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HomeMy WebLinkAboutJJ Nguyen, Inc.AGREEMENT THIS AGREEMENT is made and entered into on the b'd, day of ! ( 2010 by and between the TOWN OF LOS ALTOS HILLS (hereinafter referred to as "TOWN") and JJ NGUYEN, INC. (hereinafter referred to as "CONTRACTOR"). In consideration of their mutual covenants, the parties hereto agree as follows: CONTRACTOR.. Shall provide or furnish the following specified services and/or materials: Provide landscape maintenance at Westwind Community Barn every two weeks. 2. EXHIBITS. The following attached exhibits are hereby incorporated into and made a part of this Agreement: Proposal from CONTRACTOR dated 3/26/10 3. TERMS. The services and/or materials furnished under this Agreement shall commence 5,01/2010 and shall be completed by 4/30/2011, unless terminated pursuant to Section 5(f), 4, COMPENSATION. For the full performance of this Agreement: a. TOWN shall pay CONTRACTOR an amount not to exceed six thousand dollars and zero cents ($6,000.00) within thirty-five (35) days following completion/delivery of services/goods as detailed in Sections 1, 2, and 3 of this Agreement and only upon satisfactory delivery/completion of goods/services in a manner consistent with professional/industry standards for the area in which CONTRACTOR operates. TOWN Is not responsible for paying for any work done by CONTRACTOR or any subcontractor above and beyond the not to exceed amount. b. Town shall not reimburse for any of CONTRACTOR's costs or expenses to deliver any services/goods.. Town shall not be responsible for any interest or late charges on any payments from Town to CONTRACTOR. c. CONTRACTOR is responsible for monitoring its own forces/employees/agents/ subcontractors to ensure delivery of goods/services within the terms of this Agreement. TOWN will not, accept or compensate CONTRACTOR for incomplete goods/services. Town of Los Altos Hills Page 1 of 4 Not to excaad $15 000 per fiscal year Updaled 3 17 08 5, GENERAL TERMS AND CONDITIONS, a. HOLD HARMLESS. CONTRACTOR agrees to indemnify, defend and hold harmless the TOWN, its officers, agents and employees from any and all demands, claims or liability of personal injury (including death) and property damage of any nature, caused by or arising out of the performance of CONTRACTOR under this Agreement. With regard to CONTRACTOR'S work product, CONTRACTOR agrees to indemnify, defend and hold harmless the TOWN, its officers, agents and employees from any and all demands, claims or liability of any nature to the extent caused by the negligent performance of CONTRACTOR under this Agreement. b. INSURANCE.. CONTRACTOR shall file with the TOWN a certificate of insurance before commencing any services under this Agreement as follows: I, WORKERS COMPENSATION INSURANCE: Minimum statutory limits, COMMERCIAL GENERAL LIABILITY AND PROPERTY DAMAGE INSURANCE: General Liability and Property Damage Combined, $1,000,000.00 per occurrence including comprehensive form, personal injury, broad form personal damage, contractual and premisestoperation, all on an occurrence basis. If an aggregate limit exists, it shall apply separately or be no less than two (2) times the occurrence limit. iii, AUTOMOBILE INSURANCE: $1,000,000.00 per occurrence, iv. ERRORS AND OMISSIONS INSURANCE: $1,000,000.00 aggregate. v. NOTICE OF CANCELLATION: The City requires 30 days written notice of cancellation. Additionally, the notice statement on the certificate should not Include the wording "endeavor to" or "but failure to mail such notice shall impose no obligation or liability of any kind upon the company, its agents or representatives." vi, CERTIFICATE OF INSURANCE: Prior to commencement of services, evidence of insurance coverage must be shown by a properly executed certificate of insurance and it shall name "The Town of Los Altos Hills, its elective and appointed officers, employees, and volunteers" as additional insureds. vii.. To prevent delay and ensure compliance with this Agreement, the insurance certificates and endorsements must be submitted to: Town of Los Altos Hills Not la ahead 516.000 per fiscal goer Updated 3 17 08 Town of Los Altos Hills - Contracts 26379 Fremont Road Los Altos Hills, CA 94022 Page 2 of 4 c. NON-DISCRIMINATION. Nondiscrimination shall be made in the employment of persons under this Agreement because of the race, color, national origin, age, ancestry, religion or sex of such person. INTEREST OF CONTRACTOR. It is understood and agreed that this Agreement is not a contract of employment and does not create an employer- employee relationship between the TOWN and CONTRACTOR. At all times CONTRACTOR shall be an independent contractor and CONTRACTOR is not authorized to bind the TOWN to any contracts or other obligations without the express written consent of the TOWN. In executing this Agreement, CONTRACTOR certifies that no one who has or will have any financial interest under this Agreement is an officer or employee of TOWN. e. CHANGES. This Agreement shall not be assigned or transferred without advance written consent of the TOWN. No changes or variations of any kind are authorized without the written consent of the City Manager, This Agreement may only be amended by a written instrument signed by both parties f. TERMINATION. This Agreement may be terminated by TOWN upon seven (7) days written notice to CONTRACTOR. Monies owed for work satisfactorily completed shall be paid to CONTRACTOR within 14 days of termination, g RECORDS. All reports, data, maps, models, charts, studies, surveys, calculations, photographs, memoranda, plans, studies, specifications, records, files, or any other documents or materials, in electronic or any other form, that are prepared or obtained pursuant to this Agreement and that relate to the matters covered hereunder shall be the property of the TOWN. CONTRACTOR hereby agrees to deliver those documents to the TOWN at any time upon demand of the TOWN. It is understood and agreed that the documents and other materials, including but not limited to those described above, prepared pursuant to this Agreement are prepared specifically for the TOWN and are not necessarily suitable for any future or other use. Failure by CONTRACTOR to deliver these documents. to the TOWN within a reasonable time period or as specified by the TOWN shall be a material breach of this Agreement. TOWN and CONTRACTOR agree that until final approval by TOWN, all data, plans, specifications, reports and other documents are preliminary drafts not kept by the TOWN in the ordinary course of business and will not be disclosed to third parties without prior written consent of both parties. All work products submitted to the TOWN pursuant to this Agreement shall be deemed a "work for hire." Upon submission of any work for hire pursuant to this Agreement, and acceptance by the TOWN as complete, non-exclusive title to copyright of said work for hire shall transfer to the TOWN.. The compensation recited in Section 4 shall be deemed to be sufficient consideration for said transfer of copyright. CONTRACTOR retains the right to use any project records, documents and materials for marketing of their professional services. Town of Los Altos Hills Page 3 of 4 Nal to exceed $15 000 per fiscal yeer updelod 317 08 h. ENTIRE AGREEMENT. This Agreement represents the entire agreement between the Parties, Any ambiguities or disputed terms between this Agreement and any attached Exhibits shall be interpreted according to the language in this Agreement and not the Exhibits. 6. INVOICING. Send all Invoices to the contract coordinator at the address below. This Agreement shall become effective upon its approval and execution by TOWN. In witness whereof, the parties have executed this Agreement the day and year first written above. CONTRACT COORDINATOR and representative for TOWN: CONTRACTOR: Richard Chiu Public Works Director Town of Los Altos. Hills By; 26379 Fremont'Road signature '-baie Los Altos Hills, CA 94022 U'vPrint _ Print name, 7fkie TOWN OF LOS ALTOS HILLS; By: Lpamo Carl Cahill, City Manager Qate Town of Los Altos Hills Page 4 of 4 Not to exceed 315 000 per fiscal year Updated 3 17 08 JJ NGUYEN, INC 3172 Salem Dr, San Jose CA 95127 Office Phone: 408-259-7982 Fax: 408-347-8183 Date:3/26/2010 Project Name: Los Altos Barn Description of charge: Los Altos Barn Clean up and Backflow Preventer 50 C.Y mulch Lawn,plants and Irrigation Maintenance (every 2 week) Total Cost $1,500 $2,500.00 $ 5,500.00 6,000.00 $ 15,500 Forrn W-9 Request for Taxpayer Give fort, to the (Frau October 2007) Identification Number and Certification requester. Do Sof n,manmt�nt of u,o m,est:�j send to the IRS, 4oanrtd Bevowa sotkw7t. Name (as shown on your Income tax retum) N N ` V ro ausiness name, if diffare t Irom above C b Check approprlate box: ❑ Indivldual/Scle proprietor Ctxporatlon ❑ ParinareND ❑ Limited 1lability company Enter the tax dassincation (0 -disregarded entity. C=eorporotion. Prpartnership) N Exempt ❑ r U o .. • .... ❑ Other (see insvucGena) 0 - payee Address fnumber. street. and apt or suite no) Requester's name and address (optional) IL Town of los Altos Hills City state, and zip coda • q S E0379 Fremont Road h TO I S Los Altos Hills CA 94022 m r� List account number(a) here (opdonalI can Taxpayer Identification Number (TIN) Fatter your TIN In the appropriate box. The TIN provided must match the name given on Une 1 to ovoid Social ssourity number backup withholding For individuals, this is your social security number (BBN) However, for a resident alien. sols proprietor, or disregarded entity, see iiia port I instructions on page 3 For other antilles. it Is your employer identification number (EIN) It you do not have a number. see Now to get a 77N on page 3 or Note. If the account Is In more than one name. see the chart on page 4 for guidellnes on whoseI Employer idonUfloation number number to enter 20 ! $ 5 (I O 2 Under penalties of perjury. I certify that: The number shown on this form Is my correct taxpayer identification number (or i am wafting for a ntanber to be issued to me). and i am not subject to backup withholding becaueet (a) I rats exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup wlthholding as a result of a iallure to report all Interest or dividends. or (c) the IRS lion notified me that I am no longer subject to backup wllhholding, and I am a U S citizen or.other U 8 person (daltned below) Certification htstruettons. You must cross out Item 2 above It you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all Interest and dividends on your tax return For real estate troni;000118, item 2 does not apply For mortgage Interest paid, acquisition or abandonment of secured property, cancellation of debt. contributions to an Individual retirement arrangement (IRA), and generally, payments other Ilion Interest and dividends. you are not required to sign the Certification, but you must provide your Correct TIN See the IiVorTCf�ns on page 4 Sign Signature of Hero I U.S. Person 11- General ► General Instructions Section references are to the Internal Reuenua Code unless otherwise noted Purpose of Form A person who is required to file an Information return with the IRS must obtain your correct taxpayer identification number (TIN) to report, for example, income paid to you, real estate transactions, mortgage Interest you paid, acquisition of abandonment of secured property, cancellation of debt, or contrdbutlons you made to an IRA Use Form W•9 only If you are a U Serson (Including a resident alien), to provide your oorreot THIN to the, person requesting it (the requester) and. when applicable to: I Cert Hy that the TIN you aregiving Is correct (or you are wailing for a number to be issued). 2 Certify that you are not subject to backbp withholding. or 3 Claim exemption from'backup withholding It you are a U S exempt payee If appplicable. you are also certifying that as a U S person. your allocable share of any partnership Income from a U S trade or business is not subject to the withholding tax on foreign partners' share of effectively connected Income Note. If a requester gives you a form other than Form W-9 to request your TiN. you must use the requester's form If it is subslanllally similar to this Form W-9 Date "I I—' Definition of a U.S. person. 'Fk fade al tax purposes. you are considered a U S person H you are: • An individual Who Is a U S citizen or U S resident alien. s A partnership. corporation, company, or association created or organized in the United States or under the laws of the United States. a An estate (other than a foreign estate). or e A domestic trust (as defined In Regulations sectlon 3017701-7) Special rules for partnerships. partnerships that conduct a trade or business In the United States are generally required to pay a withholding tax on any foreign partners' share of Income from such business Further, In certain cases where a Form W-9 has not been received, a partnership Is required to presunia that a partner Is a foreign person, and pay the withholding tax Therefore, K you are a U S person that Is a partner In a partnership conducting a trade or business In the United States. provide Form W-9 to the partnership to establish your U S status and avoid withholding on your share of partnership Income The person who gives Form W-9 to the partnership for purposes of establishing Its U S status and avoiding withholding on its allocable share of net Income from the partnership conduoting a trade or business In the United States Is In the following cases: e The U S owner of a disregarded entity and not the entity, Cat No 10M1X Form W79 (Rev 10.2007) T&LLARID-01 ADN/ AC®R®� CERTIFICATE ®F LIABILITY INSU NCE DAT7/6/2DIYYYY, XpD'L 716/2009 PRODUCER (530) 668-2777 Armstrong & Associates Insurance Services THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE License # 01350501 P.O. Box 1270 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, INSURERS AFFORDING COVERAGE NAIL # Woodland, CA 95776-1270 INSURED JJ Nguyen, 11TC. 3172 Salem Drive San Jose, CA 95127- INSURER A:Golden Eagle Insurance _ 10836 INSURER B: National Union Fire Ins. Co. of Pittsburg, _ INSURER c: State Compensation Insurance Fund _ INSURER D: INSURER E: PERSONAL &ADV INJURY $ 1,000,00 COV 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, AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I 0SR XpD'L POLICY NUMBER POLICY E E E POU Y EXP/ P N LIMITS A X GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE ® OCCUR CBP8656577 5/10/2009 5/10/2010 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL &ADV INJURY $ 1,000,00 —_ GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICYX PRO -QT LOC PRODUCTS - COMP/OPAGG $ 2,000,00 A AUTOMOBILE LIABILITY ANY AUTO BASS56477 5/1012009 5/1012010 COMBINED SINGLE LIMIT $ 1,000,00 (Ea accident) X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY �$ 5,00 (Per person) X X HIREDAUTOS NON -OWNED AUTOS BODILY INJURY $ 1,000,00 (Per accident) X Comp $500 deductible X COIIISIon $500 deductible (Per PROPERTY DAMAGE $ eccldent) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ _ EA ACC $ OTHER THAN —__. ANY AUTO AUTO ONLY: AGG $ B EXCESSIUMBRELLA LIABILITY OCCUR E CLAIMS MADE BE053820588 6/9/2009 5/1012010 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 $ DEDUCTIBLE X RETENTION $ 10,000 $ _ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? I ea, describe under SPECIAL PROVISIONS below 290226009 12/20/2009 12/20/2010 X TORY LIMITS R E.L. EACH ACCIDENT $ 1,000,00 _ E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,®00,00 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 10 day notice of cancellation applied for nonpayment of premium Re'. Westwind Community (BARN). Town of Los Altos Hills is named additional Insured In respect general liability per attached. Town of Los Altos Hills SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATK 26379 Fremont Road DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN Los Altos Hills, CA M022- NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 25 (2001108) © ACORD CORPORATION 1988 MLLAND-09 ADNI [141,11-909 If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), 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). The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. AWK9 zs (zoo1/08) I—, O-0# ►��l-fF . ►1I THIS AGREEMENT Is made and entered into on the 6 °Cly day of Rrd 2010 by and between the TOWN OF LOS ALTOS HILLS (hereinafter referred to as "TOWN") and JJ NGUYEN, INC. (hereinafter referred to as "CONTRACTOR"). In consideration of their mutual covenants, the parties hereto agree as follows: CONTRACTOR.. Shall provide or furnish the following specified services and/or materials: Install lawn, plants, irrigation system, clean up, and place mulch at Westwind Community Barn, 2. EXHIBITS.. The following attached exhibits are hereby incorporated into and made a part of this Agreement. Proposal from CONTRACTOR dated 3/26/10 3. TERMS. The services and/or materials furnished under this Agreement shall commence .3/.30/2010 and shall be completed by 4/15/2010, unless terminated pursuant to Section 5(f). 4. COMPENSATION, For the full performance of this Agreement. a. TOWN shall pay CONTRACTOR an amount not to exceed nine thousand five hundre dollars and zero cents ($9,500.00) within thirty-five (35) days following completion/delivery of services/goods as detailed in Sections 1, 2, and 3 of this Agreement and only upon satisfactory delivery/completion of goods./services in a marinerconsistent with professional/industry standards for the area in which CONTRACTOR operates. TOWN is not responsible for paying for any work done by CONTRACTOR or any subcontractor above and beyond the not to exceed amount. b Town shall not reimburse for any of CONTRACTOR's costs or expenses to deliver any services/goods. Town shall not be responsible for any interest or late charges on any payments from Town to CONTRACTOR. c. CONTRACTOR is responsible for monitoring its own forces/employees/agents/ subcontractors. to ensure delivery of goods/services within the terms of this Agreement., TOWN will not accept or compensate CONTRACTOR for incomplete goods/services. Town of Los Allos Hills Page i of 4 Not to excood $IS OM par flscat yoor Updalad 3 17 D8 5. GENERAL TERMS AND CONDITIONS. a. HOLD HARMLESS CONTRACTOR agrees to indemnify, defend and hold harmless the TOWN, its officers, agents and employees from any and all demands, claims or liability' of personal injury (including death) and property damage of any nature, caused by or arising out of the performance of CONTRACTOR under this Agreement. With regard to CONTRACTOR'S work product, CONTRACTOR agrees to indemnify, defend and hold harmless the TOWN, its officers, agents and employees from any and all demands, claims or liability of any nature to the extent caused by the negligent performance of CONTRACTOR under this Agreement. b. INSURANCE. CONTRACTOR shall file with the TOWN a certificate of insurance before commencing any services under this Agreement as follows: i. WORKERS COMPENSATION INSURANCE: Minimum statutory limits. COMMERCIAL GENERAL LIABILITY AND PROPERTY DAMAGE INSURANCE: General Liability and Properly Damage Combined. $1,000,000.00 per occurrence including comprehensive form, personal injury, broad form personal damage, contractual and premises/operation, all on an occurrence basis. If an aggregate limit exists, it shall apply separately or be no less than two (2) times the occurrence limit, iii. AUTOMOBILE INSURANCE. $1,000,000.00 per occurrence. iv. ERRORSAND OMISSIONS INSURANCE: $1,000,000.00 aggregate. v. NOTICE OF CANCELLATION: The City requires 30 days written notice of cancellation. Additionally, the notice statement on the certificate should not include the wording "endeavor to" or "but failure to mail such notice shall Impose no obligation or liability of any kind upon the company, its agents or representatives." vi. CERTIFICATE OF IN Prior to commencement of services, evidence of insurance coverage must be shown by a properly executed certificate of insurance and it shall name "The Town of Los Altos Hills, its elective and appointed officers, employees, and volunteers" as additional insureds. vii. To prevent delay and ensure compliance with this Agreement, the insurance certificates and endorsements must be submitted to: Town of Los Altos Hills - Contracts 26379 Fremont Road Los Altos Hills, CA 94022 Town of Los Altos Mills Page 2 of 4 Not to oxcoad $16 000 per Oscal year Updated 3 17 08 c NON-DISCRIMINATION. No discrimination shall be made in the employment of persons under this Agreement because of the race, color, national origin, age, ancestry, religion or sex of such person. d. INTEREST OF, CONTRACTOR. It is understood and agreed that this Agreement is not a contract of employment and does not create an employer- employee relationship between the TOWN and CONTRACTOR. At all times CONTRACTOR shall be an independent contractor and CONTRACTOR is not authorized to bind the TOWN to any contracts or other obligations without the express written consent of the TOWN. In executing this Agreement, CONTRACTOR certifies that no one who has or will have any financial interest under this Agreement is an officer or employee of TOWN. e. CHANGES. This Agreement shall not be assigned or transferred without advance written consent of the TOWN.. No changes or variations of any kind are authorized without the written consent of the City Manager This Agreement may only be amended by a written instrument signed by both parties. f, TERMINATION. This Agreement may be terminated by TOWN upon seven (7) days written notice to CONTRACTOR. Monies owed for work satisfactorily completed shall be paid to CONTRACTOR within 14 days of termination. g. RECORDS. All reports, data, maps, models, charts, studies, surreys, calculations, photographs, memoranda, plans, studies, specifications, records, files, or any other documents or materials, In electronic or any other form, that are prepared or obtained pursuant to this Agreement and that relate to the matters covered hereunder shall be the property of the TOWN. CONTRACTOR hereby agrees to deliver those documents to the TOWN at any time upon demand of the TOWN. It is understood and agreed that the documents and other materials, including but not limited to those described above, prepared pursuant to this Agreement are prepared specifically for the TOWN and are not necessarily suitable for any future or other use. Failure by CONTRACTOR to deliver these documents to the TOWN within a reasonable time period or as specified by the TOWN shall be a material breach of this Agreement. TOWN and CONTRACTOR agree that until final approval by TOWN, all data, plans, specifications, reports and other documents are preliminary drafts not kept by the TOWN -in the ordinary course of business and will not be disclosed to third parties without prior written consent of both parties. All work products submitted to the TOWN pursuant to this Agreement shall be deemed a "work for hire." Upon submission of any work for hire pursuant to this Agreement, and acceptance by the TOWN as complete, nonexclusive title to copyright of said work for hire shall transfer to the TOWN. The compensation recited in Section 4 shall be deemed to be sufficient consideration for said transfer of copyright, CONTRACTOR retains the right to use any project records, documents and materials for marketing of their professional services. Town of Los Altos Hills Page 8 of 4 Not to Oxcoad 810 000 par Oscal year Updated 3 V 08 h.. ENTIRE AGREEMENT. This Agreement represents the entire agreement between the Parties. Any ambiguities or disputed terms between this Agreement and any attached Exhibits shall be interpreted according to the language in this Agreement and not the Exhibits. 6. INVOICING. Send all invoices to the contract coordinator at the address below. This Agreement shall become effective upon its approval and execution by TOWN. In witness whereof, the parties have executed this .Agreement the day and year first written above. CONTRACT COORDINATOR and representative for TOWN: CONTRACTOR: Richard Chiu Public Works Director Town of Los Altos Hills By.�q-2./ b �j O 26379 Fremont Road signature to Los Altos Hills, CA 94022 i `vim Print name, Title TOWN OF LOS ALTOS HIL S: By: Carl Cahill, City Manager ate Town of Los Altos Hills Page 4 of 4 Nolto exceed 515.000 par fiscal year Updated 3 17 08 JJ NGUYEN, INC 3172 Salem Dr, San Jose CA 95127 Office Phone: 408-259-7982 Fax: 408-347-8183 Date:3/26/2010 Project Name: Los Altos Barn Description of charge: Los Altos Barn Clean up and Backflow Preventer 50 C.Y mulch Lawn,plants and Irrigation k) Total Cost $1,500 $2,500.00 $ 5,500.00 $ 15,500 q -t S-�Do - 616 0'6 �,S-®b =ami W 07 Request. for Taxpayer Clive foals to the ,Rev October 2007) Identification Number and Certification requester. Do not 7opNlmnm rl the Troasc4 send to the IRS, wo-11 r RVVerHo strvv;e Nnm (as shown an your Income tax return) - - T N(YUVEt� + — cr CL C 0 Bustners name. if dl"ere t from above G Check appropriate box: ❑ Individual/Sole proprietor ❑ corporation ❑ ParinerahP ❑ Limited liability company Enter the tax daeetfication (Dmf6sregarded entity, Cmcorporation. Pnpartnership1l N , . , ... , pt pay%* 1,. v ❑ Othar (flee in5truoicno) Y- ( LAddress (number. street and apt or suite no) Requester's nnmo and address (optlowli =' e—r Town of Los Altos Hills city state. and ZIP rode (�C -l7 ' 29979 Fremont Road v� Los Altos Hills, CA 94022 List account numbers) here (optional) IRM Taxpayer Identification Number (TIN Fater your TIN In the appropriate box. The TIN provided must match the name given on Line 1 to avoid social eoaruity number backup withholding For individuals, this Is your social security number (BSN) However, for a resident alien. sole proprietor, or disregarded entity, sse the Part I Instructions on page 3 For other entities. it Is your employer Identlllcatlon number (EIN) It you do not have a number. see How to pet a TiN on page 3 or Note If the account Is In more than one name. see the chart o1 page 4 for guidelines on whose Employ, identification number number to enter Under penalties of peritrry. I certify that: 1 The number shown on this form Is my correct taxpayer Identification number (or I am waking for a number to be issued to me), and 2 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a foliurs to report all Interest or dividends, or (c) the IRB has notified me that I am no longer subject to backup withholding. and 3 1 am a U S citizen or other U 6 - person (defined below) Certification instructions. You must cross out Item 2 above it you have been notified by the IRB that you are currently subject to backup withholding because you have lolled to report all Interest and dividends on your tax return For real estate transactions, Item 2 does not apply For mortgage interest paid, acquisklon or abandonment of secured property, cancellation of debt. contributions to an individual retirement arrangement (IRA). and generally, payment' is other than Interest and dividends. yet are not required to sign the Certification, but you must provide your correct TIN See the 11na on pL1514age ',e / jgn ere I U.S.persongnatuto , 111r H�rz Data ► General instructions Section references are Io the Internal Revenue Code unless otherwise noted Purpose of Form A person who Is required to file an information return with the IRS must obtain your correct taxpayer Identification number (TIN) to report, for example, Income paid to you, real estate transactions, mortgage interest you paid. acquisition or abandonment of secured property, cancellation of debt. or contributions you made to an IRA Use Form W-9 only if you are a U & person (Including a resident alien), to provide your correct TIN to the person requesting It (the requester) and. when applicable to: 1 Certify that the TIN you are giving Is correct (or you are wailing for a number to be Issued), 2 Certify that you are not subject to backup withholding, or 3 Claim exemption from backup withholding if you are a U S exempt payee If appilcable. you are also certifying that as a U S person. your allocable share of any partnership income from a U S trade or business Is not subject to the wilhhoUing tax on foreign partners' share of effectively connected Income Note. If a requester gives you a form other than Form W-9 to request your TiN. you must use the requester's form if k Is substantially siml lar to this Form W-9 Definition of a U.S. person, For federal lax purposes. you are considered a U S person if you are: • An Individual who Is a U S ckizon or U S resident alien, • A partnership. corporation, company, or association created or organized in the United Stales or under the laws of the United States. • An estate (other than a foreign estate). or • A domestic trust (as defined In Regulations section 301 7701-7) Spacial rules for partnerships- Partnerships that conduct a trade or business In the United States are generally required to pay a withholding lax on any foreign partners' share of Income from such business Further, In certain cases where a Form W-9 has not been received, a partnership is required to presume that a partner is a foreign person, and pay the withholding tax Therefore, K you are a U S person that Is a partner In a partnership conducting a trade or business in the United Slates. provide Form W-9 to the partnership to establish your U S status and avoid withholding on your share of partnership Income The person who gives Form W-9 to the partnership for purposes of establishing its U S status and avoiding withholding on As allocable share of net income from the partnership conducting a trade or business In the United Slates Is in the following cases: • The U S owner of a disregarded entity and not the entity. Cat No 10231x Form -0 (Rev 10-2007) `r•>SI r A hlr% RiA n w A, AC®R®rm CERTIFICATE OF LIABILITY INSURANCE DATfi,pAAA/DDIYYYY) 7/s/2oos PRODUCER (530) 668-2777 Armstrong & Associates Insurance Services License # 0®50501 P.O. Box 1270 Woodland, CA 95776-1270 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, INSURERS AFFORDING COVERAGE MAIC # INSURED JJ Nguyen, Inc. 3172 Salem Drive San Jose, CA 95127- INSURER A; Golden Eagle insurance 10836 INSURER B: National Union Fire Ins. Co, of Pittsburg, GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE ; - OCCUR INSURER C: State Compensation Insurance Fund 1 INSURER D: _ INSURER E; MED EXP (Any one person) $ 5,0 W1111U:4Ii[rl*1 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRDDLTR INSR'L —_ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRA710N LIMITS A X GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE ; - OCCUR CBP8656577 5/10/2009 5/10/2010 EACH OCCURRENCE $ _1,000,0 PREMISES Ea occurence $ 100,0 MED EXP (Any one person) $ 5,0 PERSONAL& ADV INJURY $ 1,000,0 GENERAL AGGREGATE $ 2,000,0 GEN'L AGGREGATE LIMIT APPLIES PER: 1-1 POLICYFX PRO- LOC PRODUCTS - COMPIOP AGO $ 2,000,0 A AUTOMOBILE LIABILITY ANY AUTO BA8656477 5/10/2009 5/1012010 COMBINED SINGLE LIMIT $ 1,000,0 (Eaecddent) X ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY $ S,0 (Per person) X X HIREDAUTOS NON -OWNED AUTOS BODILY INJURY$ 1,000,0 (Per accident) X X Comp $500 deductible Collislon $500 deductible PROPERTY DAMAGE $ (Par accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ i OTHER THAN EA ACC $ AUTO ONLY: AGG $ ANY AUTO B EXCESSIUMBRELLA LIABILITY OCCUR FICLAIMS MADE BE053820588 6/9/2009 5/10/2010 EACH OCCURRENCE $ 5,000,0 AGGREGATE $ 5,000,0 $ $ DEDUCTIBLE X RETENTION $ 10,000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Des describe under SPECIAL PROVISIONS below 290226009 12/20/2009 12/20/2010 X TORY LIMIT OER E.L. EACHACCIDENT $ 1,000,0 ___ E.L. DISEASE • EA EMPLOYE $ 1,000,0 -- E.L, DISEASE - POLICY LIMIT $ 1,000,0 OTHER i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 10 day notice of cancellation applied for nonpayment of premium Re: Westwind Community (BARN), Town of Los Altos Hills Is named additional insured in respect general liability per attached, I CERTIFICATE HOLDER CANCELLATION Town of Los Altos Hills 26379 Fremont Road SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATI DATE THEREOF, THE ISSUING INSURER WALL ENDEAVOR TO MAIL 30 DAYS WRITTEN Los Altos Hills, CA 94022- NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGA71ON OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE AUUKLJ au (auuvual © ACORD CORPORATION 1988 lit T&LLAND-01 A If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER I The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2001108)