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Graniterock/Pavex - Project No. 11-CDD-183 - Change Order No. 2
t(Cftp of IffiiCrop Public Works Department - Engineering Division 7351 Rosanna St., Gilroy, CA 95020 Phone (408) 846 -0451; Fax (408) 846 -0429 CHANGE ORDER NO. 2 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 Due to design changes, the sidewalk has been relocated to include a 2 -1 cut and fill slope. Pavex is to be compensated to clear and grub, cut and fill a keyway due for the new sidewalk configuration which will eliminate any conflicts with the existing utilities, as directed in FO #12. 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. 2. I (We) agree to make the above change subject to the terms of this Change Order for a NET INCREASE not to exceed $22,754.48. CONTRACTOR By: K�P, L f)A l p-ov �TGLf RECOMMENDED BY: ACCEPTED BY: Construction Cost Percentage Initial Original Contract Price $248,844.00 Previous Change Orders $17,384.27 6.99% Total to Date $266,228.27 This Change Order $22.754.48 Total Change Orders to Date $40,138.75 16.13% Revised Contract Price $288,982.75 Date: 18 Date %.,uy r,uuu1oauawi uaic 4 A IL e GENERAL ENGINEERING CONTRACTOR - LICENSE #22 PAVEX CONSTRUCTION DIVISION August .14, 20.12 City of Gilroy, Public Works Department 7351 Rosanna Street Gilroy, CA 95020 Attn: David Stubchaer Senior Civil Engineer Re: Gilroy Crossing Offsite Improvements, Project No. 11 -CDD -183 Pavex Job No. 4162 Subj: LTO -19 —Area 3 Import Fill Costs Mr. Stubchaer, Please see below breakdown for the following extra costs incurred for the import fill material at Area 3. Please issue a change order for $22,754.48 to Pavex for the following work; E"# Date Description Cost 31.0 7/12/12 Clear & grub, demo large tree, cut $3,476.24 ke wa for fill, dust control 32.0 7/13/12 Finished keyway for fill, compact $1,663.46 and repair irrigation 45.0 7/25/12 Compact remaining loose material $1,273.11 in fill area 46.0 7/24/12 Place and compact all remaining $2,605.71 fill in area 3 47.0 7/18/12 Finish placing all dirt from wall $2,081.59 footings in fill Area 3 48.0 7/17/12 Work on fill area and compaction $3,312.98 in Area 3 49.0 7/31/12 Placed fill dirt, compacted and $5,203.61 raded in Area 3 50.0 8/2/12 Finish slope, finish last lift of fill, $2,562.78 compacted and passed final inspection Totals $22,754.48 Should there be any questions, please feel free to contact me (408)590 -1767. Sincerely, Graniterock Company Pavex Construction Division N l� Project Name: Gilroy Crossing Offsite Improvements City Of Gilroy 7387 Rosanna Street Gilroy, CA 95020 FIELD ORDER FIELD ORDER NO. 12 Project Name: GIROY CROSSING OFFSITE IMPROVEMENT 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 7/11/12 Due to design changes at station 54 +00 — 55.01 the sidewalk has been relocated to include a 2 -1 cut and fill slope. All soil import (delivery and compaction) will be expensed on a forced account during these operations. Time tags to be approved and signed daily by the construction manager. Estimated Adjustment of Contract Sum: (T &M) Ron Barri / PM (Name of Construction Manager /Title - typed or printed) By: (Signature) Date: 7/11//2012 Matt Christie / Project Manager (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 Z c 0 0 a W T 0 a °o v m O X T O o r m o (T g o B o m W N r g o W 0 N o r r-' SU o g 00 O = m �. r O00 O a o 9 R . 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O A A A n N w0 0 00 00 W n c c m A c c m m m 7 c iE; a, .•o O o C Q w g CD d OF 3 m" v v o 0 0 0 ;c I� ♦ o 0 3 �- m c N j m m r °% 3 a D cn �: o cD o cn k 0 3 cn o 0 m o C) Ot o CD o 0 o 0 e� 0 W W d m 0) t0 N Ito a V � H t0 m' C -4 M 4 cn P. -N -(0 00 O OD N OD O% Q1 w Ln W O w O V — O O (n w N O O, a O io N c0 io G? 61 o P o O m :p i Al OD O O W O A W -� O O N A W N N p N v m O X T O a 0 C- -n -1 (A 'a X () o 6 a v U x j 0 a m tr Z° m < O [D m° O ° u? 3a to cn ' m C_ o C.1Qx E Z) c. cx Ica 0 ^ p lb 3 -• m N M i i o m fl' COL m T N r- �, s p N; n p a (n G � y z n Z Q rn ° ° y am O z m ■■ m 0 _ O © O z C 9 m .O 3 n f1 N p Ck 5. tT O µ z m w T_ 3 O LQ ac N o m n Cp. n � t (J+ O It 3 3 m 7 PL ic z 0 n z CD *�J x c� n o c a {€ 0. :Z .. p m � m C) o tJ United R Sj;' Rentals -94M (80171181 1{,x itii,,rfNT�i:ar. -8T7 3C+iT1 uniice?rrrt� 4 crn LOCATION ,#051 37 TARP CIRCLE SALINAS, CA +939 02 832- 422 -7421 831- 422 -5981 FAX II IIIIIIIIIIIIIIIIIIII�IIIIIIINIIIIIIifllllll f III 1J GILROY CROSSING 10TH ST x:152«. p GILROY, CA 95020 h Office: 408- 574 -1400 Ce1.1s 831- 970 -0206 I PAVER CONS'T'RUCTION CO CA s INVOICES ('(TAILED WEEKLY TO O KATHY AND DIANA M SAN JOSE, CIS 95136 RENTAL AGREEMENT ---1. 1 Customer Number Agreement Date Rental Out Scheduled In IN 415006 6/25/12 6/25%12 8:41 Apt 7/02/12 8:41 AM Job Location: 10TH ST, GILROY Job Number 212 P.O. Number ; 4162 Ordered By DWAYNE PLUMBER Written By UR051JG2 Salesperson 8057 __qty qj!I tnerlt Description Minimum Day week 4 Week_ 1 923828 *WATFit TANK TRAILER 500 GAL - 160.00 516.00 1121., (30 eke: WYLIE Model: EXP -500 -5 Serial: 1i297W1324 61,342802 COMMENTS /NOTES: Rental Subtotal: ENVIRONMENTAL CHARGE: CONTACT: DWAYNE PLUMEIER CEL# 931 - 9'70 -0296 A CLEANING CHARGE WILL APPLY TO EQUIPMENT RETURNED WITH EXCESSIVE DIRT, CONCRETE, AND /OR PAINT. CUSTOMER IS RESPONSIBLE FOR ALL DAMAGE INCLUDING TIRES. THERE WILL BE AN ADDITIONAL CHARGE FOR MISSING KEYS. A FUEL CHARGE WILL BE APPLIED TO ALL UNITS NOT RETURNED FULL OF FUEL f It's aentc innina:otl aaova.wa sutryaci to an anvirdnnnnlal charge wlticn k daatgned tO rs®ser Unitod'a:diradt Anti indiract expanses lot the handfirg, rtgnagingadl dtapaautg or wagta. pFpauCis: Iia,2anipua Mumeif artrrxnuclfaliva costs . r ti,s isnui a gavans:?eM+aanafatan charge. FUEL: Fuel charges do net include tuderal, ataas. or local excise taaaa OPTIONAL RENTAL PROTECTION PLAN NOTICE FOR RENTAL OF A MOTOR VEHICLE: INS CONTRACT OFFERS, FOR AN ADDITIONAL CHARGE, A DAMAGE WAIVER TO LIMIT YOUR FINANCIAL RESPONSIBILITY FOit DAMAGE TO OR THEFT OF THE MOTOR VEHICLE. BEFORE DECIDING WHETHER 1'O PURCHASE THE DAMAGE WAIVER; YOU MAY WISH TO DETERMINE. WHETHER YOUR OWN INSURANCE AFFORD6 YOU COVERAGE FiSt DAMAGE TO OR "THEFT OF THE MOTOR VEHICLE ANO THE AMOUNT OF THE DEDUCTIBLE UNDER YOUR OWN INSURANCE COVERAGE, THE PURCHAM CFTNIS DAMAGE WAIVER IS NOT DA DRY MAY BE WAR�UR t)ECLINEO. ENTAL PROTECTION PLAN 1S NO7INSURAACEt Ira Rental Wolection Plan a only araaab.0 to d4acl c m"ha ial Custantsm. Utwn Accepting the ophonal Rental Protect(on pWn, axtelnet agrees to pay a charge Oqua] to et tho ranter the {lets un =,uip rw tt Custemet woes COVeaod by tnol7ental protection Plan. In return, as sat -forth is Addendum T b Iha Rental AgnsemonL United 89"o" to waiva.Cadr Wirrrs Tar auCManta( damage Iv or ehaR of such cavorod Equitsnwnt otcwnrgt Junng nOlmaa and oratul use Customer remouts liable for all other riarnagas am) loss duo to (haft As sal Ibfth in the Conditions found In Section 6(B) Of Addowlarn 1 to the Rental Agreamunl, 7a tenrrs unn +.exndiricros al Ina OPCO tai RwOa l PfO,atarn Pian�it appiiaatite� and (x) Au1lwr�fiasaUrdrM to rargIt It C 1" a man crrd .05 that the equipmm�t to m the Condition 4 atatetlaathe Cnnd,fien report {c), (x) All." to above or on [do +! Vtsrn at d use r;i ptu e6jle+pment an.. naS Y0C81Vea (a) dw equ�pmnn; m goad working. order; (b) all sa!6!y fwilatinE: (C) as aperatOr mnnuafo; arW (d) all monuloCturet a tabulated data Ivry �r iha�ggtatCtiva'sNsfazfi. {af�u .0 the Pt y aquipment Rated OMER SIGNATURE DATE CUSTOMER NAME PRINTED UNITED RENTALS REPRESMTATIVE/DELIVERED BY DATE A LAMUER FONT COPY OF THE TERMS AND CONDITIONS IS AVAILABLE UPON REQUEST, Tuna • , En n 0 rn rn A O v w N O_ N W O 0 N c m O M N O O O 0 0 m 0 0 N A W N yQ A W N mlS O r- 00 0 Cr (31 A 0) m - W 40ODWrnS� m mm Noo -�o � 0 0 C/) �0) -4 w00 3CO m r- mc ai m w w p.7 K v G) 9 D O- '= N ti ' C D O— CLOG C) —I 7 �. � C) CC N � . (D `< 0 a CD 3 (m x C C j N N O 7 (D 2 `C .O .O A - O 0 O o W -+ -,J —1 —I ;o o w � W co W m -n CD n 00 co 0 CO W W A 00 CO . 0 G Ct " a CO CD CD T7 O ? A O Z Cn s ,-s 111111 w 8 889) p CO CO CO m co O O O O O W A co O (O O) c0 A CD W CID N 0) A O (T O O O O ni v a rn X O m O C CD ,' W -,J —1 —I CO v W co W m 00 co CO CO W W a CO . a CO CD CD N O ? A O Cn s CL < a go D (n m (n r O (n m 0 M m a t c C'o o C m to & -� S. , E; m om } °ic o� c °- m $ o a .b tD rri o 0 3 o m o 3° o CD o 0 0 n cSi � to :.i m W I m N -4. 4 a W to 0) O (n _ W N N W o W CD C) C.77 00 (D y C" 0 0 0 O O O 3 A IJ �I .A b1 O W VI W O O IV O N O 0) C7f N -! Cn CO 00 Ch O O A Cl .A N N N v a rn X O m O N X o 6 m O 0" X��O -� m m Z m < � � w O ' a d � � to . � ? ° t° m C I W ��CD tr X, = z O) > cr WK CL rA , _ Q N < 3 m 7� T / (D (Jt 3 ° p w lkz rn -I m, _ ' O � A 0 b �` J 3 CD e c. Zp s v _ . •yi rj I m O m m X m ON l o2 ' y' aQ/ CP Z 0 K_ iii 3 ( V! N o .t ce m O M (D n m (D Q W PL Sil m S cn D M CJ 6 o 15 z 3 -4 0 z v p w co C O I m (fl o m CD °: o -., (D y cn o d o c m 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 —SPM SAT SAM -SPM SUN 9AM -4PM CUSTWO: JOB NO: PURCHASE ORDER:' REFERFACE: TERMS: CLERK: ., 51.55 000 4261 10ST PO # 4261 10ST 2% 10TH NET # 1TH GS DUE DATE: 8111112 TERMINAL: 70 SOLD TO: SmP TO: `-PAVX <, Iii 411 WALKER ST WATSONVILLE CA 95076 831 -768 -2708 PAGE NO 1 DATE) TIME: 7112112 2:56 RESALE NO: UGRND SALESPERSON: GS GREG S TAxc 004 CITY OF WATSONVILLE INVOtC :166410 LINE SHIPPED ()RQEREQ UM SfZU DESCRIPTION SUGG UNITS PRICE/ PER EXTENSION 1 1 i EA Rrli4 RED MOT BLUE GLUE 1/4 Iy1NT 10 +OS 6.99 1 6.09 IEA 6.10 C 2 1 1 EA P7014 P -70114 PINT PRIMER PURPLE /18 6.99 1 5.79 /EA 5.70 C 3 14 14 EA P34C 314 COUPLING SXS SCH 40 1225' 49 !4' 0.39 1EA 5.44 C 4 1 1 EA P34L 314 90 ELL SXS SCH 40 1225 .49 1 0-43 IEA 44 C 5 60 60 PT 'S4034 314" SCH 40 PVC PIPE 14060 .33 60 0.29 /FT 17.82 C t (MIKE) *" AIMOUNT CHARGED TO STORE ACCOUNT *" .77 TOT WT-. 1.53 I.M]1iF\RLC JV.Ja NON- TAXABLE 0.00 SUBTOTAL 35.52 38.915 TAX AMOUNT 2.93 ?OTAL 38.45 Received By 0 0 010I0 0 W N O m /m m to VI p a -D A N tA,G)0D o G) b C O m N to m (D so D m 0 0 m m 0 ('012 W O O tb ?_ v to I -� Cb O OD -A CO O V N O co Z.,:: �. to O al O nS to O to CD Ul A1. , y , .. 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Mb ƒ |� \ E / ƒ R 2 o CD — 0 F f - 0 & T(n ?�f z = to /SR °cn < L7L > x « � 0 2 7 > i ka C . � United' � � 37 ARP C cLE 37 TARP CIRCLE ORentals 631 -422, CA 93901 f4oipmsnt Aentaf 6l31- {{422-7421 833 -422-981 FAX GILROY CROSSING 'H 10TH ST ca x:152:. GILROY, CA 95020 h office: 408- 574 -1400 Cell: 831- 970 -0206 k! PAVEX CONSTRUCT ;ION CO CA I INVOICES MAILED WEEKLY TO M KATHY AND DIANA M SAN JOSE, CA 95136 RENTAL AGREEMENT .Customer Number : 415006 Agreement Date 6/25/12 :Rental Out 6/25/12 8:41 AM Scheduled In 7/02/12 8:41 AM t Jab Location: 10TH ST, GILROY EJob Number 212 P.O. Number 4162 iOrdered By DWAYNE PLUMBER (Written By UR051JG2 I L Sale'sperson : 8057 j l AL ITEA:Si Qty ._�q_ ?ptn -rtt Descri_ption Minimum Day. Week 4 Week_ 1 923828 *WATER TANK TRAILER 500 GAL 160.00 526.00 1221.010 IPake: WYLIE Model, EXP -500 -S Serial: 1;19'1111132461,34 2902 CC*v -E ITS /NOT2S: Rental Suhtotal: CONTACT; DVAYNE PLUMBER CELLr, 831- 970-0206 A CLEANING CfiARGE WILL APPLY TO EQUIPMENT RETURNED WITH EXCESSIVE DIRT, CONCRETE, AN} /OR PAINT. CUSTOMER IS RESPONSIBLE FOR ALL DAMAGE INCLUDING TIRES THERE WILL BE AN ADDITIONAL CHARGE; FOR MISSING KEYS. A i'URL CHARGE WILL BE APPLIED TO ALL UNITS NOT RETURNED FULL OF FUEL r * * * * * * a * * * ' ENVIRONMENTAL CHARGE: The earns rnnji -,ton above Are subject Tp an msvironnorMSl chatge which Is dosig ±sod to recover United's:dbed raid Indirect axporees for handhri , rrvt in wed di fklaleo aalRnitirallYN assts. Tnla la'Y+QE a gaYena'!pal•1?tanKlatetl Etlwgi: FUEL: Fuel charges Co not include dedefei i {eta.•Or local X4 titter, nag 9 spasug attrale praductt, IiazartYVUs NOTICE FOR RENTAL OF A MOTOR VEHICLE; THIS CONTRACT OFFERS, FOR AN ADDITIONAL CHARGE, A DAMAGE WAIVER TO LIMIT YOUR FINANCIAL RESPONSIBILITY FOR DAMAGE TO OR THEFT OF THE MOTOR VEHICLE, BEFORE DECIDING WHETHER TO PURCHASE THE DAMAGE WAIVER; YOU MAY NRBH TO DETERMINE WHIMER YOUROMN- INS)RANCE AFFORDS YOU COVERAGE FOR DAMAGE TO THEFT OF THE MOTOR VEHICLE AND THE AMOUI4T OF THE DEDUCTIBLE UNDER YOUR MN INSURANCE COVERAGE.. THE PURCHASE OF THIS DAMAGEWAIVER I8 AN EA FFORDSY'AND MAY WAIVED OR AGE T �, r/ RENFAL PR0IECT R7N PLANS NOT INSURANCEI Tha Ronilst PmlaMion Plan N only available to direct carnihaftfal Oustantars: 4;wrr eecop:itg the optional Rental Pmlact:an Plane, Customer agreasbinry a charge equal to such of the name{ roue gas on EquiprtwnS nrutonar wants Coverod bT Nto Rental ptotootian P!an In totem, as tot forth m Addanduru I toilet Rental Agreement, United agrees 10 Weivpcedotn claims for a+sdk.dal damage to or Shaft et each cavatw EGutprew. t oCCUtrirrg ;lunrrg +wand and Caravel use Cusdeewn tamauts liable far all olher tiornagec and loss Cue to Ihaflas safdwgr In Me conditions :a4hd or 36000 b(BI of Addandirm t to the Re."Agrea nt. ,,, IT -11111V carsw, tur.tanWr ixj Agre6sb gw terms and conditions contoured !n this ronlal agreomonl, (x) Aorss that itw equi ve terms and Cbn n turns of h+a Opt ... 1 RwsIW Prv{pptrrii PEan, it atN✓KCaWa: and (x) AUttrorizes UrdMItl charge n>rwd u I. It.. condition as stalad an the car+ddron a;tatt(s), (x) Agrees to. 16- and roe of the of Me01 arge Cuttomer t credit card iieted above or — quo, ii eppiiesbW CuttanteT also acknowtedgat III is fully tarntuo with the a t an;l has (a) the eq'uipmrc In good working order; (b) ail se!oey bu!lodnb: (C) as operate nrwrrk -; atsd (d) all me"u4111urer a tabulated data for the kr SM proteeYae system equipnwnt Indira OMER SIGNATURE DATE CUSTOMER NAME PRINTED UNITED RENTALS REPRESENTATIVEJDBIVERED BY DATE A LARGER FONT COPY OF THE TERMS AND CONDITIONS IS AVAILABLE UPON RECCUEST. Parr. L 9 c 00 rn�-4 A A N cn v 11g)ot�° N h Oo m CL W N 2 c m�' O r- 0 0O 3 v C) < w A v��0 0 a cn o wcA0c) 0) m A A z ic 0) CO M ': N ' OD ;o O C71 C CT fn m O n m = 0 CO v? N W ia r O m O O O m" Z n ? U) " iii Oc o Z O N 1 O 7 o, o w N: 1 N 3 P j oW W A N y m !A OD � W O O O m (n -+ OD N CU W V V O O O O W t0 OD OD O m to M O O D O O cD ?.a 3 m cn a A 0 v CD CD L' 3 O CD o NN (D .i. w PM OD � N O b W CD t31 a a A A A -1 Oo °o °o °o Iop�Cp)�o °° • Mmmk v a m X Ca G O T� N m �o O w N Co M ° 00 rn�-4 A A N cn v 11g)ot�° N h Oo m CL N' c d c c ID m 3 v .n c a c 3 a Q w A A O A cn 0) m A A CO ic 0) CO M ': N w OD ;o O C71 C CT fn m O OD m = 0 CO O) N O Cl O m O O O m" Z n ? " iii Oc o m O N 1 O N ai 1 (D _a N cn N ID H OD iJ � W ul N y m !A OD � W O O O m (n -+ OD N O) D) O V V O O O O W t0 OD OD O m to M O O D O O cD cn ti v CD L' v a m X Ca G O T� N m �o O w N Co M ° 00 rn�-4 A A N o `. �4f- O 11g)ot�° N h Oo m CL c c d c c ID m 3 v .n c a c 3 a Q 78 m ic m d1 in O C71 C CT fn m c 0 3 0 o N e o n o Z n ? " iii s m N 1 m N ai (D _a N cn N ID H OD iJ � W ul N y !A OD � W O O O 17N (n -+ OD N O) D) O V V O O O O to t0 OD OD O pf 0) O to M O O D O O v a m X Ca G O T� N m �o O ( 2 ( \ Cl) �^ \� t # \ 2 E / \ { I 2E ƒ /2% F � - ;o ƒ co $ / §\ §i \} ƒ°� m i m / / ƒ 7 ` 0 \ f � 0 m m 0 United' + Rentals fatipmedRealal I;:IeI•JirPi£NTS i8nc -Si7 367) RnI1tTfl!PRIatA -td;n LOCATION #051 39 TARP CIRCLE SA LINAS, CA 93901 831- 422 - 942.1 832- 422 -596I FAX �fl II1111I�I11111iIINl�lllllllllllllllllllll I III -) GILROY CROSSING -H 10TH ST W x :152 @. 4 GILROY, CA 95020 h Office: 408- 574 -1400 Ce1.1t 831 -970 -0206 PA'VEX CONSTRUCTION CO CA INVOICES MAILED WEEKLY TO KATHY AND DIANA SAN JOSE, CA 95136 RENTAL AGREEMENT # 1035999 Customer 'Number 415006 Agreement Date 6/25/12 Rental Out 6/25/12 Scheduled In 7/02/12 Jclb Location: Job Number P.O. Number ; Ordered By Written By IN 6:41 AN 8:41 AM 10TH S:', GILROY 212 4162 DWAYNE PLUMBER URO51JG2 8057 Oty _ Egl.ti1__ent Descri tion �_ i_ :Minimum Day Week 4 Week 1 423828 *WATER TANK TRAILER 500 GAL 160.00 526.00 1121. CIO Make: WYLIE Model: EXF -500 -S Serial: 1 W9'P4t13 24 6L342402 CO!"IME2NTS /NOTES : Rental Subtotal: CONTACT: DWAYNE PLUMBER CELL##': 831-970-0206 A CLEANIM CHARGE WILL APPLY TO EQUIPMENT RETURNED WITH EXCESSIVE U =•RT, CONCRETE, ANI� %OR PAINT. .CUS'MER IS RESPONSIBLE FOR ALL DAMAGE INCLUDING TIRES. THERE WILL BE AN ADDITIONAL CHARGE FOR RISSING KEYS. A FUEL CMARGE WILL BE APPLIED TO ALL UNITS NOT RETURNED FULL OF FUEL k * * * * * * a * * * ENVIRONMENTAL CHARflf: The kerns tnrrieeted 6aovv are sui»ect b an enview+rsrdel charge vfiictY Isdestanal t0 talwvar Iiralod's:dhnCt anll Ydaact exaeiKes ldtihs tuindiinp; awnaph+9 arxf dtapa5itlg o(watte pwV¢tt, Fiazsnbua I adnstrativa costa. Ftus M IMI gavarnineMamuxtated charge.. FUEL -Fuel chergot do not include Isdwahviate: or local excisn taxes. OPTIONAL.IIENTAL PROTECTION PLAN j{ NOTICE FOR RENTAL OF A MOTOR VEHICLE: THIS CONTRACT OFFERS, FOR AN ADDITIONAL CHARM A DAINAAE WAVER TO LIMIT YOUR FINANCIAL RESPONSIBILITY FOR UAMAAE TO OR THEFT OF THE MOTOR VEHICLE. IEEFORE DECIONO WHETHER TO PURCHASE THE I)AMAOE WAikER; YOU MAY WtSH'FO DETERMINE WHETHER YOUR fTVNM9IKANGE AFFORDS YOU NxJVENAOE FOR 1)AMA,OE TO OR THEFT OF THE MOTOR VEHICLE MID THE AMOUNT OF THE OEUUCT/8LE UNDER YOUR OWN INSUMOCE COVERA915. THE PURCH"R OF THIS OAMADE WAIVER RNOT MMOATORY AND MAY WAIVED OR DECLINED. i TINE REM L_P"rSf7 QN PLAN IS NOT INSURAiVCEi The Rental Protodfpn Plan is Only avekatfe Wilfred omarmclsl Custemas, Up—a of the will c Cegsr p the optiwlal RadW Proiea! ee Y!an, Cuslarreragnaa to Pay a ga ga egwlln charges trn Epwpnrant tSUaWmdr wme Oove.od by the RenrlyroNcifon PNOi;. In latern, mast ladh In Addanduin 1-to the RanidAllift"w"t. United ag use (o voi_ cadain shims Yor aaGdantaTawge to oir tnah of such coveted Equuvw *a occurra>hdwtnp aamud ant "ratio u,, Gu4bmer l MON lahle'Mr all other damages and lest due to theft as set kith le IMsonifkloru found In Ssodoa N11) Of AdCONOm I to the RmifalApraoMnL .. Pv»n , iwrmr ix; eVNrees w me lams ana candnane.esatamatl inttria lentel apreoment (x) Ayrtos Nst W k la /arms Oas mndilains of inn �) stpdpntenl is Condition as slated an the condition re a reas to APtiansl Rsntel Prslacaan Piari, it A icaWe; anI Aulhdnzea Unkad p ehmpa CrM1tomrr s aedd 0 rd fisted andM el on Me. 11 spippcah:6: Custaima, akq acknowSsdgea 11roi it le WaT havilar witA he wetpn anfusa i:l mo aais;prrgrtl airf has received (ej hw equiR+aant in good Walking ortlei; (D) ali'aa!atY tale: Nc) an eaeratoi nwnwls; and lej as manufeclurer s tabubtat data far die 101 inn pratecliva syslesatgidpngnl Rated b 9MER SIGNATURE DATE CUSTOMER NAME PRINTED UNITED RENTALS REPRESENTATNEiDELIVERED. BY DATE A LARGER FONT COPY Of THE TERMS AND CONDITIONS IS AVAILABLE UPON REQUEST. Darya T 2 H c a m W 0 c s D r m O m a O 0 0 m 0 m 0 m 0 m 0 m 0 m r r 1 r r 0 r 0 N r 0 (- Qi p c n 0. 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O O CL W O O O N p- co A N OD OD A a W W d O W C O N W 7 t D r *--1 - d'.. < C O� C' p EP z 0 C N y O y p d _. o a x g a tp'; oor-o 1 p m m d m 3 t T N [P (D O Ln C a S Cn N O m O N. m O O O 0 0 CD O 3 0 W S 02 N w y W i L H 000 CD c W O C�J) W O N co Cb O -4 0 ' N N -I (O Cb V J O -4 O CO Cn w N N N p O O .00 C to W W W O W v 0 0? C) � .a 1 co -N+ �Wa 4 N iV N D r m O m a O D @ A O m VD p cr x w 0 x m Q !n @ D m a m R m 3 6 0 a 0 n i° co n _ a �3 n c C o N' t0 � N m o, o� x 3 (D o CD (n n (n m o 0 OL m x .. n 0 . _ CD ...# 0 fli Q lit :3 0 q i°° �. C o 7 0 m ° m o' -` 3 Q 0 0 m mm�m pp C. Q Q C -n (n -� O' n CD x 3 m 3 *x Vii. G) 4. a• OD— (D CD Ox 3 P D 0 to 0) CD 4 m i z z a x 4' D m� cu 0 0 z v O Z m x n z 0 Vi Q x � n o dCL Ix o M II "R 0 I� 4 A 0 N N IN W I0�0 N I N 0 0 o° °O N « N I N W I N 0 00 � N N j O N m N j W O N ca o m o a O w A n N D d m b W mW A 0 N V S N N N N A N e N W I� N O N V s N 0 V N N j � N I O 01 N 0 C C. 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" D D N Z O N m d 7 N v N 'O m m n 0 O N CL s 0 m 0 0 A O N O H Q a � y : _ o Y a C w 2 N n m o � 0 m 0 °e = ' N CL R n � A N N o � pN x X A 0 01 e 0 O a d G A 0 � N Qo °o N 3 c° 3 r r N M N D A C A A qLn �' ch O S O O N 2° N N pN O Ivy N N 0 N V m r N y c P N O C w e N CL m a 9 'o o n c o n � O ^� A A A � N � w o N � O O C O � J it V N x A 0 0 0 N r J N N i T » M V p 0 N N JVN O O � V qVq O O N 3 r r o o °o °o DN 00 c r r N N N D j N O N N V NV V V O O O O a m N 0 m N A m N 0 « V 2 .Z1 0 °o N U O cxi N W W N 2° N N (h O IW N S N �i pb gI r �w4 y,. 4 �a i T t--1 4 S- +lrzh E z n �O x W CL O D A 3 ` D v ° Nrn O pr d a h1 00 n m p Q L CO ~ 03� m � ) c O a C < y co y rt O G e 7 O Q ` d c O 0 D a 3 A 3 06 O 0 rt a n O a 7 a n �- T x ° O W Q -0 N 0 O O C. W 3 N g c ° m v d A R V m N X # n A 0 _1 N +n N — fG `G N n N � N m 7 � 0 N �.N a CO m v C 0 "0 A O ita,0� m � ra O A N COl ° M a a c. " D D N Z O N m d 7 N v N 'O m m n 0 O N CL s 0 m 0 N S r 00 c N N N ' N � O 0 X °o °o N co 0 0 N A N O N N o O S N Qo °o N 3 c° 3 r r N M N D A C A A qLn �' ch O S O O N 2° N N pN O Ivy N N 0 N V m r N y c P N O C w e N CL m a 9 'o o n c o n � O ^� A A A � N � w o N � O O C O � J it V N x A 0 0 0 N r J N N i T » M V p 0 N N JVN O O � V qVq O O N 3 r r o o °o °o DN 00 c r r N N N D j N O N N V NV V V O O O O a m N 0 m N A m N 0 « V 2 .Z1 0 °o N U O cxi N W W N 2° N N (h O IW N S N �i pb gI r �w4 y,. 4 �a i T t--1 4 S- +lrzh E z n �O x W CL O D A 3 ` D v ° Nrn O pr d a h1 00 n m p Q L CO ~ 03� m � ) c O a C < y co y rt O G e 7 O Q ` d c O 0 D a 3 A 3 06 O 0 rt a n O a 7 a n �- T x ° O W Q -0 N 0 O O C. W 3 N g c ° m v d A R V m N X # n A 0 _1 N +n N — fG `G N n N � N m 7 � 0 N �.N a CO m v C 0 "0 A O ita,0� m � ra O A N COl ° M a a c. " D D N Z O N m d 7 N v N 'O m m n 0 O N CL s 0 m 0 N o U) pm O N p mp A o W 0 N 0 U2 CD . A °w N (O (1 A V OD 00 i. A O m, a co CO CO CO 1•I , N K 0 m 0 m 0 m O is ns •,�o zOo Q) •.a 000� rn -I o w 00 � -i N 00 co "F w f0 CAO j -4 - N: r C M C CT m O 0 C, a. 0 CL 0 i C m O W rl O i13 U) 0 0) W W i v c0 N U2 CD . A A O N (O (1 A V OD 00 i. A O m, a co CO CO CO 1•I , N K v D < u O is -r Q) •.a -I -I o C0 7D.. -i N 00 co "F w f0 0 j 0 0 N: n C d C CT m O 0 C, a. 0 CL 0 O O � d L0 Ca O b, i i 0 p co U7 W o vim' W W V A W OA A O O O O O O W V N p 3 x ♦♦y/w/�' '� Z.�/: �An VI Q O Ut {� <C - O O v O 00 CO OD O O OD N `7 :3 v m Ln N H S O O (D p O f'D 0:, x 1p _ O [A 5 N O O N N ' N' O Q) ;I 0' Q : A A 00 CO co O -d- OD OD OD OD 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 vi? O O O O m i C m O W rl O i13 i O O O 0 0) i i i v c0 N M . A A O N (O (1 A V OD 00 i. A O m, a ' CO CO CO 111111' -i 0) P I is i C m O W rl O i13 i O O O 0 0) i i i v c0 N M . A A O N (O (1 A V OD 00 i. A O m, a ' CO CO CO O -i 0) P A Q) •.a Cp (O CO C0 7D.. co N 00 N "F 0 0 0 0 0 0 K 00 CAD O CT m O 0 C, a. 0 0 0 O O � d L0 O O i`' ! i 0 p co U7 W A A co -co W co CA 00 V l(D vim' W W V A W OA A O O O O O O W V N p 3 Ei C1 Q1 A IV O Ut {� <C - O O v O 00 CO OD O O OD N N y Ln i C m O W rl O i13 i O O O V W O '. CL O 0> A CO A A U1 co A v c0 N Ul " A . A ,I C1 O N (O (1 A V OD 00 i. A O m, a ' S. f71 m 50 N N O 0 a X O d _ "F _ Gi 03 CT _ 1 C �7 N (D v yT ,n K 00 CAD O CT m O C, iu d L0 N O t7i N W y O O O) i 0 p co U7 W A A co -co W co CA 00 V l(D vim' W W V A W OA A O O O O O O W V N p 3 Ei C1 Q1 A IV O Ut {� <C - O O v -i CO OD O O OD N W O O A P O 0 United' HSC Rentals � EaarpmlldRental Ina JR41F NTS ;uac$77 307) aRit,,1rebtA s t;m LOCATION #051 37 TARP CIRCLE SALINAS, CA 93901 831 -422 -7421 833- 422 -5992 FAX. �IIIIIflllllfllllllf lllllllllllllllllllllllllllllll 0 GILROY CROSSING ru 10TH ST A x:152v. GILROY, CA 95020 Office: 408- 574 -1400 Cell: 831 -970 -0206 PAVEK CONSTRUCTION CO CA al INVOICES MAILED WEEKLY TO KATHY AND DIANA M SAN JOSE, CA 95136 RENTAL AGREEMENT # 1 Customer Number Agreement Date Rental Out Scheduled in u 415006 6/25/12 6/25/12 8:41 A14 7/02/12 8: 41 A4 Job Location: 10TH S:', GILROY Job Number 212 P.O. Number 4162 Ordered By DWAYNE PLUMBER Written By UR051JG2 sales rson 8057 t cnent Description — E �— uin�--- ...... --- -- -: Minimum Darr Week 4 Week 1 923828 *WATER TANK "TRAILER 500 GAL - - -- 160.00 526,00 1121.00 ;lake: WYLIE Model: EXP -500 -S Serial: 1W9114132461,342402 COMMENTS /NOTES: CONTACT: DWAYNE PLUMBER CELLO, 831 - 9'70 -0206 A CLEANING CHARGE WILL APPLY TO EQUIPMENT RETURNED WITH EXCESSIVE DIRT, CONCRETE, AND /OR PAINT, CUSTOMER IS RESPONSIBLE FOR ALL DAMAGE INCLUDING TIRES. THERE WILL BE AN ADDITIONAL CHARGE FOR KISSING KEYS. A FURL CHARGE WILL BE APPLIED TO ALL UNITS NOT RETURNED FULL OF FUEL • * * * * t A, *- * * * * Rental Subtotal: ENYtRONIf10NTAL CHARGE; The iterr?s indi0ated abovO:,are auOtact to an anvignnrantel cnatga whiciY k ilea tnad p remover Uniledk dirnOl antl kglaaCl eapensas pl'tha handlirtl; rrMnrsging and disposing at waste products. .hazautou8 tu4fteu adrralsirative coats Tiss ;s -nof al gove mnenl- rnamiatOd Cbarge.. FUEL: Fuel chergds do not include pduai, trMp; of 1oca1 excise toxbs. NOTICE FIBt RENTAL OF A MOTOR VEHICLE: THIS CONTRACT OFFERS, FOR AN ADDITIONAL CHARGE. A DAMAGE WAIVER TO LIMIT YaM FINANCIAL RESPONSIBILITY FOR DAMAGE TO OR THEFT Or THE MOTOR VEHICLE, BEFORE AMOUNT WHETHER C PURCHASE THE DAMAGE SUR , You MAY WISH TO DETERMINE WHETHER YOUR OWN INSIMANCE AFFORDS YOU COVERAGE FOR DAMAGE . TO OR THEFT OF THE MOTOR VEHICLE MID THE AMOUNT Op THE OEbUCTtBIE UNDER YOUR OWN tNStIIANCE COVERAGE.. THE PURCHASE OF THM DAMAGE WAIVER aMOT MANDATORY AND MAY BE WAIVED OR DECLINED. 'HE RENT,@J?ROTECTJON PLAN tS NOT JNSflRANCEI Th. Rebtat Ptatecim plan k only ovagabte p dltad corr?mercial Cu6pnwnt, Uponaag6rrg the ttpiksnal !xentet Protentipnpfar?, Customer agrees to pay a eaerge equal p 74. . of t{armMar Chingos on Eguipnreni Cj Barer wants CO—od by the - Rontalpretech li Plan. In relvm, asset Ionfr m Addendum Ito life RenllAgr"nalrt, United . agrees to "ve Codmn claims for accidonlet dan"O to or fret{ Of suds cOVarad EGuI{utmncdCCUSruM ;funng eomvV and c-1," use C-1-au "masse beau (41 ail other dan?ages;sM loss due to iheh as set forth n tlNmndi{iona f-4-4 In Section SIB) Of Addendum t to the Rental.Agreerwrit. °d' v,t? vnlw lnlocb±O;Pl3 Agrees to the IsareaAnd rantldwna CoMeirrad in {iris iontal agreer lit; (a) Agroos that as", pnxu?I16'lnthe Condition as slated do the Corsdrtion reportle); (,4Agreas to: 7e txnrxs oaf m Jlii na or Ina Upt•onat Rw?lat PrOladte�a? Pian, st appliCaWe; alb (a; Auth"n"s Unild p charge Cuapmer s credit Card Listed &bow at on file, if appl£cahfa: CuslOmor also .6mowisdgea that it. Is full tarregar with the shun ens ussc 0 nut uQ .powl and bas received (a) tho oouipmont in goad asorkmg order; IN all gallery bulletins: iC) as operator nurnuale;. and" SO manufacturer, s tabulated data pi the tar the prdtoCtiva systernetuipnwht sated WER SIGNATURE DATE CUSTOMER NAME PRINTED UNITED RENTALS REPRESENTATIVE /DELIVERED BY DATE A LARGER FONT COPY OF THE TERMS AND CONDITIONS IS AVAILABLE UPON REaUEST. pmryP. T I' E Rental Subtotal: ENYtRONIf10NTAL CHARGE; The iterr?s indi0ated abovO:,are auOtact to an anvignnrantel cnatga whiciY k ilea tnad p remover Uniledk dirnOl antl kglaaCl eapensas pl'tha handlirtl; rrMnrsging and disposing at waste products. .hazautou8 tu4fteu adrralsirative coats Tiss ;s -nof al gove mnenl- rnamiatOd Cbarge.. FUEL: Fuel chergds do not include pduai, trMp; of 1oca1 excise toxbs. NOTICE FIBt RENTAL OF A MOTOR VEHICLE: THIS CONTRACT OFFERS, FOR AN ADDITIONAL CHARGE. A DAMAGE WAIVER TO LIMIT YaM FINANCIAL RESPONSIBILITY FOR DAMAGE TO OR THEFT Or THE MOTOR VEHICLE, BEFORE AMOUNT WHETHER C PURCHASE THE DAMAGE SUR , You MAY WISH TO DETERMINE WHETHER YOUR OWN INSIMANCE AFFORDS YOU COVERAGE FOR DAMAGE . TO OR THEFT OF THE MOTOR VEHICLE MID THE AMOUNT Op THE OEbUCTtBIE UNDER YOUR OWN tNStIIANCE COVERAGE.. THE PURCHASE OF THM DAMAGE WAIVER aMOT MANDATORY AND MAY BE WAIVED OR DECLINED. 'HE RENT,@J?ROTECTJON PLAN tS NOT JNSflRANCEI Th. Rebtat Ptatecim plan k only ovagabte p dltad corr?mercial Cu6pnwnt, Uponaag6rrg the ttpiksnal !xentet Protentipnpfar?, Customer agrees to pay a eaerge equal p 74. . of t{armMar Chingos on Eguipnreni Cj Barer wants CO—od by the - Rontalpretech li Plan. In relvm, asset Ionfr m Addendum Ito life RenllAgr"nalrt, United . agrees to "ve Codmn claims for accidonlet dan"O to or fret{ Of suds cOVarad EGuI{utmncdCCUSruM ;funng eomvV and c-1," use C-1-au "masse beau (41 ail other dan?ages;sM loss due to iheh as set forth n tlNmndi{iona f-4-4 In Section SIB) Of Addendum t to the Rental.Agreerwrit. °d' v,t? vnlw lnlocb±O;Pl3 Agrees to the IsareaAnd rantldwna CoMeirrad in {iris iontal agreer lit; (a) Agroos that as", pnxu?I16'lnthe Condition as slated do the Corsdrtion reportle); (,4Agreas to: 7e txnrxs oaf m Jlii na or Ina Upt•onat Rw?lat PrOladte�a? Pian, st appliCaWe; alb (a; Auth"n"s Unild p charge Cuapmer s credit Card Listed &bow at on file, if appl£cahfa: CuslOmor also .6mowisdgea that it. 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O >L m ca ro cE W nt C O O E Y :3 0 co 3 C cu cc �+ Q N N c a� a U) C 3 O a ro O O_ Q Q z9tr eor it *yY :N,1, v 01 d!4S (,�g6 ZiOZfzl /R aoIOnul eiia GOIOAU 1 of Ifl t,9ZI-IZ096 rMUID4111e3 jAQ iio S9Zi X09 ,0,d (u,DdsUPJ,L 3100'U IUD) ljodswu ,{4uno:) pi 2 1d 6728S92:01 00L6 9t78 801? 1.1NnOO lai:wo8j U82:2 -0 2TO2- £z -J(lb 00'06VIS IejO1 00'0 00`569 00"SU °1u00'0 00'SA 00.58 tojl!D- Iipluopq- inicH,410-laagA% Q I lliJ 1jpjt w- jnvHjjp-p* 01 sQ W86 WS 09LL6 90055 -60 90OS5-60 L L lunotuy 4on8 G►ud uogduasep II #9 i481e�� epo0 QoP kpont) -T 00L6`968 ~SOb # xezl 0904-08-got # euoyd swral jo4wnN z9tr eor it *yY :N,1, v 01 d!4S (,�g6 ZiOZfzl /R aoIOnul eiia GOIOAU 1 of Ifl t,9ZI-IZ096 rMUID4111e3 jAQ iio S9Zi X09 ,0,d (u,DdsUPJ,L 3100'U IUD) ljodswu ,{4uno:) pi 2 1d 6728S92:01 00L6 9t78 801? 1.1NnOO lai:wo8j U82:2 -0 2TO2- £z -J(lb A��,�� L �J CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/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. 0. BOX 2690 Watsonville, CA 95076 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: ZURICH AMERICAN INS CO 16535 INSURER B: DAMAGE TO RENTED PREMISES Ea occurrence GRANITE ROCK COMPANY DBA PAVEX CONSTRUCTION DIVISION INSURER C: CLAIMS -MADE OCCUR P. 0. BOX 50001 INSURER D: WATSONVILLE, CA 95077 MED EXP (Anyone person) $ NIL INSURER E: $ 1,000,000 INSURER F: • XCU Hazards 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 SUER POLICY NUMBER MM / DfYYYY 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 OCCUR MED EXP (Anyone person) $ NIL PERSONAL & ADV INJURY $ 1,000,000 • XCU Hazards • Contractual Liability GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 $ POLICY X PRO- 7 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 I Contractual Liability UMBRELLA LIAB EACH OCCURRENCE $ HOCCUR AGGREGATE $ EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION S • WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? N❑ (Mandatory in NH) NIA X WC3472667 -10 09/30/1 09/30/12 X WC STATU- IOTH- T R E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EM-PLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1 $ 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) CERTIFICATE HOLDER CANCELLATION 4162 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 yrivera ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD 23100638 SUPPLEMENT TO CERTIFICATE OF INSURANCE DATE 09/17/2011 NAME OF INSURED: GRANITE ROCK COMPANY DBA PAVEX CONSTRUCTION DIVISION SUPP (10100) 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 9/30/2011 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 contractor 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: 9130/11 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, NON- 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: 9/30/11 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.