HomeMy WebLinkAboutGrimes Natural landscape, Inc. V
AGREEMENT
THIS AGREEMENT Is made and entered into on thea/siday of & c3f t , 2014 by
and between the TOWN OF LOS ALTOS HILLS (hereinafter referred to as "TOWN")
and Grimes Natural Landscape, Inc. (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:
Install 1 Claifornia gold boulder (1,000 lbs) with carved bowl
for Dog Park water fountain.
2. EXHIBITS. The following attached exhibits are hereby incorporated into and made
a part of this Agreement:
Proposal from CONTRACTOR dated October 20, 2014
3. TERMS. The services and/or materials furnished under this Agreement shall
commence ie-3/-/'1 and shall be completed by //- ;,' , unless terminated
pursuant to Section 5(f).
4. COMPENSATION. For the full performance of this Agreement:
a. TOWN shall pay CONTRACTOR an amount not to exceed One thousand seven
hundred fifty dollars and zero cents ($1,750.00) 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.
Town of Los Altos Hills Page 1 of 4
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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.
iii. 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
Shod am,
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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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V
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: CONTRACTOR.
Richard Chiu
Public Works Director
Town of Los Altos Hills By:
26379 Fremont Road SigSure Date
Los Altos Hills, CA 94022
(T21rr S +' lit
Print name, Title
TOWN OF LOS ALTOS HILLS:
ifittla
By:
Carl Cahill,-City Manager Date
Town of Los Altos Hills Page 4 of 4
Shod form
Updated 4123110
.4iieut ! lo (.2o f .'Lc3l4
Grimes Naturai Landscape `
Custom Design&Construction Since st 1949 ' iltkb
www.gnmesnaturailandscapecom •ti 4'*n
Los Altos HiOgCA Uc#517810 j'•"- ' J '
City of Los Altos Hills
26379 Fremont Rd
Los Altos Hills, Ca 94022
bog Park water fountain estimate
Install 1 California gold boulder (1,000 lbs) with carved bowl. Install 6"x6"
steel square tubing 3' tall with self shutting water valve. Turning the valve
will fill water bowl from the bottom. Surround area with small to large size
gravel.
Estimate $1,500
Self shutting valve $250
$1,750
it
Foe, W-9 Request for Taxpayer Give tore to the
pew.Octtha 2007) Identification Number and Certification requester.Do not
oepatonent erne Trendy send to the IRS,
Internal Ree„ie Ser.,m
Name(as shown on your Insane Oce return)
71r> ;I,�/)(I/ /I L- t. rt,'D`r;•A1 /Ai(.
Bustin•.name,X differenttam above
Check appropriate box, 0 ktlNIdu /So pt ylNta p,Lorperaaan ❑ partnership
0 Limited liability company.Enter the to deeaM®ibt(ndbrparded rattily,Gmrpaatbn,Pywrmeralrp) ❑ Exempt
ti
payee
❑ aber(saei bucmg -
£$ Address(neer,etre,end qn or suite not —_---- Requestr'e nate and address tt0lorel)
�.. a / j/- ')• I Tann of La Altos WIN
n Oily•mate,and ZIP code ' / ; /� 2837BFrement Read
Loc RATOS y-T/a-l1� ( '/}. %40 ) Los Altos1911s,CA 94022
Lit•ccamt number-is)here(optional)
Part I Taxpayer Identification Number(TIN)
Enter your TIN In the appropriate box.The TIN provided must match the name given a line 1 to avoid snow sewing number
badap w4hhcitig. For indleduae,this Is your social security number(BBN).However,to a resident
alien,sole proprietor,or cloregerded entity.see the Part I instmdlcns on page 3. For other enfiea,n is
your employer Identification number(EIN). If you do not have a number.see How to gets TW on page 3. Of
Note.X the account Is b more than one name,see the chart at page 4 for guidelines on whose Employern�// IdolisationrnI
� fineither
number to enter. /T : 5/ 5
Part II Certification
Under penalties of perjury,I certify that:
I. The number shown on Ns form is my comm taxpayer Identification number(or I ern wafting for a number to be Issued to me),and
2. I am not subject to backup withholding because:(a)I am exempt from backup wXhholdng,or(D)I have not been notified by the Internal
Revenue Sonice(IRS)that 1 am abject to backup withholding as a result of a faIlure to report all Interest Cr dividends,or(c)the IRS has
notified me that I an no longer albiect to backup withholding,and
3. I am a U.S.citizen or other U 8.person(defined below).
certification Instructions.You must arose out nen 2 above if you have bean notified by the IRS that you ere currently subject to backup
Withholding because you have failed to repel el interest and dvidands on your lax return.For real estate transactions,Item 2 does not eater
For mortgage Interest paid,acquisition or abandonment of'embed property.cancellation of debt,contribution to an individual retirement
arrangement(IR().and general) -. ,rite other than Interest and divdends,you are not reasred to sign the Certification,but you must
provide your correct TIN.S:- no on page 4.
Sign Stratum 1 /U/�! //,I'_—
Here us.pear _ oats a `(
General Instruo • s Denntnon of a U.S. person. For federal tax purposes, you are
considered a U.S.person If you are:
Section references are to the Internal Revenue Code Unless
otherwise noted. • An individualindividualwho is a U.S.citizen or U.S. resident alien,
• A partnership. corporation,company.a association created or
Purpose of Form organized In the United Stales or under the laws of the Untied
A person who Is required to file an information return with the States,
IRS must obtain yew correct taxpayer Idempication number(TIN) •An estate(other than a feign estate),or
to repot,for example,Income paid to you, real estate • A domestic trust(as defined In Regulations section
transactions, mortgage Interest you paid, acquisition or 3017701-7).
abandonment of secured property, cancellation of debt,or speoW rules for partnerships.Partnerships that conduct a
contributions you made to an IRA. trade a business in the United States are generally required to
Use Form W-9 only if you are a U.S. person(Including a pay a withholding tax on any foreign partnere'share of Income
resident alien),to provide your correct TIN to the person from such business. Further,In certain cases where a Form W-9
requesting X(the requester)arid,when applicable,to: has not been received,a partnership Is required to presume that
1.Certify that the TIN you are giving Is correct(a you are a partner Is a foreign person, and pay the withholding lax.
waiting for a number to be Issued), Therefore, X you we a U.S.person that Is a partner In a
2.Certify that you are 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 Us.
3.Claim exemption from backup withholding X you em a U.S. status and avoid withholding on your share of partnership
exempt payee. If applicable, you ere also certifying that as a Income.
U.S. person, your allocable Share of any partnership income from The parson who gives Form W-9 to the partnership for
a U.S.trade or business is not subject to the withholding tax on
foreign partners'share of effectively connected income purposes of allocable
Its V.S. a status and avoiding w9hholtling
on Its ctingaa shoe d net income from the StTa in
Note.t a requester gives you a form quest than Form W-9 to conducting g c a trade or business In the United States N In the
request your TIN,you must use the requester's form If ft is following cases:
substantially similar to this Form W-9. • The U.S. owner of a disregarded entity and not the entity,
Cm.No.10231X Fam W-g g v.10-2007)
•
4110
aka GRIMNAT-01 TAVE AVE
AR 9CERTIFATE OF LIABILITY INSUANCE 1/2912014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER (866)340-2247 War. Sharon E.Harris,CIC
CoreMark Insurance Services,Inc. PHONE FAX
License 40172684 �AJc tick EMI: (AIL,Net:916-923-2797
2520 Venture Oaks Way,Suite 240 ACORES&:SharrisgArmstrongprofessional.com
Sacramento,CA 958334228 INSUREWS)APEOROING OVERAGE MICR
INSURER A:Argonaut Great Central Insurance Company
INSURED Grimes Natural Landscape Inc. imam e:State Compensation Insurance Fund
28010 Elena Road INSURER C:
Los Altos Hills,CA 94022- INSURE°:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR ADPL5UIN POLICY BEE POuCVEXP
LTR TYPE OF ISUMNCE EMI MD POLICY NUMBER IMYDDWYYI 01101/1:0.fWYY1 llr'11Ta
GENERAL UABAITY EACH OCCURRENCE f 1,000,000
A X COMMERCIAL GENERALLIABILITY X LAN290100700 1/31/2014 1/31/2015 DMMGEroRENTED 100,000
PREMISES(Ea owmmoal S
CLAIMSMADE X OCCUR MED EXP(Any one person) f 5,000
PERSONAL a ADV INJURY f 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENY AGGREGATE UNIT APPLIES PER: PRCWCTS-CCMP/OP AGG a 2,000,000
POICYPFP I ILO f
AUTOMOBILE LIABILITY COMBINED LIMIT $
ANY AUTO BODILY INJURY(Per person) $
ALA OWNED SCHEDULED BODILY INJURY
AUTOS AUTOS rye,amtlmJ) f
HIRED AUTOS AUTOS DAMAGE
PROPERTY DGE
AUTOS (PER ACCIDENT) f
S
UMBRELLA LMB OCCUR EACH OCCURRENCE f
EXCESS MB CLAIMS-MADE AGGREGATE a
DED RETENTIONS $
WORMERS COMPENSATION X NCORY LMSTAITU-1 I0T-
ANDF]FLOYERS'MBIUTY TT£I ER
B ANYYIPPR EINeCJExRTNER CUTIVEYY NIA 908737014 2/1/2014 2/1/2015 EL EACH ACCIDENT $ 1,000,000
(Mslidatoly In NHI E.L.DISEASE-EA EMPLOYEE f 1,000,000
yesbe under
DESCRIRTRN OF OPERATIONS below EL.DISEASE-POLICY LIMIT f 1,000,000
OESLWPI1ON OFOPERATMINS/LOCATIONS/VEHICLES(Attach ACORD tel,Additional Remarks SCMdle,N Imre Space InrguIled)
Certificate Holder is named as additional insured per attached AGCG2010BPN0704
CERTIRCATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of Los Altos Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
Attn:Eric Christiansen ACCORDANCE WITH THE POLICY PROVISIONS.
26379 Fremont Road
Los Altos Hills,CA 94022- AUTHORIZED REPRESENTATIVE C1/1
_
W1988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
STATE v ENDORSEMENT AGREEMENT 400
EXECUTIVE OFFICERS REP 06
FUND
MINIMUM/MAXIMUM LIMITS 9087370-14
NEW
NF
HOME OFFICE 1-14-81-07
SAN FRANCISCO EFFECTIVE FEBRUARY 1, 2014 AT 12.01 A.M. PAGE 1 OF 1
ALL EFFECTIVE DATES ARE
AT 12:01 AM PACIFIC
STANDARD TIME OR THE
TIME INDICATED AT
PACIFIC STANDARD TIME
GRIMES NATURAL LANDSCAPE INC.
28010 ELENA ROAD
LOS ALTOS HILLS, CA 94022
ANY CONTRADICTION BETWEEN THE POLICY AND THIS ENDORSEMENT
WILL BE CONTROLLED BY THIS ENDORSEMENT.
IT IS AGREED THAT UNLESS OTHERWISE EXCLUDED BY ENDORSEMENT
THE ACTUAL REMUNERATION EARNED BY EACH EXECUTIVE OFFICER
DURING THE POLICY PERIOD SHALL BE USED AS THE BASIS OF
PREMIUM, SUBJECT TO
THE MINIMUM AMOUNT OF $ 42,900 PER ANNUM
AND THE MAXIMUM AMOUNT OF $ 109,200 PER ANNUM
AS SPECIFIED IN THE CALIFORNIA WORKERS' COMPENSATION
UNIFORM STATISTICAL REPORTING PLAN, FOR WORKERS'
COMPENSATION INSURANCE IN EFFECT DURING THE POLICY PERIOD.
NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE
OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS
POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE
HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR
LIMITATIONS OF THIS ENDORSEMENT.
COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: FEBRUARY 3, 2014 [�
a 1 1'YJHY C�yF�
AUTHORIZED REPRESENTA???IIVE PRESIDENT AND CEO 3015
SCF FORM 10217 (REV.1-20121 OLD OP 217
Allstate.'rain Intwed hands
` V
DM CW 02 01 10
Poky Number
048862936
COMMON POLICY DECLARATIONS
Allstate Insurance Company
2775 Sanders Road, Northbrook, IL 60062
A STOCK INSURANCE COMPANY
hem 1. Named Insured and Mailing Address Agent Name and Address
GRIMES NATURAL LANDSCAPE INC DAN LORBER AGENCY
28010 ELENA ROAD 730 E ELCAMINO REAL A
LOS ALTOS HILLS CA 94022 SUNNYVALE CA 94087
Iem2. Policy Period From: 02-01-2014 To: 02-01-2015
at 1201 A.M.,Standard Time at your miring address shown above.
Item 3. Business Description:
Form of Business: CORPORATION
Item 4. In return for the payment of the premium, and subject to all the terms of this policy,we agree with you to
provide the insurance as stated in this policy.
This policy consists of the following coverage parts for which a premium is indicated. Where no premium is shown, there
is no coverage. This premium may be subject to adjustment.
Coverage Pars) Premium
Commercial Property Coverage Part
Commercial General Liability Coverage Part
Crime and Fidelity Coverage Part
Commercial Inland Marine Coverage Part
Commercial Auto(Business or Truckers)Coverage Part $ 13, 675.00
CorTvrlerclal Garage Coverage Part
Terrorism Risk Insurance Act Coverage
Total Policy Premium $ 13,675.00
Item 5. Forms and Endorsements
Form(s)and Endorsement(s)made a part of this policy at tine of issue:
See Schedule of Forms and Endorsements
SEE THE IMPORTANT PAYMENT INFORMATION FORM FOR DETAILS ABOUT PAYMENT OPTIONS
Countersigned:
Date: 01-16-14 By: DAN LORBER AGENCY
aaaYYyXX�
Authorized Representative
[h THIS COMMON POLICY DECLARATION AND THE SUPPLEMENTAL DECLARATION(S),TOGETHER WITH THE COMMON POLICY CONDITIONS,
COVERAGE PART(S),COVERAGE FORM(5)AND FOFVAS AND ENDORSEMENTS,IF ANY,COMPLETE THE ABOVE NUMBERED POLICY.
9Utl4R-
OM CW 02 01 10 Allstate Insurance Company
Insured Full COPY
•
®Allstate.
ITEM TWO
SCHEDULE OF COVERAGES MID COVERED AUTOS
This policy provides only those coverages where a charge is shown in the premium column below. Each of these
coverages will apply only to those "autos" shown as covered "autos". "Autos" are shown as covered "autos"
for a particular coverage by the entry of one or more of the symbols from the Covered Autos Section of
the Business Auto Coverage Form next to the name of the coverage.
COVERAGES CA OS OMIT PREMIUM
$1, 000, 000 Combined Single Limit
LIABILITY 07, 1Per Pelson/Per Occurrence $ 10,568
Properly Damage
PERSONAL INJURY SEPARATELY STATED IN EACH P.I.P.ENDORSEMENT
PROTECTION(or equivalent MINUS
No-fault Coverage) DEDUCTIBLE.
ADDED PERSONAL INJURY SEPARATELY STATED IN EACH ADDED P.I.P.
PROTECTION(or equivalent ENDORSEMENT.
Added No-fault Coverage)
PROPERTY PROTECTION SEPARATELY STATED IN THE P.P.I.
INSURANCE(Michigan only) ENDORSEMENT MINUS DEDUCTW F FOR
EACH ACCIDENT.
AUTO MEDICAL PAYMENTS 07,1 $ 1, 000 $ 484.00
MEDICAL EXPENSE AND SEPARATELY STATED IN EACH MEDICAL
INCOME LOSS BENEFITS EXPENSE AND INCOME LOSS BENEFITS
(Virginia only) ENDORSEMENT.
MEDICAL EXPENSE BENEFITS
EACH PERSON
INCOME LOSS BENEFITS
EACH PERSON
UNINSURED MOTORISTS $1,000, 000 Combined Single Limit
07, 1Per Person/Per Occurrence $ 1, 608.00
Property Damage
UNDERINSURED MOTORISTS $1,000, 000 Combined Single Limit
(Wien not included in Uninsured
Motorists Coverage) 7 Per Person/Per Occurrence INCL
Property Damage
PHYSICAL DAMAGE AC NAL CASH VALUE OR COST OF REPAIR,
COMPREHENSIVE COVERAGE WHICHEVER IS LESS,MINUS See Sched
07, 1 DEDUCTIBLE.FOR EACH COVERED AUTO,BUT NO $ 310.00
DEDUCTIBLE APPLIES TO LOSS CAUSED BY
FIRE OR LIGHTNING.
See ITEM FOUR For Hired Or Borrowed'Autos'.
PHYSICAL DAMAGE ACTUAL CASH VALUE OR COST OF REPAIR
SPECIFIED CAUSES OF LOSS WHICHEVER IS LESS,MINUS
COVERAGE DEDUCTIBLE FOR EACH COVERED AUTO FOR LOSS
CAUSED BY MISCHIEF OR VANDALISM.
See ITEM FOUR For Hired Or Borrowed Autos.
PHYSICAL DAMAGE ACTUAL CASH VALUE OR COST OF REPAIR,
COLLISION COVERAGEWHICHEVER IS LESS,MINUS See Sched
07, 1 DEDUCTIBLE,FOR EACH COVERED AUTO. $ 705.00
See ITEM FOUR For Hired Or Borrowed'Autos'.
PHYSICAL DAMAGE TOWING FOR EACH DISABLEMENT OF A
AND LABOR PRIVATE PASSENGER AUTO.
TAX/SURCHARGE/FEE
PREMIUM FORENDORSEMEHTS
'ESTIMATED TOTAL PREMIUM $ 13,675. 00
'This policy may be subject to final audit.
sU„4A.3 DA CW 01 0310 Allstate Insurance Company Page 2
Inured Full Copy
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V
POLICY NUMBER: LAN2901007-00 COMMERCIAL GENERAL LIABILITY
CG DS011001
COMMERCIAL GENERAL LIABILITY DECLARATIONS
Argonaut Group Alteris Insurance Services, Inc.
225 West Washington Street 250 Summer Street
._-. 24th Floor 3rd Floor
Chicago, IL 60606 Boston, MA 02210
NAMED INSURED: Grimes Natural Landscape Inc
MAILING ADDRESS: 28010 Elena Road
Los Altos Hills,CA 94022
-.. POLICY PERIOD: FROM 01/31'2014 TO 01!31/2,015 AT 12:01 A.NL TBIE AT
YOUR MAILING ADDRESS SHOWN ABOVE
IN RETURN FOR THE PAYMENT OF PREMIUM,AND SUBJECT TO ALL THE TERMS OF THIS POLICY,
WE AGREE WITH YOU TO PROVIDE THE INSURANCE AS STATED IN THIS POLICY.
LIMITS OF INSURANCE
EACH OCCURRENCE LIMIT $ 1,000,000
DAMAGE TO PREMISES
RENTED TO YOU LIMIT $ 100,000 Any one premises
MEDICAL EXPENSE LIMIT $ 5,000 Any one person
PERSONAL&ADVERTISING INJURY LIMIT $ 1,000,000 Any one person or organization
GENERAL AGGREGATE LIMIT $ 2,000,000
PRODUCTS/COMPLETED OPERATIONS AGGREGATE LIMIT $ 2,000,000
—is, PESTICIDE HERBICIDE APPLICATORS COV-OCC LIMIT $ 1,000,000
PESTICIDE HERBICIDE APPLICATORS COV-AGG LIMIT $ 1,000,000
RETROACTIVE DATE(CC 00 02 ONLY)
THIS INSURANCE DOES NOT APPLY TO"BODILY INJURY", "PROPERTY DAMAGE"OR"PERSONAL AND
ADVERTISING INJURY" WHICH OCCURS BEFORE THE RETROACTIVE DATE,IF ANY,SHOWN BELOW.
^'
RETROACTIVE DATE: None
(ENTER DATE OR"NONE"IF NO RETROACTIVE DATE APPLIES)
DESCRIPTION OF BUSINESS
FORM OF BUSINESS:
❑ INDIVIDUAL 0 PARTNERSHIP 0 JOINT VENTURE ❑ TRUST
❑ LIMITED LIABILITY COMPANY p✓ ORGANIZATION,INCLUDING A CORPORATION(BUT NOT IN-
- CLUDING A PARTNERSHIP,JOINT VENTURE OR LIMITED LIABILITY
COMPANY)
BUSINESS DESCRIPTION: Landscape Gardening, Lawn Care Services
CG DS 01 10 01 G'ISO Properties,Inc.,2000
E
(Si `i !
ALL PREMISES YOU OWN,RENT OR OCCUPY f
LOCATION NUMBER ADDRESS OF ALL PREMISES YOU OWN,RENT OR OCCUPY
1 28010 Elena Road,Los Altos,CA 94022 !
2 910 S McGlincy Lane,Campbell,CA 95008
CLASSIFICATION AND PREMIUM
LOCATION CLASSIFICATION CODE PREMIUM RATE ADVANCE PREMIUM II
NUMBER NO. BASE Prem/ Prod/Comp Preto Prod/Comp
Ops Ops Ops Ops C
1 Landscape Gardening 97047+ payroll 11.884 Included 238 Included
1 AGO/3 Employee 4.400 50 a
Benefits
1 AG197 Landscapers 750.000 750
Workmanship Error-
Property Damage C
1 AG60R General 50.000 50
Liability Enhancement
2 Landscape Gardening 97047+ payroll 11.884 Included 4,987 Included C
2 Lawn Care Services 97050+ payroll 9.243 Included 555 Included
2 Contractors- 91585 cost 1.860 1.086 82 48 Ci
subcontmcted work-in
connection with ■
construction.
reconstruction,repair C
or erection of buildings
PREMIUM FOR ENDORSEMENTS $ 850.00 C
TOTAL PREMIUM(SUBJECT TO AUDIT) S 6,760.00 C
C
PREMIUM SHOWN IS PAYABLE: $ 6,760.00 AT INCEPTION $ 6,760.00
AT EACH ANNIVERSARY $ C
(IF POLICY PERIOD IS MORE THAN ONE YEAR AND PRE-
MIUM
L IS PAID IN ANNUAL INSTAL III�--MENTS) C
AUDIT PERIOD(IF APPLICABLE) E✓J ANNUALLY IE] SEMI-ANNUALLY QUARTERLY J MONTHLY C
Ci
ENDORSEMENTS
ENDORSEMENTS ATTACHED TO THIS POLICY: C
See Attached Form Schedule C
THESE DECLARATIONS,TOGETHER WITH THE COMMON POLICY CONDITIONS AND COVERAGE C
FORM(S)AND ANY ENDORSEMENT(S),COMPLETE THE ABOVE NUMBERED POLICY. C
C
Ci
C
CG DS 01 10 01 t1 ISO Properties,Inc.,2000 C
C
C