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Harley Ellis Devereaux - Insurance CertificateDATE I MIDD/YYYY) A� °R°® CERTIFICATE OF LIABILITY INSURANCE 12/21/2009 PRODUCER (800) 969 -4041 FAX: (800) 969 -4081 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Professional Concepts Insurance ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1127 South Old US Highway 23 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Brighton MI 48114-9861 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Travelers Indemnity Co 25658 Harley Ellis Devereaux, DBA: Harley Ellis INSURER B: Charter Oak Fire Ins. Co. 25615 601 S. Figuero Street INSURER C:AmeriCan Home Assurance Cc INSURER D: Travelers Cas CO of Conn 36170 Los Ang las CA 90017 INSURER E: Lexington Insurance Co. ,awrea w i.�c 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. INSR T D' POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑X OCCUR 680732SL742 1/1/2010 1/1/2011 EACH OCCURRENCE $ 11000,000 PREMISES (Ea occurrence) $ 11000,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY $ PRO- LOC PRODUCTS - COMP /OP AGG $ 2,000,000 B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS BA730OL364 1/1/2010 1/1/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY ANY AUTO AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC AUTO ONLY: AGG $ $ C EXCESS /UMBRELLA LIABILITY X OCCUR EI CLAIMS MADE DEDUCTIBLE X RETENTION $ 10,000 BE065325301 1/1/2010 1/1/2011 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE � OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below UB2952T763 1/1/2010 1/1/2011 X I WC STATUS OTH- E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE - EA EMPLOYEd $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 E OTHER professional Liability 024647135 1/1/2010 1/1/2011 $5,000,000 per claim $5,000,000 aggregate DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS 2009- 00015 -000 Gilroy Public Library City of Gilroy 7351 Rosamma Street Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBUGAT10N OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE Mike Cosgrove /DES�`� ACORD 25 (2009/01) ©1988 -2009 ACORD CORPORATION. All rlgnts reservea. INS026 (200901) The ACORD Tian ?t zind 1: gc &:e;Y ?! ztarcd m2rks Of ACORD __­, ® DATE(MM /DD/YYYY) A� D CERTIFICATE OF LIABILITY INSURANCE 10/29/2012 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). 6E-MAIL PRODUCER Professional Concepts Insurance Agency, Inc. (B00) 969 -4041 FAC No. (800)969 -4081 1127 South Old US Highway 23 .certs@pciaonline.com Brighton MI 48114 -9861 INSURERA:Travelers Indemnity Co of CT 25682 INSURED HARLEY ELLIS DEVEREAUX CORPORATION DBA CRIME LAB DESIGN DBA GREENWORKS STUDIO 601 SOUTH FIGUEROA, SUITE 500 LOS ANGELES CA 90017 INSURERB:Travelers Indemnity Co 25658 INSURERC :Travelers Prop Casualty of Amer 25674 INSURERD:Starr Surplus Lines Ins Co 13604 INSURER E: LIMITS INSURER F: C, n>rn.in 0C %1ICInAI Al11MRFR• COVERAGES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. F INSURANCE DD SUER POLICY NUMBER POLICY EFF MM /DD Y POLICY EXP /DDIY Y LIMITS Y EACH OCCURRENCE $ 1 , 000, 000 DAMAGET ED PREMISES Ea occurrence $ 3OO OOO GENERAL LIABILITY MEDEXP(Anyone erson) $ 5,000 MADE FX OCCUR r X 6807322L113 /1/2012 /1/2013 PERSONAL &ADVINJURY $ 1,000,000 ual Liability 6807325L742 - CA /1/2012 /1/2013 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OPAGG $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: COMBINED SINGLE LIMIT Ea accident $ 1,000,000 POLICY X PRO LOC AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ C X ANY AUTO ALL OWNED SCHEDULED X 730BL364 /1/2012 /1/2013 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ AUTOS AUTOS NON -OWNED X X $ HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10, 000, 000 EXCESS LIAB CLAIMS -MADE $ B UPOOBB8710 /1/2012 /1/2013 X 10,00 DED RETENTION$ X WC STATU- OTH- A WORKERS COMPENSATION E.L. EACH ACCIDENT $ 1,000,000 AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE NN OFFICERIMEMBEREXCLUDED? NIA B2952T763 /1/2012 /1/2013 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If es, de scribe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below D Professional Liability 62213 -12 /1/2012 /1/2013 Per Claim $ 5,000,000 Aggregate $ 5,000 , 000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) 9, 10 & 11 to Agreement for Architectural Services, dated 8/3/2009. City of Project: Amendments Nos. Gilroy is considered additional insured with respects to general and auto liability coverage as long as required within a written contract. Waiver of subrogation in favor of certificate holder and additional insured's as long as required within a written contract. Coverage is considered primary and non - contributory where applicable. 30 day written notice provided to certificate holder and additional insured's for cancellation of coverages listed. 10 day notice for nonpayment of listed policies. lip City of Gilroy Risk Manager 7351 Rosanna Street Gilroy, CA 95020 ACORD 26 (2010106) mign9F ion —nn n SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Cosgrove /CHUCK r�nnl�CA TIn AI A11 .; ..kF.. rnce.w.e`7 Policy # BA73081-364 Insured: Harley Ellis Devereaux Page 1 of 2 Policy Dates: 7/1/2012 - 7/112013 CA T4 37 08 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO 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 the endorsement. The following is added to the Section II — Liability Coverage, Paragraph A.1. Who Is An Insured Provision: Any person or organization that you are required to include as additional insured on the Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period is an "insured" for Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. htti):Heforms travelers com/nYt /_gateway dll /fssformsl/ automobile /cat4370808.htm ?f= tempt... 6/6 /2011 Policy # BA73081-364 Insured: Harley Ellis Devereaux Page 1 of 1 Policy Dates: 711/2012- 7/1/2013 CA T3 40 08 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION 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 the endorsement. Paragraph 5. Transfer of Rights Of Recovery Against Others To Us of the CONDITIONS section is replaced by the following: Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident' or "loss ", provided that the "accident' or "loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. CA T3 40 08 08 Privacy I Legal Notices 02008 The Travelers Companies, Inc. http: / /eforms travelers cominxt/ a� tew,ty dlllfssformsll automobile lcat3400808.htm ?f— templ... 6/6/2011 Policy # BA7308L364 Insured: Harley Ellis Devereaux Page 1 of 1 Policy Dates: 711/2012- 7/1/2013 CA T3 40 08 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET WAIVER OF SUBROGATION 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 the endorsement. Paragraph 5. Transfer of Rights Of Recovery Against Others To Us of the CONDITIONS section is replaced by the following: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident' or "loss ", provided that the "accident' or" loss" arises out of the operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. CA T3 40 08 08 Privac I Legal Notices ©2008 The Travelers Companies, Inc. http: / /eforms travelers com/nxt /gateway dll /fssformsl/ automobile /cat3400808.htm ?f= templ,,, 6/6/2011 Harley Ellis Devereaux Policy # 68073251-742 - CA & # 68073221-113 Page 1 of 1 Policy Dates: 7/01/2012- 7/1/2013 CG DO 37 04 05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - ADDITIONAL INSUREDS This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV), Paragraph 4. (Other Insurance). is amended as follows: 1. The following is added to Paragraph a. Primary Insurance: However, if you specifically agree in a written contract or written agreement that the insurance provided to an additional insured under this Coverage Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named Insured, and we will not share with that other insurance, provided that: a. The 'bodily injury" or "property damage" for which coverage is sought occurs; and b. The "personal injury" or "advertising injury" for which coverage is sought arises out of an offense committed subsequent to the signing and execution of that contract or agreement by you. 2. The fist Subparagraph (2) of Paragraph b. Excess Insurance regarding any other primary insurance available to you is deleted. 3. The following is added to Paragraph b. Excess Insurance, as an additional subparagraph under Subparagraph (1): That is available to the insured when the insured is added as an additional insured under any other policy, including any umbrella or excess policy. CG DO 37 04 05 Privacy I Legal Notices 02006 The Travelers Companies, Inc. http / /eforms travelers com /ixt /g w dll/ fssformsl/ I ;oneral %201iahilit\,lcgd0370405 ht... 6/14/2011 Harley Ellis Devereaux Policy # 68073251-742 - CA & # 6807322L113 Policy Dates: 7/1/2012- 7/1/2013 COMMERICAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. The following is added to WHO IS AN INSURED (Section II): Any person or organization that you agree in a "contract or agreement requiring Insurance" to in- clude as an additional insured on this Coverage Part, but only with respect to liability for "bodily in- jury", "property damage" or "personal injury" caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing opera- tions; b. In connection with premises owned by or rented to you; or c. In connection with "your work" and included within the "products- completed operations hazard ". Such person or organization does not qualify as an additional insured for "bodily injury", "property damage" or "personal Injury" for which that per- son or organization has assumed liability in a con- tract or agreement. The Insurance provided to such additional insured is limited as follows: d. This insurance does not apply on any basis to any person or organization for which cover- age as an additional insured specifically is added by another endorsement to this Cover- age Part. e. This insurance does not apply to the render- ing of or failure to render any "professional services ", f. The limits of insurance afforded to the addi- tional Insured shall be the limits which you agreed in that "contract or agreement requir- ing insurance" to provide for that additional insured, or the limits shown in the Declara- tions for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance staled in the LIMITS OF INSURANCE (Section III) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a "contract or agreement requiring insurance" that the insurance provided to an additional insured under this Cov- erage Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such addi- tional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily Injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring insurance ", But this insur- ance still is excess over valid and collectible other Insurance, whether primary, excess, contingent or on any other basis, that is available to the insured when the insured Is an additional Insured under any other insurance. C. The following Is added to Paragraph 8, Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CON- DITIONS (Section IV): We waive any rights of recovery we may have against any person or organization because of payments we make for "bodily injury", "property. damage" or "personal injury" arising out of "your work' performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that person or organization. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insur- ance" with such person or organization entered Into by you before, and in effect when, the "bodily CG D3 8109 07 © 2007 The Travelers companies, Inc. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission. COMMERICAL GENERAL LIABILITY injury" or "property damage" occurs, or the "per- sonal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement un- der which you are required to include a person or organization as an additional Insured on this Cov- erage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal in- jury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2007 The Travelers Companies, Inc. CG D3 8109 07 Includes the copyrighted material of Insurance Services Office, Inc., with its permission. TRAVELERS ONE TOWER SQUARE HARTFORD, CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 00 0313 (00) -01 Harley Ellis Devereaux Corporation dba Crime Lab Design dba Greenworks Studio POLICY NUMBER: UB2952T763 7/01/2012-7/01/2013 WAIVER OF 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 any one not named in the Schedule. SCHEDULE DESIGNATED PERSON: DESIGNATED ORGANIZATION: ANY PERSON OR ORGANIZATION FOR WHICH THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. DATE OF ISSUE: 06 -28 -12 ST ASSIGN: