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Home My WebLink AboutGraniterock/Pavex - Project No. 11-CDD-183 - Change Order No. 1Citp of Oilrop Public Works Department - Engineering Division 7351 Rosanna St., Gilroy, CA 95020 Phone (408) 846 -0451; Fax (408) 846 -0429 CHANGE ORDER NO. 1 To contract for: Gilroy Crossing Offsite Improvements City Project No. Contractor: Pavex / Graniterock Construction Contract Date: 11 -CDD -183 2/22/2011 This order shall become effective when it has been signed by the City Administrator, City Engineer, Project Engineer, and Contractor. All copies forwarded to Contractor for signature shall be returned to the City of Gilroy properly filled out. Upon acceptance by the City, the Contractor's copy will be returned to him as his authority to proceed with the work. Description of Work Pavex is to be compenstated for remobilzation costs due to the start and stop of the project. Upon project re- design Pavex re- surveyed the project to represent the revised drawings dated 4/16/2012. (FO #1), and re- marked the faded survey hubs (FO #8). Pavex will be compensated for the cost of Caltrans enchroachment permits,signage updates (due to delays), additional potholing as requsted by the construction manager for unmarked utilities. Because of new design changes, the northbound left turning lane will need to be closed to construct the new median pedestrian island. Pavex is being directed to supply and install the proper signage as per the detour plan (HMH) dated 6/29/12 (FO #10). Per the new project design Pavex to be compensated for new perforated pipe wall drain system underneath the retaining wall. All requirements of the original Contract Documents shall apply to the above work except as specifically modified by this Change Order. The contract time shall not extend unless expressly provided for in this Change Order. By signing this Change Order, Contractor acknowledges and agrees that the adjustments to cost and time contained herein are in full satisfaction and accord, and are accepted as payment in full, for any and all costs and expenses associated with this Change Order, (the "Extra Work "), including but not limited to labor, materials, overhead and profit, delay, disruption, loss of efficiency and any and all other direct and /or indirect costs or expenses associated with the Extra Work and hereby waives any right to claim any further cost and time impacts at any time during and after completion of the Contract associated with the Extra Work. ► All Extra Work authorized under this Change Order must be billed separately from the original contract. All bills for work done under this Change Order shall reference this Change Order No. 1. (We) agree to make the above change subject to the terms of this Change Order for a NET INCREASE not to exceed $17,384.27 Original Contract Price Previous Change Orders Total to Date This Change Order Total Change Orders to Date Revised Contract Price CONTRACTOR By: i< 0� L PA 1L1 P O V 1 T- GL, Date: ^3O Cost Percentage Initial $248,844.00 0.00% $248,844.00 $17,384.27 $17,384.27 6.99% $266,228.27 RECOMMENDED BY: ACCEPTED BY: Construction Manag(er Date DAILY EXTRA WORK REPORT M 1 10 Gbange Order 01 City Of Gilroy co tcod. 940001 Billing Number 21.0 Contractor Job: 4162 - Gilroy Crossing Off Site Imp Report Date 6/04/2012 Work Porfonned By: Pavex Construction Perform Pate 6/03/2012 Description otwok Protect Planning Activltes �-,1: �. dedz4. Equipment Charges. - - ---- ._ - - - -- --- - - - -_— -- - -.____ __ Labor Charges __. -__ Labor Charges Invoice bate Vondor Nnmc /invoice Descri �tion -- - -- -- I -- — - - = -- -- 1.000 Ls Mo1 23130 Subs Rate Eidegded_ R T Labor 3 0 91.72 Craft ID cEm to ee Name RT Hrs Or Hrs Subs Units RT Rates .'_'_OT_Ratc -. -- _ 79.220 1,667.82 921.21 — 1.0_00 LS rot OE SUP2 CS Gebhart — 26.00 1.00 61.100 - -- — _ - 79 220 _ 158.44 OT Labor A$2 21 L02 OE SUP2 CS Gebhart - — — 2.00-- -- _ - -- - - - -- 81.515 _ 1.747.67 L03 OE SUP r DG Plummer _ _ __- - -- -- _ 24.00 _ _—_ 3.00 _... 62 630 - k.r, � a Labor Subtotal 3,573.93 Equipment Charges - OT Rates w Delay Factor Extendedr Subsistence 0.00 Equipment ID Description --------- - - - RT firs - -- - OT Hrs - RT Rate -- - - 19.980 539.46 - Other Expenses 0.00 Lot 15904 3/4 Ton Utility Truck - -- 27.00 -- -- - - -- - - 39.96 25.00% 893.4 — - - -- - eoa 15904 3/4 Ton Utility Truck 2.00 19.980 - - - - -- _ _ 539. 46 Mu - - eoa 15807 3/4 Ton Pickup 27.OU 19 980 Labor Total 4,467.42 Material /Specialist Work/Lump Sum or Unit Price Payment �-,1: �. dedz4. Equipment Charges. 64.91 ,xf 64.91 subtotal 1,118.88 Invoice No. -- - Invoice bate Vondor Nnmc /invoice Descri �tion -- - -- -- I -- — - - = -- -- 1.000 Ls Mo1 23130 5/0212012 Legacy Sanitation, Inc / Blue Room Equipment Total _ Moe 23770 5/17/2012 Legacy Sanitation, Inc / Blue Room _ 1.000 LS Mas 001 5/04/2012 Pavex Company / Small Tools Supplies 921.21 — 1.0_00 LS Moo 002 6/03/2012 Pavex Company / Move- In/Out Equipment — 1.000 LS 010704 Bill Total + 6,813.52 Page �-,1: �. dedz4. Equipment Charges. 64.91 ,xf 64.91 subtotal 1,118.88 55.83 55.83 Mu 15.00% 167.83 467.35 467.35 Equipment Total 1,286.71 333.12 -- 333.12 - Material Charges Subtotal 921.21 Mu 15.00% 138.18 Material Total 1,059.39 Activity Total 6,813.52 Bill Total + 6,813.52 Page Lepiq-1 gaAjtgthpti: line.. 311 OB asset.St Smite 'ECEI E Irwo 0 Swita. Cbra, CA k,4 A.Y 0 4 201? Number: 23110 Telephone i (*68-)727,77`60 QW: 02--Kay-42012 PXV N r. T I � R.:: N mber D M Fax,, (40&), 727-7704 D1 JIM SITE BIL, TO 248 Pavex I opi St 110 Granite- Rack. Wy G41'rey,, CA- 9,%-20 San Jose, CA 95136 Last Payrnerit.,batei Job NuMben 4962. ACcoUMt1hg•15, 27-Aptw201..2 - Job Site-Safance Summary Current: $64.91 90-oary+: $0,.0o 30-Day: $0.'0q TOW:Dge; HjbZ- - 6030. 54WIO Please Pay: Payment Terms: Net 30 S7 v0jq YOW=',d*qrdj Credit Gard Number 43ttj Expires Ztc, G'd Your, busYness1s.-opproa tedi AftnOrftfb Pay . liTliiU 'bfahk A per-Oilingcyple-Is�ppl .to'alV open Mvotces,after 45 to W days To Ekqr-qdqn VOtt".I.S.oryippe Type Quantity POO�POjr TW E tpjj$tO 02-may-2012 --> 1E May-2012 1,5 Rental- standard , ' I EV] $5:36 02-Miy=20T2 => 02-May-2012 I Delivery GhNege q -,Oo t 535:! 1 $35 o2-Mgy-2012 => 16,MaY7201,-z 15 VV6dkjY,;8erVfCe.- Standard Unit I $4S= $24.11 040totgi NonTaixed: Rate, prescription SO to tal T-d-tble,Rental: $5i36 6.25 Gilroy R6ntdl Tax: $0.44 Current Invoice, Total'. $64.91 - Job Site-Safance Summary Current: $64.91 90-oary+: $0,.0o 30-Day: $0.'0q TOW:Dge; HjbZ- - 6030. 54WIO Please Pay: Payment Terms: Net 30 S7 v0jq YOW=',d*qrdj Credit Gard Number 43ttj Expires Ztc, G'd Your, busYness1s.-opproa tedi AftnOrftfb Pay . liTliiU 'bfahk A per-Oilingcyple-Is�ppl .to'alV open Mvotces,after 45 to W days Legacy Sanitation Inc. 3730 Bassett St suite #B Santa Clara, CA 95054 Telephone: (408) 727 -7700 Fax: (408) 727-7704 BILL TO 248 Pavex 120 Granite Rock Wy San Jose, CA 95136 Invoice Number: 23770 Date: 17- May -2012 P.O. Number: JOB SITE 3969 10th St Gilroy, CA 95020 Last Payment Date: Job Number: 4162 Accounting ID: 11- May -2012 From => To Duration Unit/Service Type Quantity Price /Per Tax? Extension 17- May -2012 => 13- Jun -2012 28 Rental- Standard 1 $10.00 Q Q 510.00 17- May -2012 => 13- Jun -2012 28 Weekly Service- Standard Unit 1 $45.00 F-1 $45.00 Subtotal NonTaxed: $45.00 Rate Description Subtotal Taxable Rental: $10.00 8.25 Gilroy Rental Tax: $0.83 Current Invoice Total: $55.83 Job Site Balance Summary Current: $120.74 90 -Day +: $0.00 Please Pay: $55.83 30 -Day: $0.00 10 60 -Day: $0.00 Total Due: $120.74 Payment Terms: Net 30� Rental- Standard 1171083 Your business is appreciated) j. ii f� fiz If you would like to pay using your credit card, please fill in the following information: Credit Card Number Date Expires Sec Cd Signature A Late Charge of 1.5°% per billing cycle is applied to all open invoices after 45 ❑Check to enroll in auto -pay days Amount to Pay or leave blank to pay in full Job -To -Date Detail Account 4162.105020.6016 Document Number /L Date Invoice Number Equip. No Description T2 -10470 4/23/11 Payroll LaborDistibuaon T2 -10470 4123111 Payroll LaborDis0ibution T2 -10478 4123111 Payroll Labor Distribution T3 -10479 4123 /11 Actual Burden Journal Entries T3 -10479 4123/11 Actual Burden Journal Entries T2 -10498 5/14/11 Payroll Labor Distribution T2- 10498 5114/11 Payroll Labor Distribution T2- 10503 5/14/11 Payroll Labor Distribution T3 -10504 5114 /11 Actual Burden Journal Entries T3- 10504 5114111 Actual Burden Journal Entries T2 -11120 5/5/12 Payroll Labor Distribution T2 11120 5(M P.aydR� '1SS9i[o0' T2.11130 5/5/12 Payroll Labor Di3tdl>u0on T3 1�1 �LSGt a l l�tl��1lN O.bl9 , 7317;13] 5!5112.' MON it ep�ig({ip��Er�r es Units AnIount 0.00 158.37 6.00 168.48 0.00 - 158.37 0.00 121.28 0.00 40.63 0.00 65.99 2.50 70.20 0.00 -65.99 0.00 47.48 0.00 16.94 0.00 79.18 3:49' �4_Za 0.00 -79.18 1919 MOM ` --WO - -i1.56 Description L$141. :La:bor n/ Job -To -Date Detail Account 4162.105020.6920 Document Number G/L Dale invoice Number FQuip. No oscri Lion Units Arnount T5.10471 423/11 01936 TRUCK TRANSPORT 3.50 140.00 T5.10471 4/23111 16012 TRUCK TRANSPORT 2.50 100.00 TE- 1259049 4123/11 16013 TRAILER 2.50 45.00 TE- 1259480 4123111 01596 TRAILER 3.50 63.00 T5 -10499 5114/11 01936 TRUCK TRANSPORT 2.50 100.00 TE- 1265591 5/14/11 01596 TRAILER 2.50 45.00 TE- 1270613 614111 01596 TRAILER 1.50 27.00 T5.t 21, N0 0104" MM S -RO—T, &50, ia�a 75 11121;, 1P9 1661,2` ?w ; / f 5 Bil 1y % 7E 1'3Q�Q29 5/3123' 1Tt Tg_i OMQQ 499 __7rFW 2T 0 Description $192 Equipment Costs to Move -In/ Out (fob -To -Date Detail Account 4162.861040.6030 Document Number G/L Date Invoice Number Equip. No. Description Units Amount Description II -80880 4114/11 4162 CHRIS 0.00 33.40 TOW AWAY / NO PARKING 12 "X18" 11 -80880 4114/11 4162 CHRIS 0.00 2.25 HAND SANITIZER II -81060 4119/11 4162 RAY 0.00 17.85 SIDEWALK CLOSED 24X24 II -81060 4119/11 4162 RAY 0.00 2.65 STAPLES II -81061 4120/11 4162 RAY 0.00 38.39 LUTE RAKE POLE 11-81061 4/20111 4162 RAY 0.00 20.28 MARKER DIX 8717 II -81061 4120/11 4162 RAY 0.00 8.97 CEMENT UTILITY BRUSH 11 -81061 4/20/11 4162 RAY 0.00 54.04 48" LATH II -81061 4120/11 4162 RAY 0.00 27.06 SQUARE RAZORBACK SHOVEL II -81061 4120/11 4162 RAY 0.00 106.68 ALL LEATHER WORK GLOVES II -81235 4122/11 4162 RAY 0.00 33.40 TOW AWAY/ NO PARKING 12 "X18" II -81235 4122111 4162 RAY 0.00 89.25 OPEN TRENCH 24 X 24" II -81235 4122/11 4162 RAY 0.00 35.70 SIDEWALK CLOSED 24X24 11 -81235 4/22/11 4162 RAY 0.00 30.70 VIRTUA GRAY II -81549 5!11/11 4162 ROBERT L 0.00 90.85 1- 1/4" ASPHALT SPADE 11 -81630 5112111 4162 RAY 0.00 96.00 VISQUENE 20'X 100' 6MIL THICK PV- 952231 5/31/11 101 - 295434 United Site Services Inc 0.00 139.81 PV- 954897 6130/11 93484939 -001 United Rentals Inc 0.00 245.81 JE- 1338114 12/31/11 Wells One GRC December 2011 0.00 266.51 SPEEDY CLEAN II -86067 1127/12 4162 CRAIG 0.00 285.00 DUCTILE DIAMOND II -87722 514/12 4162 Craig: 0.00 92.80 MARKING PAINT FL PINK 11-87722 5!4/12 4162crai� 0.00 34.12 48" LATH II -87853 514/12 4162'KYi_E 0.00 7.14 TOW AWAY / NO PARKING 12 "X18" II -87853 514/12 4162 "KYLE 0.00 7.14 ROAD WORK AHEAD 24 X 24" 11 -87853 514112 4162 KYLE,- 0.00 2.65 STAPLES 11 -87853 514/12 4162 KYLE . 0.00 38.50 ARROW T -50 STAPLE GUN II -88678 6122/12 4162 0.00 16.80 2 -CYCLE ENGINE OIL, 6.4 OZ II -88678 6122/12 4162 0.00 4.67 BAR & CHAIN OIL (QUART) II -88678 6122/12 4162 0.00 13.85 UNION SQUARE SHOVEL II -88678 6122/12 4162 0.00 8.15 BROOM HANDLE 60" TAPERED II -88678 6122/12 4162 0.00 22.66 BROOM HEAD 24" STREET/ ORANGE 11-88678 6122/12 4162 0.00 2.65 STAPLES 11 -88678 6122/12 4162 0.00 46.40 MARKING PAINT FL PINK 11 -88678 6122/12 4162 0.00 27.02 48" LATH 0.00 1,949.15 DAILY EXTRA WORK REPORT City Of Gilroy cost code: 940100 contractor roc. 4162 - Gilroy Crossing Off Site Imp Work Performed By: Bestors Engineers, Inc. (For Pavex Construction) Description of work: Survey After Redesign Change order 005 Billing Number 22.0 Report Date 6/04/2012 Perform Date 6/04/2012 This Bill Has Been Plugged with No Details Labor Charges i Equipment Charges t (i I 4 i Material Charges "vity Taal 2,250.00 i I i f Subcontract Markup I` Sc 10.00% 225.00 Btu Subtotal 2,475.00 Bpi Tact + 2,475.00 Page NTS universal SM Form 010704 bwroucn - k:vwws.com SESTOR ENGINEERS, INC. �_ -� --- - - SURVEYING - LAND PLANNING I CIVIL ENGINEERING -3 9701 LLLUE LARKSPUR LANE. MCH UTEREV. CALIFORNIA 93940 (B311 373 -2941 • SALINAS 424 -76L31 • FAX 849••411B INVOICE rtU. 4731 GRANITE ROCK PAVEX 411 Walker Street Watsonville, CA 95076 Attn: Accounts Payable P.O. /CONTP,ACT NO. PROJECT• W0.6892.00 Gilory Crossing Construction Staking Pavex .lob #4162 DATE: 3 May 2012 For professicnai services rendered and reimbursable expenses incurred in April 2012 as follows: DESCRIPTION Extra Work #2: Restaked curb. Staked slope and prepared cutsheets. Agreed Previousiy ITEM Amount % Complete Total Invoiced Amount Due Extra Work #2 $2,250.00 100% 52,250.00 $0.00 $2,250.00 THIS INVOICE IS FOR PROFES=MAL SERVICES RENDERED AND FS DUE UPON RECEIPT. AFTER 94 DAYS, A SERVICE CHARGE MLL SE MADE AT A RATE OF 1 112% pER MONTH. T $,250.00 65 YEARS OF PROVIDING QUALITY ENGINEERING /SURVEYING SERVICES Project Name: Gilroy Crossing Offsite Improvements Project No: 11 -COD -183 FIELD ORDER City or Gilroy 4125/12 7387 Rosanna Street Gilroy, CA 95020 FIELD ORDER NO. 1 Project Name: GIROY CROSSING Ofl°SI.11i M9PROVENIENs us ('ontract Date: 02L)2/2011 1'o Contractor: Granite Rock Company d.b.a P1ve\ Construction Division Address: 411 Walker Street Watsonville. CA 95076 1)1:S('RIP1'I0N OF WORK: Due to the re- design of the Gilroy Crossing Project (directed by the ('OG). Paves is hereby given direction to re- survey the project as per the new design. This includes working with Cruz, Brothers locatirto and identifying unmarked ('altrans utilities and traffic loops thru potholing. i; r%Au V XAI aCDl1RT Lapor4nargs�t- � , RT`L(rt- ;OT Hrs? +5ubs`UnRS °' RT Rate .?xd.OT G�ratt Ip - ^•Emd�yee`Name � . u� RT Labor (t 61.100 t Lapor4nargs�t- � , RT`L(rt- ;OT Hrs? +5ubs`UnRS °' RT Rate .?xd.OT G�ratt Ip - ^•Emd�yee`Name � . ��= rte ed ; RT Labor 1.00 61.100 t.ot OE SUP2 CS Gebhart OT Labor 0.00 -CO2 LBR LBSP C Short Jr. _ 1.00 44.940 — L03 OE OE4 H Islas- Trej------ _ —, - - -- 1.00 _58.240 -_ -i E w 'C h' es ,,� p g y , r, 4 N t �t .�r e.' � RT,atirs UT Hrs V, RT RB�� Ettutp ertt ID's .� Descgptiort � , .x ._ . _. .. ., .w�: , ... , ... .�:,� .. , ., 20.01 E01 14893 GMC 3/4 TON 1.00 19.980 __- 52 15904 3/4 Ton Utility Truck 1.00 19.980 Em 16436 185 CFM Air Compressor 1.00 20.010 010704 xt'k Labor Charges ��= rte ed ; RT Labor 164.28 61.10 OT Labor 0.00 44.94 58.24 Subtotal Labor 164.28 traded Subsistence Other Expenses MU 25.00% Labor Total 0.00 0.00 41.08 205.36 19.98 19.98 20.01 Equipment Charges Subtotal 59.97 MU 15.00% 9.00 Equipment Total 68.97 Material Charges Activity Total 274.33 I Bill Total .F. Page 1 EWrouch - 274.331 120 Granite Rock Way San Jose, CA 95136 Tel: (408) 574-1400 Fax: (408) 365-8349 Job #: IM/ Date: SU M T W Description: & NT / DAY F S . 4 Graniterock. GENERAL , [�_RAI FW[;j_NEERINGC0NTRACT0R -LICENSE #22 PAVEX CONSTRUCTION DIVISION LA EXTRA WORK FORM Page ___ of N/T Billing # CCO # Task Cod _aW t LABOR CHARGES HOURS LABOR CHARGES HOURS Employee Number Name Class ST OT Employee Number Name Class ST OT - ------ - --------- EQUIPMENT CHARGES HOURS EQUIPMENT CHARGES 'HOURS Move In/Out Equipment Number Description ST OT Move In/Out Equipment Number Description ST OT I�U /Z ---- it-4, MATERIALS/TRUCKING MATERIALS/TRUCKING Tag # Vendor Description Qty wom, Tag # Vendor Description Qty Uom - - -. __._._ As an authorized representative of I am authorizing Granite Rock Company d.b.a. Favex construction uivision to pei-torm material basis. his �_� ��is in extra work on a time and n addition to any contract quantities or items. Approval by owner's representative Date Gra niterock's Representative _ Date C) n 1: C) 0 Project Name: Gilroy Crossing Offsite Improvements City Of Gilroy 7387 Rosanna Street Gilroy, CA 95020 FIELD ORDER FIELD ORDER NO. 1 Project Name: GIROY CROSSING OFFSITE IMPROVEMENTS Contract Date: 02/22/2011 To Contractor: Granite Rock Company d.b.a Pavex Construction Division Address: 411 Walker Street Watsonville, CA 95076 DESCRIPTION OF WORK: Project No: 11 -CDD -183 4/25/12 Due to the re- design of the Gilroy Crossing Project (directed by the COG), Pavex is hereby given direction to re- survey the project as per the new design. This includes working with Cruz Brothers locating and identifying unmarked Caltrans utilities and traffic loops thru potholing. Estimated Adjustment of Contract Sum: Ron Barn / PM (Name of Construction Manager/Title - typed or printed) By: (Signature) Date: 4/25/2012 Kvle McLean / Proiect Manaeer (Name of Contractor Representative/Title - typed or printed) (Signature) Date: Estimated Adjustment of Contract Time: 0 Note: This Field Order will be superseded by an allowance adjustment or a Change Order that will include the scope of the change in the Work and any actual adjustments of the Contract Sum. Attachment: none ... .. ......_._ ................ DAILY EXTRA WORK REPORT City Of Gilroy Contractor Job: 4162 - Gilroy Crossing Off Site Imp work Performed By: Pavex Construction Descdoon of Work: Sign Date Modification Change order 007 Billing Number 29.0 Report Date 6/14/2012 Perform Date 6/13/2012 Material/Specialist Work/Lump Sum or Unit Price Payment Invoice No. Invoice Date Vendor Name! Invoice Description Units Unit Price Extended Labor Charges Mot 001 6/13/2012 Statewide Safety / Sign Date Update 1.000 LS 275.00 275.00 Equipment Charges Material Charges Subtotal 275.00 MU 15.00% 41.25 Material Total 316.25 Activity naiv� 316.25 Bill Total + 316.26 Page NTS Universal SIR Form 010704 twroucn - twoars.com ~i ®�XFAFAVRWIW ® FOR: Graniterock - Pavex Construction k&lipovitchiygranite rock. com Office 831- 768 -2744 Cell 831 - 750-0541 Fax 831 -768 -2701 Proposal /Quote Statewide Safety & Signs License # 523594 130 Grobric Court Fairfield, CA 94533 Ph (707) 864 -9952 Fax (707) 864 -9956 Bid Date: 4/11/2012 Contract Information: gilroy crossing sign date modification Proposal: custom Estimator: Adam Freeland TRAFFIC CONTROL. SYSTEM IS A FOUR (4) HOUR MINIMUM CHARGE AT 70% OF RATES. FULL RATE CHARGED AFTER FOUR (4) HOURS. THE MINIMUM CHARGE WILL BE APPLIED ON CANCELLATIONS WITH LESS THAN FOUR (4) HOURS NOTICE. sign date modification for 3 signs on gilroy crossing project, hwy 152 and 101 NEW START DATE: TITLE: SIGN: DATE: PO4f: NEW END DATE: $275.00 Bakersfield Fairfield Fresno Garden Grove Nipomo Poway Sacramento San Jose Project Name: Gilroy Crossing Offsite Improvements Project No: 11 -CDD -133 FIELD ORDER City Of Gilrov 7337 Rosauna Strcet Gilroy, CA 95020 FII?LD ORDER NO. 6 Project Name: GIROI' CROSSING; OFFSITE UMPROVEiMENT Contract Date: 02i22.120I I To Contractor: Granite Rock Company d.b.a f'avex Construction Division ldeiress: 411 Walker Street Watsonville, CA 95076 DI"SC-RIPTION OF WORK: Pavex to change construction si;ttage for completion ol'August 17' ", 201?. Estimated Adjusunent of, Contract Sunl: _ Ron 13arri 1 f'tM 1Name of ('onstruction'v•lanager% Title - typed or printed) (5i�_nahn•c) [);tic: 61115!2012 Kvic McLcan j Proicct Nlanager (Name of Contractor Representative.4itic - typed or printed)^ ( Shmaturc) Date: 6115112 Estimated Adjustment ofCorttract fime: 0 Note: This Field O reler will be superseded br an ullou•unce adjesawent nr it C'Irwt ge !h•der that t. ill include the scope u/ the chca;ce in the 11'nrk andanY etcautl adjustments nj7he ( muruct .Start . -1 ttachment none DAILY EXTRA WORK REPORT City Of Gilroy Contractor rob: 4162 - Gilroy Crossing Off Site Imp work Performed By: Pavex Construction Description or work: Caitrans Enc Permit (Karl's) Change order 008 Billing Number 28.0 Report Date 6/14/2012 Perform Date 6/13/2012 Material /Specialist Work/Lump Sum or Unit Price Payment Invoice No. Invoice Date Vendor Name / Invoke Description Units Unit Price Factended Labor Charges Moi 001 11/07/2011 Pavex Company/ Caltrans Encroachment Permit 1.000 LS 164.00 164.00 b Equipment Charges Material Charges Subtotal 164.00 mu 15.00% 24.60 Material Total 188.60 Activity Total 188.60 Bill Total + 188.60 Page NTS universal Bill Form 010704 1=wrOuch - twerrrs.Con? I ACCOUNTS PAYABLE,: DAI'E: ur "LEASE "S-S-IJ.0 (IIIE0 T VE 1\4 D R A. A IM E; ADDRESS: PlIONEA, Lt".. #vs's, 1"i J-)ESMIPTIO► CHARGE TO. ORG• 'A-leoa 400 io # AUTHORIZED BY ALL QUESTS MUST 13E RECEIVED AT LE'AST OMI'l DAY IN ADVAI ('13. PLEASE TRY TO SCHEDULE ALL CHECK RPQU'ESTS ON ON R OF THE FOLLOWING COMPUTSP-1713D PAYOFr, DATES DAIT REQUIR&D, ROUTING INST-RUCTIONS uranfleru- • crystal Enterprise J88D Invoice Entry by Batch NuI1,13er Printed: 1117/2011 9:59:3,SAM 2(zC—u Vendor tqf.2g 9530828 977374 74392 Caflrzns - Ail !nvoices are attached behind this cover shoe; Appropiate approvals are on each invoice Sales Tax has been reviewed for each znvoice This batch is approved in JOE Patch Entered and Reviewed by: CGRACIA CONFIDENTIAL PROPERTY Or GRANITEROCK C-2 4 m usithy 40 Giffemnite-rock, amour In! Date ^ue hate t�;sc Avail nisc Tai:en L�U !Jab i G." 10 i 111,71"t I I i 711 000 000 hn,ount G> nc -curd n,, Discount AQunt r . . Discount ..... . ..... .... ...... I 4 m usithy wmu 9.1.00 n0++:.1.a. 1r2.4_ 1210 Glraniterodc. I PAVOCCONSlrtucriaNbmstoN Date Check No. Vendor Po. Wxsroo+•w.tz.+w++aca!�5'07iC.LUI 11/10/11 04074250 7439?_ Net Amount 164.00 ONE HUNDRED SIXTY FOUR AND 00/ 100 """ *' " " "'...... DOLLARS Pay to the Order of Void After 90. Days j Caltrans ,Q 5900 Folsom Blvd. By /QLt✓Y G2 Sacramento CA 95819 -0128 L 11.040 74 2 50,,' 1: 1 2 1000 2481: 1, L 2 20 56 3 36i1' Please Detooh aoWe DepoOM9 Grani�roek. Vendor Date Check No. PAVER 74392 11/10111 Stub 1 of 1 4074250 Accounts Payable invoice Number Date Description Amount Discount Net Amount 110711 4162 11/07/11 Encroachment Permit 164.00 _ 164,00 - - - -_ 164.00 - - -____ r ^164.00 Caltrans 5900 Folsom Blvd. Sacramento CA 95819.0128 DAILY EXTRA WORK REPORT City Of Gilroy Contrador Job: 4162 - Gilroy Crossing Off Site Imp work Penormea Br: Pavex Construction Description of Work: Updated Caltrans Encroachment Permit ChareeOrder 009 BHWV Number 36.0 Report Date 7/20/2012 Perform Date 7/19/2012 Material/Specialist Work/Lump Sum or Unit Price Payment Invoice No. Invoice Date Vendor Name I Invoice Description Units unit Price Extended Labor Charges M01 002 7/19/2012 Pavex Company/ Updated Caltrans Encroachment Permit 1.000 Ls 164.00 164.00 Equipment Charges I Material Charges Subtotal 164.00 MU 15.00% 24.60 Material Total 188.60 Activity Total 188.60 1 i I t Bi0 Total + 188.60 Page t NTS Universal Bill Form 010704 ✓= wouoh - err=$. cam 3672 1 DATE PAYTgl (.1 TOTAL THOS CHECK OTHER TRANS i. :T;A BALANCE STATE OF CALIFORNIA • I)FFAtrr.Nir r OFTRANSPOR,ra "CIO\ ENCROACHMENT PERMIT RIDER 17.- o122!REV T()- f Granite C'011(rt) ;1 411 Walker Street Watsonville, CA 9-5076 Attn: Chris Soriano Phone: (831) 765 -2700 At i��•m:it V�. d[h:�rrui? Date R:ucr Vc:rai+.r �!urtc_'3 ZUl � 0412- 6RW1. {)1S ....._._._. 7 I . PERitITi'FE In compliance with your request of June 13, 2012, we are hereby amendirlg the above number (I encroachment permit as follows: Date of completion extended: to December.') i . 2012. Reference your project to perform the foliowin`,: works for City of Gilroy. Engineering Oivision: 1-o Construct sidewalk on the southerly side of State Highway 04- SC'L -I5Z. Post lvlile E U. ;. 1?ct,,veen ROL1tCS 101:152 on- and off -ramps in the City of Gilroy. Your permit is amended as follows: Eric the revised plan sheers A 13, A14. A 13. At 6 - of 16 in lieu of plan streets 13. 14, 13. 16 - of 10. Closure of the eastbound Route i 52 on -ramp into the northbound Routel01 is authorized between 9:00 AN-1 and 3:00 PN•l, Monday through Thursday, and between 9:00 AM and 2:00 PM on Friday. holidai:; e,%CCPt::i. R nnp clos..r'= information shall be posted at least 72 hours Ill advance: and adc:ouale de (Our {Slust be provided and clearly posted. On the foot of southbound Route 101 ot; ratrrp to Rnutc 132 o,]c traffic lade may be ctu� %ci ilet�y�en 4:Clt:= Pit and 6:00 Abt Sunday through Tltumday. One lane of right turn traffic movement on the northbound. Route l0I of =ramp to eastbound Route 152 be closed between 9:00 - \M and 3:00 PM Monday througll'I hursday, and b(fween 9:00 A.'vt and 21:00 11L1 Except as amended. all other terms and provisions of the original permit shall remain in effect. :1P{'t20VED: KR CC: Bob Salazar (2), Dist. fra iic rP. C'raa BI.JAN SARTIP1. District Dii FVtC:' J. Richaresso:i BY: 4041 I6DPOR if) L.�IICI {.'LI:i;IY.�t')1�iIE, Dist a NA,.',11:: Uranite Company PEANUT T __: !k1I2- 6pw1028`f74I1- 61)10030 DATE .ere 2R. 2012 One taste op the eastbound Route 152 may be closed from 9:00 AM to t :00 NO Monday throw -li Thursday. and from 9:00 Ail to 2:00 PVI on Friday. One lane on the Westbound Route 152 to southbound Route 101 on -ramp Inay be closed fronn 9:00 A 41 to 3 :f 0 ??.1 N:londay through Thursday. and fort -9:00 AIM to 2:00, PM ()II Friday. On northbound Route 101 off-ramp to westbound and eastbound Route ! 52 provide one 1 I' wide 1,ux: for ear ;h o the left and right turns traffic movement between 9:00 AM and ?:(i) PM. '<fnnday through Thursday and be ..- ecn 9 :00 AM to'_:00 PM on Friday. Permittee's contractor also shall apply for a pertmit rider for closure of.1115 on -ramp, aril Submit S i 0- :.I:)o nerl ;i' rider fee. 11, Ininimum of one week prior to the start of work under this permit. notice shall be F,iven and advance approi ai ctl constnlction detail, operation. public safety and traffic control shall be obtained from State Representative. J in, Wong, 500 Queens Lane. Sant lose 95 111 (408) 452 113 1, weekdays, between 7:30 W and 4:00 P:�l . 2 of 2 DAILY EXTRA WORK REPORT City Of Gilroy Contractor Job: 4162 - Gilroy Crossing Off Site Imp wok Performed By: Statewide Safety (For Pavex Construction) Description of work: Installation Of Secondary Detour Change order 010 failing Number 38.0 Report Date 7/24/2012 Perform Date 7/23/2012 Material/Specialist Work/Lump Sum or Unit Price Payment Invoice No. Invoice Date Vendor Name ! Invoice Description Units unit Price Extended Labor Charges f snot 001 7/13/2012 Statewide / Secondary Detour 1.000 LS 1,750.00 1,750.00 Equipment Charges Material Charges Sublolat 1,750.00 MU 15.00% 262.50 Material Total 2,012.50 Activity Total 2,012.50 Subcontract Markup Sc 10.00% 201.25 END Subtotal 2,213.75 sm Total + 2,213.75 Page 1 NTS Universal Bin Form UIUM4 Proposal /Quote Statewide Safety & Signs BID DATE: 11 /03/11 TRAFFIC SAFETY & SIGNS License # 523594 CONTRACT INFO 130 Orobric Court GILROY CROSSINGS OFFSITE Fairfield, CA 94533 DETOUR QUOTE Ph (707) 864.9952 PROPOSAL:101971 Fax (707) 864 -9956 ESTIMATOR Adam Freeland CLIENT: PAV PROJECT: PAVEX CONST GILROY CROSSINGS OFFSITE 120 GRANITE ROCK WAY SAN JOSE, CA 95136 ITEM # DESCRIPTION QUANTITY PRICE AMOUNT — A CONSTRUCTION AREA SIGNS 1 LS 1750.0001LS 1,750.00 SPECIFICATIONS: PER PROVIDED PLAN: DE02 INCLUSIONS: C.A.S FURNISHED, INSTALLED, AND REMOVED TO REMAIN THE PROPERTY OF STATEWIDE EXCLUSIONS: DOES NOT INCLUDE CHANGEABLE MESSAGE SIGN (C.M.S.) TOTAL BID: $1.750.00 Signed: Dated: Title: Project Name: Gilroy Crossing Offsite Improvements Project No: 11 -GDD -183 FIELD ORDER City Of Gilroy 7/5/12 7387 Rosanna Street Gilroy, CA 95020 FIELD ORDER NO. 10 Project Name: GIRO' CROgSI. Id OFFSiTE IMORO FMIN, " Contract Date: 02/22/2011 To Contractor: Granite Rock Company d.b.a Paves Construction Division Address: dll Walker Street Watsonville. CA 95076 DESCRIPTION OF WORE: Because of new design changes, the northbound left turning lane will need to be closed to construct the new median pedestrian island. Pavex is being directed to implement the secondary ramp closure detour plan (MvII -1) dated 6/29/12. Estimated Adjustment Estimated Adjustment of Contract Sum: of Contract Time: 0 _ _ Ron Bard / PM _ (Natnc of Construction Manager/Title - typed or printed) By: (Signature) Date: 7/51/2012 Matt Christie / Proie) ct Manager (Narne of Contractor Representativerfitle - typed or printed) (Signature) Date: Note: (his Ffetel Order will he snlxlrseded by an ollois•ance adjusltnent or it Chcnlge Order 1ha1 wil/ inchuh! the scope c f the chungv in the Work curd Ono actual Off1t1stments Cf file 001111 -ael SI1111. Utachnl mv none DAILY EXTRA WORK REPORT City Of Gilroy Contractor rob: 4162 - Gilroy Crossing Off Site Imp work Pertormed By: Bestors Engineers, Inc. (For Pavex Construction) Description of work: Bestor Engineers Inc - Remark Cuts And Fills For Six -Foot Offset change Order 011 Baling Number 30.0 Report Date 7/19/2012 Perform Date 6/19/2012 This Bill Has Been Plugged with No Details Labor charges Equipment Charges Material Charges Aaivdy Total 1,700.00 I f Subcontract Markup Sc 10.00% 170.00 Bin subtotal 1,870.00 Bid Total + 19870.00 Page t NTS Universal Bill Form 010704 Ewroucn ., C.1 \7tL [?hiGiM1i Ei F. F111\IG - >LIMMY1I140, •. L.ANt] PI- Muh11hIG q-70.1 OtAlE LAi\w. IVIo WTER£Y, cFALwonpitf\ 511U40 (f.1 "311 173- 29cb1 • S3AL.INAS 424 -76131 • FAX 64::3- 4'I'Irl 4810 ho.:Cc�rifltf \C- GRANITE ROCK PAVEX W.O. 6892.00 411 Walker Street Watsonville, CA 95076 Gilory Crossing Construction Staking Attn: Matt Christie Pavex Job #4162 i V,. � l:. 9 Jul 2012 -.;r,E .,,.).1:Ii .r1 :_ra r.r.rLs,•,•�{ ;.r rl reit.�i,tr..,c. hie:. u.<jwns' s iml.,. ql _. in June 2012 as follows: DESCRIPTION Extra Work #4: Remarked cuts and fills for six -foot offset nail set in April per 6/19/12 agreement. ITEM Contract Amount % Complete Total Previously Invoiced Amount Due Extra Work #4 $1,700.00 100% $1,700.00 $0.00 $1,700.00 THIS INVOICE IS FOR PROFESSIONAL SERVICES RENDERED AND IS DUE UPON RECEIPT. AFTER 30 DAYS. A SERVICE CHARGE WILL DE MADE AT A RATE OF 1 112% PER MONTH. Total due In full $11700.00 65 YEARS OF PROVIDING QUALITY ENGINEERING /SURVEYING SERVICES DAILY EXTRA WORK REPORT City Of Gilroy -OT Rate - -- Delay Factor- -- - Contractor Job: 4162 - Gilroy Crossing Off Site Imp 51.0 Work Performed By: PaveX Construction 8/10/2012 Description of work: Install Wall Drain System At Retaining Wall (Area 2) Labor Charges 19.980 Craft ID Employee Name __- RT Hrs OT L01 OE SUP1 DG Plummer 4.0 . L02 OE OE4 A Andrade _ __ __ _ -- ---- _._ -- ---- L03 LBR LBSP -__ - - - -_ .. -- - -_.__ ML Toccalini 4.00 L04 OE SUP1 V Aguilar Subtotal Labor Equipment Charges 456.38 Equipment ID Description — --- -- -- -- -- -_— -- RT Hrs Ol -- - -- _ - E01 14049 John Deere Loader 210 4.00 E02 16338 Ford F250 4.00 E0315721 F150 4.00 E04 15807 314 Ton Pickup 4.00 E05 15006 3/4 Ton Pickup 4.00 Material /Specialist Work/Lump Sum or Unit Price Payment - MU 15.00 0k Invoice No. Invoice Date Vendor Name / Invoice Description Equipment Total M01 152672 8/08/2012 Graniterock Company / Transfer M02 560876 8108/2012 Graniterock Company / 3/4" Drain Rock _ Material Charges M03 166578 8/08/2012 Scotts Valley Sprinkler / Wall Drain Pipe And Fittings Universal Bill Form Hrs Subs Units RT Rate - 64.250 59.860 -- _46.340 64.250 Cost code: 940015 Rate m RT Rate - -- -OT Rate - -- Delay Factor- -- - -- 46.160 Billing Number 51.0 19.980 Report Date 8/10/2012 19.980 Perform Date 8/08/2012 19.980 Labor Charges Extended - ---- - -- - -- 19.980 938.80 257.00_ Units Unit Price OT Labor 1.000 LS 450.00 12.000 T 18.00 Subtotal Labor 1.000 LS 456.38 Bill Total + 3,044.22 Page EWTouch - EWBills. com Change Order 015 Billing Number 51.0 Report Date 8/10/2012 Perform Date 8/08/2012 Labor Charges Extended - ---- - -- - -- RT Labor 938.80 257.00_ 23_9.44_ OT Labor 0.00 185.36_ 257.00 Subtotal Labor 938.80 Subsistence 0.00 Extended Other Expenses 0.00 1.84_.64 MU 25.00% 234.70 79.92— Labor Total 1,173.50 79.92 �^— - -- - - - -- - 79.92 Equipment Charges Subtotal 504.32 -79.92- - MU 15.00 0k 75.66 Equipment Total 579.98 Extended — 450.00 _ Material Charges 216.00 Subtotal 1,122.38 456.38 Mu 15.00% 168.36 Material Total 1,290.74 Activity Total 3,044.22 Bill Total + 3,044.22 Page EWTouch - EWBills. com anile Rock Way se, CA 95136 18) 574-1400 0s) 365-8349 I s_ u Granwite -- i—I f;M 1 NT cr �C LICENSE ,1Y2 j TC%4 TH F S PAVER CONSTRUCTION DpjSION Aion: fts: HOURS T-- Name Name Class ST 0-1 Number P',oyee Number I n;0ut I Equipment Number Tag A Vencor an authorized representative Of ra work on a time and niateriA woval by owner's representative Description Description t jc - Bonk L11)(WY Pl*trO) ST I OT Qty I LIM In'Ouo1nent EXTRA WORK FORM Pago -.. _ of - - - ----- NIT Billing # -- CCO # Task Code: class I ST 1 07 Description Description I Uly ST i OT UOM any d.b.a. avex construction Division to perform I am authorizing Granite Roe I< Come �. Idippirl to an y contract quantities or items. ive Date Date Graniterock's Rep at Serial it 0 6 ° i SCOTTS VALLEY SPRINKLER & PIPE SUPPLY, WAT.BRANCH WATSONVILLE BRANCH 131 WALKER STREET WATSONVILLE CA 95076 PHONE: (831) 728 -0446 WATSONVILLE STORE NOW OPEN 7 DAYS A WEEK M -F 7:30AM -5PM SAT 8AM -5PM SUN 9AM -4PM COST NO- JOB NO: PURCHASE ORDER: REFERENCE: TERMS: CLERK: 5155 000 4165 PO# 4165 2% 10TH NET 11TH AH DUE DATE: 9111/12 TERMINAL: 70 SOLD TO: PAVE( UG 411 WALKER ST WATSONVILLE CA 95076 831 -768 -2708 SHIPTO: PAGE NO 1 DATE ITEAS 817112 3:02 RESALE NO: UGRND SALESPERSON: AH ART H TAX: 004 CITY OF WATSONVILLE INVOICE: 166578 LINE 1 t� L 3 4 5 SHIPPED 200 t(} f V 1 14 2 ORDERED 200 1� 1 14 2 UMI FT EA EA EA SKU SDR420P 4 Q 4 aS 4"SDR35IO'SOVALDISouD/FT1300 S4T S4SL S4CA DESCRIPTION "SOR35 20'SOL.WLD/PERF/FT/ 640 4~ PVC S&D TEE 126 4" PVC S&D 90 ELL SHORT TURN 140 4" PVG 5&D CAP /50 SUGG 2.49 2.39 6.99 5.99 4.99 UNITS 200 10 1 14 9 PRICE/ PER 1.59 IFT 1.46 /FT 5.31 5'`'6 � 2.54 /EA EXTENSION 318.40 C 14.69 C 5 57 O 77.84 C 5.10 C Inv (MIKE TOTCALINI) AMOUNT CHARGED TO STORE ACCOUNT" 9.13 TOT WT: 0.00 TAXABLE 421.60 NON-TAXABLE 0.00 SUBTOTAL 421.60 456.38 TAX AMOUNT 34.78 TOTAL 456.38 Xw, ��"'�',. Received By Customer: Pavex Const Intracompany rans. not Project Manager. Matt Christie Job: 4162 dmin.) CustomerJobName: Gilroy Crossing Off Site Imp 0 Graniterock. count Code (Transactions not exported to JDE) ;, Product ', fre)pht_� - Jtdd1 SatsaTa>s,: Q Clist Sesxf r 1?ilc�LCOIwp Deaedptloa Qty /UOLt y Prlos SAittt: Qty A" Prtca sAwt Rats Arra x ? rx � JokNQS, P)ice IW pese� on Total Q ty l I Total $Amo.. .t . F.iqht Qtv -_. $Amount $Amount $Amount - $ Amount - -- 10331 314 Class 2 AGG Base 110 -033 59.83 I $418.81 $418.81 Total 59.83 I S418.61 - S- $- - $- - $418.81 10241 3/4 Drain Rock 110-024 12.00 Tons $ 18.00 $ 216.00 - $ - $ - GX21164 bTotals for Product Code 1024) 314 Drain Rock 110 -024 12.00 Tons $ 216.00 $ - SubTotals for Account Code 4162.5690.940015 S 216.00 $ - $- - % $- $216.00 ICP $ 18.00 $- D.00 $ - $ 216.00 . $ - $ 216.00 Total Qty Total S Amount Froipht ON I $ Amount $ Amo t $ Amount $ Amount 1024) 3/4 Drain Rock 110 -024 - - - 12.00 $216.00 - $- $• $- $2 16.00 Total 12.00 $216.00 $• $• $• $216.00 ITR) Transfer - Hourly SubTotals for Product Code (TR) Transfer- Hourly 6.00 HR SubTotals for Account Code 4162.6026.109010 $ - 5.00 HR $ 90.00 $ 450.00 GX21164 $ - $ - $ 450.00 0.00 $ - - $ 450.00 0.00 % $ - $ 450.00 ICP $ 90.00 $ - S. $ 450.00 $ - $ 460.00 Total Qty I Total $Amount FreKlltl Qty $Amount - $ Amount $ Amount $ Amount ITR1 Transfer - Hourly - 5.00 --- -- -- $• 5.00 iI $450.00 $- $ $450.00 Total 5.00 $- 5.00 ( 5450.00 S- $- $450.00 Ai m CERTIFICATE OF LIABILITY INSURANCE DATE (7 /20 YYYY) 09/17/2011 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 LIC #0056172 1 -831- 724 -3841 CONTACT NAME: PHONE FAX A/C No): McSherry & Hudson E -MAIL ADDRESS: 575 Auto Center Drive PRODUCER CUSTOMER ID P. O. BOX 2690 Watsonville, CA 95076 X COMMERCIAL GENERAL LIABILITY INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: ZURICH AMERICAN INS CO 16535 INSURER B: GRANITE ROCK COMPANY DBA PAVEX CONSTRUCTION DIVISION INSURER C: P. 0. BOX 50001 INSURER D: WATSONVILLE, CA 95077 $ NIL PERSONAL & ADV INJURY $ 1,000,000 INSURER E: X XCU Hazards INSURER F: COVERAGES CERTIFICATE NUMBER: 23100638 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 LTR TYPE OF INSURANCE INSR S VD POLICY NUMBER MM DIDY IYYYY MM DD/YYYY LIMITS • GENERAL LIABILITY X X GL03472668 -10 09/30/1 09/30/12 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 CLAIMS -MADE a OCCUR MED EXP (Any one person) $ NIL PERSONAL & ADV INJURY $ 1,000,000 X XCU Hazards X Contractual Liability GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 $ POLICY X PRO __1 LOC • AUTOMOBILE LIABILITY X X BAP3472669 -10 09/30/1 09/30/12 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ $ X NON -OWNED AUTOS $ X Contractual Liability 1 1 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DEDUCTIBLE $ $ RETENTION $ • WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? F (Mandatory in NH) N I A X WC3472667 -10 09/30/1 09/30/12 X WC STATUS OTH- IMIT' E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) JOB #4162 GILROY CROSSING OFFSITE IMPROVEMENTS CITY OF GILROY AND CITY OF GILROY EMPLOYEES, OFFICERS, DESIGN CONSULTANTS, ELECTED OFFICIALS, CONSTRUCTION MANAGER, AGENTS AND SUB - CONSULTANTS ARE HEREBY NAMED ADDITIONAL INSUREDS PER THE ATTACHED ENDORSEMENTS (U -GL- 1175 -B) SEE ATTACHED CANCELLATION WORDING FROM POLICIES BROAD FORM PPTY DAMAGE; GLO PER ISO FORM CG0001 (12/04), BAP PER ISO FORM CA0001 (03/06) GtK I IVIGA 1 It NULUtK I,HIY IiGLLH 1 IVIY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF GILROY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 ROSANNA STREET AUTHORIZED REPRESENTATIVE GILROY, CA 95020 USA I yrivera U 1938 -2009 AGOKO GOKNOKA I ION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD 23100638 SUPPLEMENT TO CERTIFICATE OF INSURANCE 09 /DATE 17/zoii NAMt UrINSU KtU: GRANITE ROCK COMPANY DBA PAVEX CONSTRUCTION DIVISION 110/001 Additional Insured — Automatic — Owners, Lessees Or Contractors 0 ZURICH Policy No. Eff. Date of Pol. Exp Date of Pol. Agency No. AddL Prem. Return Prem. GLO 3472668 -10 9130/2011 9/30/2012 McSherry & Hudson THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 insured any person or organization who you are required to add as an additional insured on this policy under a written contract or written agree- ment. B. The insurance provided to the additional insured person or organization applies only to "bodily injury", "property damage" or "personal and advertising injury" covered under SECTION I - Coverage A - Bodily Injury And Property Damage Liability and Section I - Coverage B - Personal And Advertising Injury Liability, but only with respect to liability for "bodily injury", "property damage" or "personal and advertis- ing 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; and resulting directly from: a. Your ongoing operations performed for the additional insured, which is the subject of the written contract or written agreement; or b. "Your work" completed as included in the "products- completed operations hazard ", performed for the additional insured, which is the subject of the written contract or written agreement. C. However, regardless of the provisions of paragraphs A. and B. above: 1. We will not extend any insurance coverage to any additional insured person or organization: a. That is not provided to you in this policy; or b. That is any broader coverage than you are required to provide to the additional insured person or organization in the written contract or written agreement; and 2. We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of: a. The Limits of Insurance provided to you in this policy; or b. The Limits of Insurance you are required to provide in the written contract or written agreement. D. The insurance provided to the additional insured person or organization does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering or fail- ure to render any professional architectural, engineering or surveying services including: Includes copyrighted material of Insurance Services Office, Inc., with its permission U- GL- 1175 -B CW (3/2007) Page 1 of 2 1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. E. 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 writ- ten contract or written agreement requires that this coverage be primary and non - contributory. F. For the coverage provided by this endorsement: The following paragraph is added to Paragraph 4.a. of the Other Insurance Condition of Section IV — Commercial General Liability Conditions: This insurance is primary insurance as respects our coverage to the additional insured person or organization, where the written contract or written agreement requires that this insurance be primary and non - contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the ad- ditional insured person or organization is a Named Insured. 1. The following paragraph is added to Paragraph 4.b. 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 in- sured by attachment of an endorsement to another policy providing coverage for the same "occur- rence", 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 written contract or written agreement to provide coverage to the additional insured on a primary and non - contributory basis. G. This endorsement does not apply to an additional insured which has been added to this policy by an en- dorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. Any provisions in this Coverage Part not changed by the terms and conditions of this endorsement continue to apply as written. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U -GL -1175 B CW (312007) Page 2 of 2 Policy Number: GLO 3472668 -10 Zurich American Insurance Co. Effective Date: 9/30/2011 Commercial General Liability Coverage Part Severability of Interest The insurance afforded by this policy applies severally as to each insured except that the inclusion of more than one insured shall not operate to increase the limit of the company's liability and the inclusion hereunder of any person or organization as an insured shall not affect any right which such person or organization would have as a claimant if not so included. Waiver of Subrogation The Company waives any right of recovery the Company may have against the person or organization shown in the Schedule because of payments the Company makes for injury or damage arising out of the named insured's ongoing operations or work done under a contract with that person or organization and included in the "products - completed operations hazard ". Schedule Name of Person or Organization: Any person or organization that requires that the named insured waive the named insured's rights of recovery in a written contract or agreement with the named insured that is executed prior to the accident or loss. Notice of Cancellation If the Company cancels this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of premium, the Company will mail a copy of such written notice of cancellation to the person or or- ganization shown in the Schedule at least 30 days prior to the effective date of the cancellation. If the Company cancels this Coverage Part by written notice to the first Named Insured for nonpayment of premium, the Company will mail a copy of such written notice of cancellation to the person or organization shown in the Schedule at least 10 days prior to the effective date of such cancellation. If the Company reduces the coverage afforded by this Coverage Part, the Company will mail a written notice of such reduction in coverage to the person or organization shown in the Schedule at least 30 days prior to the effective date of the reduction in coverage. Schedule Name of Person or Organization: Any person or organization to whom the named insured is required by written contract or agreement to mail prior written notice of cancellation and /or reduction in coverage. POLICY NO.: BAP 3472669 -10 ZURICH AMERICAN INS. CO. EFFECTIVE DATE: 09/30/2011 COMMERCIAL AUTO CA 2048 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are 'insureds" under the Who Is an Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: 9/30/11 1 Countersigned By: Authorized Representative SCHEDULE Name of Person(s) or Organization(s): ANY PERSON OR ORGANIZATION TO HWOM OR TO WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS OR ADDITIONAL INSURED STATUS ON A PRIMARY, NOW CONTRIBUTORY BASIS, IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is an Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc. 1998 Page 1 of 1 Policy Number: BAP 3472669 -10 Commercial Auto Liability Coverage Part Severability of Interest Except with respect to the limit of insurance, the coverage afforded applies separately to each Insured who is seeking coverage or against whom a claim or suit is brought. Waiver of Subrogation The Company waives any right of recovery the Company may have against the designated person or organization shown in the schedule because of payments the Company makes for injury or damage caused by an "accident' or "loss" resulting from the ownership, maintenance, or use of a covered "auto" for which a Waiver of Subrogation is required in conjunction with work performed by the named insured for the designated person or organization. Schedule Name of Person or Organization: All persons and /or organizations that require by written contract or agreement with the named insured, executed prior to the accident or loss, that waiver of subrogation be provided under this policy. Notice of Cancellation If the Company cancels or non - renews this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of premium, the Company will mail a copy of such written notice of cancellation or non - renewal to the person or organization shown in the Schedule at least 30 days prior to the effective date of the cancellation or non - renewal. If the Company cancels this Coverage Part by written notice to the first Named Insured for nonpayment of premium, the Company will mail a copy of such written notice of cancellation to the person or organization shown in the Schedule at least 10 days prior to the effective date of such cancellation. If the Company reduces the coverage afforded by this Coverage Part, the Company will mail a written notice of such reduction in coverage to the person or organization shown in the Schedule at least 30 days prior to the effective date of the reduction in coverage. Schedule Name of Person or Organization: Any person or organization to whom the named insured is required by written contract or agreement to mail prior written notice of cancellation and /or reduction in coverage CA 20 48 02 99 Copyright, Insurance Services Office, Inc. 1998 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 000313 (Ed. 4 -84) WAIVER OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule ALL PERSONS AND /OR ORGANIZATIONS THAT REQUIRE BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND /OR ORGANI ZATION. 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: 9130111 Policy No.: WC 3472667 -10 Insurance Company Zurich American Insurance Company WC 00 03 13 (Ed. 4 -84) Notice of Cancellation If the insurer cancels this policy by written notice to the named insured for any reason other than nonpayment of premium, the insurer will mail a copy of such written notice of cancellation to the person or organization shown in the Schedule. Notification to such person or organization will be provided at least 30 days prior to the effective date of the cancellation. If the insurer cancels this policy by written notice to the named insured for nonpayment of premium, the insurer will mail a copy of such written notice of cancellation to the person or organization shown in the Schedule at least 10 days prior to the effective date of such cancellation. If the insurer reduces the coverage afforded by this policy, the insurer will mail a written notice of such reduction in coverage to the person or organization shown in the Schedule at least 30 days prior to the effective date of the reduction in coverage. Schedule Name of Person or Organization: Any person or organization to whom the named insured is required by written contract or agreement to mail prior written notice of cancellation and /or reduction in coverage.