amber to enter. 94 : 2578099
Igall Certification
Under penalties of perjury.I only that:
1. The number shown on Ns form Is my correct tapayer Identification number(or I am waiting for a number to be Issued to me).and
2. I am not subject to backup MtNmdng because:(a)I am exempt from backup wMthuldng,or h)I have not been notified by the Internal
Revenue Service(1RS)that I am alibied to backup withholding as a result of a Itllure to report ell Interest CO dividends,or(c)the IRS has
notified me that I am no longer eubNd to Nana withholag,and
3. I am a U.S dtzen or other U.S.person(defined beloW).
CerlNosan Instruction.You must cross out Item 2 above It you have bean notified by the RS that you are currently subject to backup
wltMddlrg because you have failed to report al Interact and dvidends on your tax ohm.For real estate transaction;Item 2 does not apply.
For mortgage Interest paid.acgulailln or abandonment of secured property,cancellation of debt.contributions to an IndMdm retirement
arrangement MA),and generally,payments other than Merest and addenda,you are not repand to sign the Certification,but you must
Provide yar correct TIN.See
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en page 4.
HereSlUs.n es,ofpersone + � ��� CMS la 10/25/17
General instructions oenniaon of a U.S person. For federal tax purposes, you are
considered a U.B.person ifyou are:
Section references we to the Internal Revenue Code unless •M Irdivduai who Is a U.S.either or U.S, resident alien,ctn./noise noted. •A partnership.corporation company,a association created or
Purpose of Form aganeed In the United Stales or under the laws of the United
A person who is required to file an information return with the Slates.
IRS must obtain your correct taxpayer identification number(TIN) •M estate(other than a foreign estate),or
to report.fa exarrpa.Income paid to you,real estate •A domesik trust(as defined In Regulatbns section
transactions,mortgage Merest you paid,acquisition or 301.7701-7).
abandonment of served properly,cancellation of debt.or Special rules for patnarsNps.Partnerships that conduct a
contributions you made to an IRA trade a business In the United States we generally required to
Use Form W-9 only N you we a U.S. person(Including a pay a withholding tax or.any foreign partneri share of Income
resident alien),to provide your cared TIN to the person Iran such bnalnere. Further,In certain cases where a Form W-9
requesting ft(the requests)and,when applicable,to has not been received,a partnership is required to presume that
1.Certify that the RN you are Ning is correct(a you are a partner Is a foreign person.and pay the withhdding tax.
wailing for a number to be Issued), Therefore,d you are a U.S.parson that Is a partner in a
2.Certify that you ore not subject to backup withholding,or partnership conducting a trade or business In the United States.
provide Form W-9 to the partnership to establish your U.S.
3.Claim exemptbn from backup withhdding if you are a U.S. status and avoid withholding On you share of partnership
exempt payee.N ppliable,you we also artiying that as a income.
U.S. person,your allocable share of any partnership Income from The person who gees Form W-9 to the partnership for
a U.S.trade or business Is not subject to the wthhddl g tax on pa yes of establishing its U.S.status and avoiding withholding
foreign partners'share of effectively connected income. on its allocable share of net income from the partnership
Note.If a requester gives you a form other than Form W-9 to conducting a trade or business In the United States Is In the
request your TIN,you must use the requester's lam If it is mowing cases:
substadaly similar to this Form W-9. •The U.S.owner of a disregarded entry and not the entity.
Cat.No.10230( fmn W-9 piss.10-2007)
v
ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDAMW)
Li 10/25/2017
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGATION IS WAIVED,subject to the terms end 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).
CONT
PRODUCER NAME.CT Certificate Department
Arthur J.Gallagher 8 Co. Insurance Brokers
ran ,,,.925-299-1112 FAX
Nnr 925-953-6270
of California, Inc. I LIC#0726293 Was,.`
3697 Mt. Diablo Blvd.,Suite 300 s,.CertRequests@ajg.com
Lafayette CA 94549 INSURER(S)AFFORDING COVERAGE NAM I
INSURER A:Zurich American Insurance Company 16535
INSURED CHRICOM-02 INSURER B:
Chrisp Company INSURER C:
43650 Osgood Road
Fremont,CA 94539 INSURER D.
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1311094783 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 ADDL SUER POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INS YNDi POLICY NUMBER IMMIDDIYYYYI (MMTDIYYYYI LIMITS
A g COMMERCIAL GENERAL LIABILITY Y 'OLD 0217730-01 12/1/2018 1211/2017 EACH OCCURRENCE $1.000.000
DAMAGE TO RENTED
CLAIMS.MADE OCCUR
RUM 310000
PREMISES(Es occurtBnce) $50,000
% MED EXP(My tone cereal) $5,000
% DFnlnff. PERSONAL&ADV INJURY $1,000,000
GENI AGGREGATE LIMIT APPLIES PER'. GENERAL AGGREGATE $2,000,000
POLICY I A 1 JEECT LOC PRODUCTS.COMP/OP AGG $2,000,000
OTHER: $
INEO
COM
A AUTOMOBILE LIABILITY BAP 0217729-01 121112015 12/1/2017 BSIN41k LIMB $
IESMINLD 1.000,000
X ANY AUTO BODILY INJURY(Per pMRM) $
— OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS ONLY AUTOS
X AV OS ONLY % NON-OWNED PROPERTY DAMAGE $
AUTOS ONLY (Per ashen)
$
UMBRELLA LIAB — OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS.MADE AGGREGATE $
DED RETENTION$ $
A WORMERS COMPENSATION WC 0217731-01 12/1/2016 12/1/2017 X STATUTE FRH
AND EMPLOYERS'LIABILm'
ANY PROPRIETOWPARTNER/EXECUTIVE YO NIA E.L.EACH ACCIDENT $1,000,000
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $1,000,000
ny CRaIPTWYJN OF l»OF0
OESOPERATIONS below EL DISEASE-POLICY LIMIT $1,000,000
[SEE ATTACHED SUPPL.PAGE)
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached If more space Is required)
Chrisp Job#: IL.7064.
RE:Repaint Curbs Project,Los Altos Hills,CA.
ADDITIONAL INSURED(S):The Town of Los Altos Hills,it's elective and appointed officers,employees,and volunteers.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of Los Altos Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
26379 Fremont Road ACCORDANCE WITH THE POLICY PROVISIONS.
Los Altos Hills CA 94022
AUTHORIZED REPRESENTATIVE
All
I
®1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD
�d v
410
AGENCY CUSTOMER ID:
LOC 8:
ACORD ADDITIONAL REMARKS SCHEDULE Page of
AGENCY NAMED INSURED
MIXT NUMBER
CARRIER NAD:CODE
EFFECTiE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:
Additional Information
GENERAL LIABILITY:
•Additional Insured if required by written contact per attached FormU—GL-1175—F Cif (04/13)
'Coverage is Primary/Non-Contributory if required by written contract per anacnea U—GL-1175—F CM (04/13)
WORKERS COMPENSATION:
'Covered States:California.Nevada.Oregon
ACORD 101 (2008/01) @ 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
V
0
Additional Insured —Automatic — Owners, Lessees Or ZURICH
Contractors
Policy No. Eff. Date of Pd. Exp. Date of Pd. I Eff.Date of End. Producer No. Addl.Prem Return Prem.
GLO 0217730-01 12/01/2016 12/01/2017 12/01/2016
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
Named Insured:
Address(including ZIP Code):
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
A. Section II—Who Is An Insured is amended to include as an additional insured any person or organization whom you
are required to add as an additional insured on this policy under a written contract or written agreement. Such person
or organization is an additional insured 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 or "your work" as included in the "products-completed operations
hazard",which is the subject of the written contract or written agreement.
However,the insurance afforded to such additional insured:
1. Only applies to the extent permitted by law:and
2. Wit not be broader than that which you are required by the written contract or written agreement to provide for
such additional insured.
B. With respect to the insurance afforded to these additional insureds.the following additional exclusion applies:
This insurance does not apply to:
"Bodily injury", "property damage"or"personal and advertising injury"arising out of the rendering of, or failure to
render,any professional architectural, engineering or surveying services including:
a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys,
field orders,change orders or drawings and specifications:or
b. Supervisory, inspection, architectural or engineering activities.
This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the
supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence"which caused the
"bodily injury" or"property damage", or the offense which caused the "personal and advertising injury', involved the
rendering of or the failure to render any professional architectural, engineering or surveying services.
U-GL-1173F CW(04/13)
Page l of 2
Includes copyrighted material of Insurance Services(Mice,Inc..with its permission.
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C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV —
Commercial General Liability Conditions:
The additional insured must see to it that:
1. We are notified as soon as practicable of an"occurrence or offense that may result in a claim;
2. We receive written notice of a claim or"suit"as soon as practicable;and
3. A request for defense and indemnity of the claim or"suit"will promptly be brought against any policy issued by
another insurer under which the additional insured may be an insured in any capacity. This provision does not
apply to insurance on which the additional insured is a Named Insured if the written contract or written agreement
requires that this coverage be primary and non-contributory.
D. For the purposes of the coverage provided by this endorsement:
1. The following is added to the Other Insurance Condition of Section IV — Commercial General Liability
Conditions:
Primary and Noncontributory insurance
This Insurance Is primary to and will not seek contribution from any other insurance available to an additional
insured provided that:
a. The additional insured is a Named Insured under such other insurance; and
b. You are required by written contract or written agreement that this insurance be primary and not seek
contribution from any other insurance available to the additional insured.
2. The following paragraph is added to Paragraph 4.6.of the Other Insurance Condition of Section IV—Commercial
General Liability Conditions:
This insurance is excess over:
Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional
insured, in which the additional insured on our policy is also covered as an additional insured on another policy
providing coverage for the same'occurrence,offense, claim or"suit". This provision does not apply to any policy
in which the additional insured is a Named Insured on such other policy and where our policy is required by a
written contract or written agreement to provide coverage to the additional insured on a primary and non-
contributory basis.
E. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement
showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to
that identified additional insured.
F. Wth respect to the insurance afforded to the additional insureds under this endorsement, the following is added to
Section III—Llmks Of Insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
1. Required by the written contract or written agreement referenced in Paragraph A.of this endorsement; or
2. Available under the applicable Limits of Insurance shown in the Declarations,
whichever is less.
This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations.
All other terms and conditions of this policy remain unchanged.
U GL-0175-F CW(04/13)
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Includes copyrighted material of Insurance Services Office.Inc.,wit,its permission.
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To: CONTRACTOR
From: Town of Los Altos Hills
Re: Agreement Transmittal Memo
Enclosed, please find the following documents:
AGREEMENT — If you require a fully executed, signed original of the
Agreement for your records, please photocopy the Agreement prior to signing
the enclosed document. Return both originals with your signature to the Town
and a fully executed Agreement will be returned.
IRS FORM W-9 — Request for Taxpayer Identification Number (TIN) and
Certification. This form is required for all vendors of the Town and it is
important that you provide the Town with the correct TIN. If your company is a:
Sole Proprietorship - The taxpayer identification number must be the
social security number of the sole proprietor.
-OR-
Partnerships or Corporations — The taxpayer identification number must
be the employer identification number issued to the partnership or
corporation.
Once all documents have been completed, please return the signed Agreement(s) and
IRS Form W-9 to the following address:
Town of Los Altos Hills
Contracts
26379 Fremont Road
Los Altos Hills, CA 94022
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