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Calstate Construction - San Ysidro Park Rec. Building Remodel - Insurance CertificateACO ® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 11/11/2016 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 MARSH USA INC. 1050 CONNECTICUT AVENUE, SUITE 700 WASHINGTON, OC 20036 -5386 Attn: DC.Cd"uestSiebel @marsh.com fax: 212 - 948-0503 NTACY NAOME: PHONE FAX A/C No EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Zurich American Insurance Co INSURERS: N/A 16535 WA 986010 - STAND -11/1 -16-17 INSURED Williams Scotsman, Inc. 8 Williams Scotsman International, Inc. INSURER C: NIA WA INSURER D: 901 South Bond Street, Suite 600 Baltimore, MD 21231 -3357 INSURER E INSURER F : GENERAL AGGREGATE CATS NUMBER CLE- 004291436 -12 REVISION NUMBER:4 COVERAGES CERTIF 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. INS -, LS A TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR A r X SUBR IGLO POLICY NUMBER 2983562 -16 POLICY EFF MM/DDNYYY 1110112016 POLICY EXP MMIDDNYYY 11/01/2017 _ LIMITS EACH OCCURRENCE $ 2,000,000 DAMAGE TO RE TED PREMISES Ea occurrence $ 50Q000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO X JECT LOC POLICY ❑: PRODUCTS - COMP /OP AGG $ 4,000,000 $ A OTHER: AUTOMOBILE LIABILITY X BAP 2983563 -16 11/01/2016 11101/2017 Ea acclidentSINGLE LIMIT $ 5,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON-OWNED SWNED X HIRED AUTOS X BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS MADE PER 0TH- STATUTE ER $ DIED RETENTION $ WORKERS COMPENSATION E.L. EACH ACCIDENT $ AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) N/A 11 as, describe udder DESCRIPTION OF.OPERATIONS below E.L. DISEASE - POLICY LIMIT $ - - DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) 1;4 City Of Gilroy Attn: Georgia Hanes 7351 Rosanna Street Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TIVE of Marsh USA Inc. Timothy M Kelly ccn 1999 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ACC>RO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 11111/2016 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 MARSH USA INC. 1050 CONNECTICUT AVENUE, SUITE 700 WASHINGTON, DC 20036.5386 Attn: DC.CerOZequestSiebel@marsh.com fax: 212 - 948.0503 CONTACT NAME: PHONE FAX IX No E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Zurich American Insurance Co 16535 986010- STAND -1111 -16-17 INSURED Williams Scotsman, Inc. & Williams Scotsman Intemational, Inc. INSURER 0: American Zurich Insurance Company 40142 INSURER C . National Union Fire Insurance Co. 19445 INSURER D: $ . 5,000 901 South Bond Street, Suite 600 Baltimore, MD 21231 -3357 PERSONAL & ADV INJURY $ 2,000;000 INSURER E GENERAL AGGREGATE INSURER F: PRODUCTS - COMP /OP AGG $ 4,000,000 r4%vc6Ad-_2:c L`CDTICIL_ATC IJI IMRFR• CLE- 004288231 -30 REVISION NUMBER :1 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_. INSIR LTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X GLO 2983562 -16 11/0112016 11/01/2017 EACH OCCURRENCE $ 2,000,000 RENTE PRE SE TO ES Ea oocuence $ 500,000 MED EXP (Any one person) $ . 5,000 PERSONAL & ADV INJURY $ 2,000;000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC JECT OTHER: GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP /OP AGG $ 4,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS BAP 2983563 -16 1110112016 11/0112017 COMBINED SINGLE LIMIT Ea accident $ 5,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 19452201 11/01/2016 11101/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DED RETENTION $ $ — B A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YN/❑N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) " describe describe under DESCRIPTION OF OPERATIONS below NIA WC2983560- 16(ADS) WC2983561 -16 (NE) 11/01/2016 1.1/0112016 11/01/2017 11N1/2017 X IPER 0TH= STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 ' E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E-L. . DISEASE -- POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) TRANSPORTATION PERMIT Certificate holder is listed as add'I insured for GL PcDTlc19`ATC unl nPo CANCFI I ATION The City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 Rosanna St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Gilroy, CA 95020.6141 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Timothy M Kelly ©1988 -2014 ACORD CORPORATION. All rights reserves. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD C40 CERTIFICATE OF LIABILITY INSURANCE A CO ® DATE (MMIDD/YYYY) 11111/2016 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 MARSH USA INC. 1050 CONNECTICUT AVENUE, SUITE 700 WASHINGTON, DC 20036.5386 Attn: DC.CertRequestSiebd @marsh.com fax: 212- 948 -0503 CONTACT NAME: PHONE FAX A/C No): E-MAIL ADDR SS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: 46Ch American Insurance Co 16535 986010-STAND -11/1 -16-17 INSURED Williams Scotsman, Inc. & Williams Scotsman Intemabonal, Inc. INSURER 8: N/A WA INSURER C : WA NIA 901 South Bond Street, Suite 600 Baltimore, MD 21231 -3357 INSURER D: GENERAL AGGREGATE INSURER E INSURER F : --- --------- ._ ter.:..... .........,. -.. -� __.. GOVEKAUt, VCrIIIrIVP+1G rwlaca.... - -- 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. RI ILTR A TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR ADDL X UBR POLICY NUMBER GLO 2983562 -16 POLICY EFF MM/DD/YYYY 11/0112016 POLICY EXP MM/DD/YYYY 11/0112017 LIMITS EACH OCCURRENCE - $ 2,000,000 DAN GE TO RENTED PREMISES' Ea occurrence) $ SOO,000_ MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO ❑ LOC X JECT PRODUCTS - COMP /OP AGG $ 4,000,000 is A OTHER: AUTOMOBILE LIABILITY X BAP 2983563-16 11!0112016 11101/2017 Ea e.d ntSINGLE LIMIT s 5,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X X NON -OWNED HIRED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA LU1B OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ PER 0TH - STATUTE OR $ DED RETENTION $ WORKERS COMPENSATION E.L. EACH ACCIDENT $ AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER/EXECU TIVE E.L. DISEASE - EA EMPLOYE $ OFFICERIMEMBER EXCLUDED? [— (Mandatory in NH) NIA If yes, describe under DESCRIPTION -0F OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) GEK I II-IUA 1 t MULLIMIK — CITY OF GILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 ROSANNA STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GILROY, CA 95020 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Timothy M Kelly _ — -- -- ^MAT1Akl All ww1.M w nfl ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AC40 CERTIFICATE OF LIABILITY INSURANCE 0/2arml�6D Ti JS 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(les) 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 endomement(s). PRODUCER MARSH USA INC. 1050 CONNECTICUT AVENUE, SUITE 700 WASHINGTON, DC 20036 -5386 Attn: DC.CertRequestSiebel @marsh.com fax: 212 - 948-0503 CONTACT NAME. PHONE FAX VC. No): ADO INSURER(S) AFFORDING COVERAGE NAIC p INSURER A: Zurich American Insurance Co 16535 986010- STAND -11/1 -16.17 INSURED Williams Scotsman, Inc. & Williams Scotsman International, Inc. INSURER B: N/A WA INSURER C: N/A N/A INSURER 0: $ 500,000 901 South Bond Street, Suite 600 Baltimore, MD 21231 -3357 INSURER E $ 5,600 INSURER F: PERSONAL & ADV (INJURY nrnr�r�l%w TC urlaaQC0. CI F- nn47xgh7_1.1% RFVIS11"N NIIMKI -Wa vv � r.ww vv 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. 1�TR TYPE OF INSURANCE ADDL UBR POLICY NUMBER MWDD EFF MM/DD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X GL0.2983562 -16 1110112016 1110112017 EACH OCCURRENCE $ 2,000,000 DAMAGE To RENTED PREMISES Ea occurrence $ 500,000 MED EXP (Anyone person) $ 5,600 PERSONAL & ADV (INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY 0 JECT LOC OTHER: GENERAL AGGREGATE $ 4,OOD,000 PRODUCTS - COMP /OP AGG $ 4,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS X BAP 2983563 -16 11/01/2016 11/01/2017 COMBINED SINGLE LIMIT Ea acci dent $ 5,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y❑ OFFICER/MEMBER: EXCLUDED? (Mandatory In NH) M yyeess describe under DESCRIPTION OF OPERATIONS below NIA PER OTH= STATUTE E E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT_ $- DESCRIPTION OF OPERATIONS / LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) i.rsrrr�nwTC uf% ncn f%All I-ATIAN CITY OF GILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 ROSANNA STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GILROY, CA 95020 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORRED REPRESENTATIVE of Marsh USA Inc. Timothy M Kelly V i woo -LUT4 At Iulw %,vmrURA I wn. Asu ngnLu renserrresu. ACORD 25 (2014101) . The ACORD name and logo are registered marks of ACORD r � � ® ACORL7 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/2srz016 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 WANED, 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 endomement(s ). PRODUCER MARSH USA INC. 1050 CONNECTICUT AVENUE, SUITE 700 WASHINGTON, DC 20036 -5386 Attn: DC.CertRequestSiebd@marsh.com fax: 212 - 948.0503 CONTACT NAME: PHONE IFAX A/C Noll: ADDRL INSURER(S) AFFORDING COVERAGE NAICl/ INSURER A: Zurich American Insurance Co 16535 986010- STAND - 11/1 - 16-17 INSURED Williams Scotsman, Inc. & Williams Scotsman Intemational, Inc. INSURER 0: American Zurich Insurance COmpany 40142 INSURER C National Union Fire Insurance Co. 19445 INSURER D: 901 South Bond Street, Suite 600 Baltimore, MD 21231 -3357 INSURER E INSURER F: GVVCKAUC0 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. ILNTSRR TYPE OF INSURANCE ADDLSUBR 7351 Rosanna St POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY .LIMITS_ A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR X Timothy M Kelly GLO2983562 -16 11/0112016 11/01/2017 EACH OCCURRENCE $ 2,000,000_ DAMAGE TO R N E PREMISES Ea bcamence $ 500,000' MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- x ' POLICY ❑ JECT � LOC GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP /OP AGG $ 4,000,000 $ A OTHER: 1 AUTOMOBILE uABILITY BAP 2983563.16 11/01/2016 11/01/2017 Ea a idEentSINGLE LIMIT $ 5,000,000 BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED x HIRED AUTOS X AUTOS PROPERTY DAMAGE Per acciden $ $ C X UMBRELLA LIAO EXCESS LU1B X OCCUR CLAIMS -MADE 19452201 11/0112016 11/01/2017 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 510001000 QED RETENTION $ WORItERS COMPENSATION X STATUTE ' ER $ B WC2983560 -16 (ADS) 11/0112016 11 /01/2017 E.L. EACH ACCIDENT $ 1,000,000 A AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Ya OFFICER/MEMBER EXCLUDED? (Mandatory`inNH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC2983561 -16 (NE) 11/01/2016 11/01/2017 E1. DISEASE - EA EMPLOYE 1,000;000 $ _ E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space is required) TRANSPORTATION PERMIT Certificate holder is listed as add'I insured for GL M• \!IM's ■ /•��It•1: VCR 1 Irn m 1 C rrVL.rJGr% - - -- The City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 Rosanna St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Gilroy, CA 95020.6141 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Timothy M Kelly W 1V00'LV110 P"'U L/ l/VRf"Vr \MrrVr�. nu nyuw �vav�wv. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD OP ID: YV .4C"Mi7v 144� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 1 05129112 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 408 -288 -6262 Barlocker I ns. Svs. - San Jose 408 298 7635 Lic. # 0580438 - - 1330 S. Bascom Ave. San Jose, CA 95128 Nicholas Weintraub CONTACT NAME: PHONE FAX (A/C, No Ext : (A/C, No): E-MAIL _ADDRESS: PRODUCER CALST01 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED CalState Construction, Inc. 4165 Business Center Drive Fremont, CA 94538 -6182 INSURERA: Kinsale Insurance Company 38920 INSURER B: Allied Insurance Co. 42579 INSURER c: Everest National Insurance Co. 10120 INSURER D: EACH OCCURRENCE INSURER E : A INSURER F X COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUB WVD POLICY NUMBER MMILDIDmYY POLICY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X X 01 000052620 04/01/12 04/01/13 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 CLAIMS -MADE FXI OCCUR MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 $ PRO- POLICY X JEC LOC B AUTOMOBILE X LIABILITY ANY AUTO ACP7833765065 11!21111 11!21!12 COMBINED SINGLE LIMIT (Ea accident) $ 1'000'000 BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ SCHEDULED AUTOS HIREDAUTOS PROPERTY DAMAGE (Peraccldent) $ $ NON -OWNED AUTOS UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00D AGGREGATE $ 3,000,000 A X EXCESS LIAB CLAIMS -MADE 01000052560 04101!12 04/01/13 DEDUCTIBLE $ $ RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORfPARTNERfEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) N/A 7600003953111 11101/11 11101/12 X I WC STATU- OTH- TORY LIMITS ER E . EACH ACCIDENT $ 1,000,000 E . DISEASE - EA EMPLOYEE1 $ 1,000,000 E . DISEASE- POLICY LIMIT I $ 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) The City of Gilroy, its officials, and employees are named as additional Insures! per GL forms CG2010 & CG2037 attached. RE: San Ysidro Park Recreation Building Project12 -PW -194 7700 Murray Ave Gilroy Ca 95020 GL Waiver of Subrogation applies & attached. CERTIFICATE HOLDER CANCELLATION CITYGIL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy, CA95070 ACORD 25 (2009109) ©1988 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — SCHEDULED PERSON OR ORGANIZATION Attached To ornd Forming Part of Policy Effective Date of Endorsement Named Insured CalState Construction Inc 0100005262 -0 04,01112 12:01AM at the Named Insured ad- Information required to complete this Schedule, if not shown above, will be shown in the Declarations. dress shown on the Declarations Additional Premium. Return Premium: X0.00 $0.00 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization(s): Locations Of Covered Operations Blanket, as required by written contract. The City of Gilroy, its officials, and employees Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section Il — Who Is An Insured is amended to include as an additional insured the person(s) or organiza- tions) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "per- sonal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your be- half; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these addi- tional insureds, the following additional exclusions ap- ply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or re- pairs) to be performed by or on behalf of the addi- tional insured(s) at the location of the covered op- erations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 2010 07 04 cp ISO Properties, Inc., 2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS — COMPLETED OPERATIONS Attached To and Forming Port of Policy Effective Date of Endorsement Named Insured 0100005262 -0 04/01/12 12:01AM at the Named Insured CalState Construction Inc address shown on the Declarations Additional Premium: Return Premium: $0.00 are in part as a residence by any person or persons. $0.00 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations As Required By Written Contract. Excludes All New Residential Construction. The City of Gilroy, its officials, and employees "Your work" does not include "New Residential Construc- tion", which means any building or structure not previously occupied and designed or intended for occupancy in whole are in part as a residence by any person or persons. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location desig- nated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Attached To and Forming Port of Policy Effective Date of Endorsement Named Insured 0100005262 -0 04/01 /12 12:01AM at the Named Insured CalState Construction Inc address shown on the Declarations Additional Premium: I Return Premium: II $0.00 i, 1 1 1 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE SECTION IV — CONDITIONS, 8. Transfer of Rights of Recovery against Others to Us is amended by the addition of the following: We waive any right of recovery we may have against persons or organizations because of payments we make for injury or damage arising out of "your work" done under a written contract with that person or organization wherein you have agreed to provide this waiver. The City of Gilroy, its officials, and employees ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. CAS4002 0110 Page 1 of 1