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SCRWA - OMI - Insurance CertificateAC40REP CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) TYPE OF INSURANCE 12/15/2017 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 CONTACT NAME: Marsh Risk & Insurance Services PHONE F� CA License X10437153 No): E-MAIL ADDRESS: 777 South Figueroa Street Los Angeles, CA 90017 DA AGE TO RENTED PREMISES Ea occurrence) $ 7,000,000 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: ACE American Insurance Company 22667 15114 - 12345- 5EX2P- 17 -18J 013428 CA INSURED OPERATIONS MANAGEMENT INTERNATIONAL INC. INSURERS: GENERAL AGGREGATE INSURER C : PRODUCTS - COMP /OP AGG 9193 SOUTH JAMAICA STREET, SUITE 400 ENGLEWOOD, CO 80112 -5946 $ A AUTOMOBILELIABILITY INSURER D : X INSURER E: ISA H09055964 07/0112017 INSURER F: COMBINED SINGLE LIMIT Ea accident $ 2,000,000 COVERAGES CERTIFICATE NUMBER: SEA -003362277 -47 REVISION NUMBER: 8 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 SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY I POLICY EXP (MWDOfYYYYI LIMITS A X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1_X I OCCUR X HDOG27865069 07/01/2017 07/01/2018 EACH OCCURRENCE $ 7,000,000 DA AGE TO RENTED PREMISES Ea occurrence) $ 7,000,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 7,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JEST LOC OTHER: GENERAL AGGREGATE $ 10,000,000 PRODUCTS - COMP /OP AGG $ 10,000,000 $ A AUTOMOBILELIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY X ISA H09055964 07/0112017 07/01/2018 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ UMBRELLALIAB EXCESS LIAS OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR /PARTNER/EXECUTIVE YIN N OFFICER /MEMBER EXCLUDED? NI (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WLRG49115581(ADS) SCFC49115623 (WI) - WCUC49115611 (AK, LA, OH & TX) 'SIR: $2,250,000 07101/2017 07/0112017 07/01/2018 07101/2018 07/01/2018 X PER OTH- 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 U more apace Is required) RE: OPERATION, MAINTENANCE AND MANAGEMENT SERVICES FOR THE SOUTH COUNTY REGIONAL WASTEWATER AUTHORITY. THE CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT VtK I IrK:A I t 17ULUtK SOUTH COUNTY REGIONAL WASTEWATER AUTHORITY 7351 ROSANNA STREET GILROY, CA 95020 ACORD 25 (2016103) 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 of Marsh Risk & Insurance Services James Vogel ©1988 -2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 15114 LOC #: Denver ACORI7® AnnlTl[)NAI RFMARKS SCHEDULE AGENCY NAMED INSURED Marsh Risk & Insurance Services OPERATIONS MANAGEMENT INTERNATIONAL INC. 9193 SOUTH JAMAICA STREET, SUITE 400 POLICY NUMBER ENGLEWOOD, CO 80112 -5946 CARRIER I NAIC CODE EFFECTIVE DATE: AUDI I IVNAL KtMAKRb r S ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, RM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance —THE TERMS, CONDITIONS, AND LIMITS PROVIDED UNDER THIS CERTIFICATE OF INSURANCE WILL NOT EXCEED OR BROADEN IN ANY WAY THE TERMS, CONDITIONS, AND LIMITS AGREED TO UNDER THE APPLICABLE CONTRACT.— Page 2 of 2 ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD C�12AN1: December 15, 2017 Dear Certificate Holder, CH2M 919 : 5. € ? N;..aic. to S€ 01801121 i�1•.'i i`Y d; Ii >ifi (Cidti As you are most likely aware, effective December 15, 2017, CH2M HILL and its subsidiaries ( "CH2M ") have merged with Jacobs Engineering Group Inc. ( "Jacobs "). Please be advised that the legal entities for CH2M and its subsidiaries have not been changed and your contract has not been impacted as the parties' respective obligations remain unchanged. As a result of this merger, CH2M has become a named insured under Jacobs' insurance policies. Be assured, there is no lapse in insurance coverage as a result: of the merger, with scope and coverage remaining active. All terms and conditions of coverage required under your contract with CH2M will continue to be met through Jacobs' insurance coverages. In that regard, included herein are new certificates of insurance evidencing coverage as required under the contract insurance language provisions. Should you have any questions, you may contact Jeff.Caudll @ch2m.com. Sincerely, CH2 Bobby Hinds Director of Risk Management LEGAL ENTITY (IF APPLICABLE) 3 NOTICE TO OTHERS ENDORSEMENT — SCHEDULE — EMAIL ONLY Named Insured Jacobs Engineering Group, Inc. Endorsement Number 3 Policy Symbol Policy Number Policy Period Effective Date of Endorsement ISA 1HO9055964 107/01/2017 TO 07/01/2018 Issued By (Name of Insurance Company) ACE American Insurance Company Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. If we cancel the Policy prior to its expiration date by notice to you or the first Named Insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the "Schedule "). You or your representative must provide us with the e-mail address of such persons or organizations, and we will utilize such e-mail address that you or your representative provided to us on such Schedule. B. The Schedule must be initially provided to us within 15 days after: I. The beginning of the Policy period, if this endorsement is effective as of such date; or H. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. C. The Schedule must be in an electronic format that is acceptable to us; and must be accurate D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. E. We will endeavor to send such notice to the e-mail address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation. I. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. I This endorsement does not apply in the event that you cancel the Policy. ALL -32685 (01/11) Page 1 of 2 All other terms and conditions of the Policy remain unchanged. Authorized Representative ALL -32685 (01/11) Page 2 of 2 NOTICE TO OTHERS ENDORSEMENT — SCHEDULE — EMAIL ONLY Named Insured Jacobs Engineering Group, Inc. Endorsement Number 12 Policy Symbo! Policy Number Policy Period Effective Date of Endorsement HDO 627865069 107/01/2017 TO 07/01/2018 Issued By (Name of Insurance Company) ACE American insurance Company risen ,ne poucy numoer. i ne remamoer or me mrorrnanon is to be completed only when Nis endorsement is issued subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A. If we cancel the Policy prior to its expiration date by notice to you or the first Named Insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the "Schedule°). You or your representative must provide us with the e-mail address of such persons or organizations, and we will utilize such e-mail address that you or your representative provided to us on such Schedule. B. The Schedule must be initially provided to us within 15 days after 1. The beginning of the Policy period, if this endorsement is effective as of such date; or ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. C. The Schedule must be In an electronic format that is acceptable to us; and must be accurate. D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. E. We will endeavor to send such notice to the e-mail address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation. I. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. J. This endorsement does not apply in the event that you cancel the Policy. ALL -32685 (01/11) Page 1 of 2 All other terms and conditions of the Policy remain unchanged. Authorized Representative ALL -32685 (01/11) Page 2 of 2 NOTICE TO OTHERS ENDORSEMENT — SCHEDULE — EMAIL ONLY Named Insured Endorsement Number Jacobs Engineering Group, Inc. 19 Policy symbol Policy Number Policy Period Effective Date of Endorsement WCU C49115611 07/0112017 to 07/01/2018 Issued By (Name of Insurance Company) ACE American Insurance Company Ins. n.ilM wwl:.+.. w.....1.... T.... .— all— a...c 1...v11 . -1-11 14 w u wn1pittivu uiny wren mis enoorsement is Issues subsequent to the preparation of the policy. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: SPECIFIC EXCESS WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY A. If we cancel this Policy prior to its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the "Schedule "). You or your representative must provide us with the e-mail address of such persons or organizations, and we will utilize such e-mail address that you or your representative provided to us on such Schedule. B. The Schedule must be initially provided to us within 15 days after: i. The beginning of the Policy period, if this endorsement is effective as of such date; or ii. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. C. The Schedule must be in an electronic format that is acceptable to us; and must be accurate. D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named Insured. E. We will endeavor to send such notice to the e-mail address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named in the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. J. This endorsement does not apply in the event that you cancel the Policy. WC 99 05 20 (01111) Page 1 of 2 All other terms and conditions of this Policy remain unchanged. Authorized Representative WC 99 05 20 (01/11) Page 2 of 2 Workers' Comnensation and Emnlevakml 1 fahililu Pnrlr�s Named Insured Endorsement Number JACOBS ENGINEERING GROUP, INC. 600 WILSHIRE BOULEVARD, SUITE 1000 Policy Number LOS ANGELES CA 90017 Symboi:WLR Number. C49115581 Policy Period Effective Date of Endorsement 07 -01 -2017 TO 07 -01 -2018 07 -01 -2017 issued By (Name of insurarce Company) ACE AMERICAN INSURANCE COMPANY [need the Palty number. The remainder of the information is to be feted ordy when this endorsement Is Issued subsequent to the preparation of the poft. NOTICE TO OTHERS ENDORSEMENT — SCHEDULE — EMAIL ONLY A. if we cancel this Policy prior to Its expiration date by notice to you or the first Named insured for any reason other than nonpayment of premium, we will endeavor, as set out below, to send written notice of cancellation, via such electronic notification as we determine, to the persons or organizations listed in the schedule that you or your representative provide or have provided to us (the "Schedule "). You or your representative must provide us with the e-mail address of such persons or organizations, and we will utilize such e-mail address that you or your representative provided to us on such Schedule. B. The Schedule must be initially provided to us within 15 days after: i. The beginning of the Policy period, if this endorsement is effective as of such date; or li. This endorsement has been added to the Policy, if this endorsement is effective after the Policy period commences. C. The Schedule must be in an electronic format that is acceptable to us; and must be accurate. D. Our delivery of the notification as described in Paragraph A. of this endorsement will be based on the most recent Schedule in our records as of the date the notice of cancellation is mailed or delivered to the first Named insured. E. We will endeavor to send such notice to the e-mail address corresponding to each person or organization indicated in the Schedule at least 30 days prior to the cancellation date applicable to the Policy. F. The notice referenced in this endorsement is intended only to be a courtesy notification to the person(s) or organization(s) named In the Schedule in the event of a pending cancellation of coverage. We have no legal obligation of any kind to any such person(s) or organization(s). Our failure to provide advance notification of cancellation to the person(s) or organization(s) shown in the Schedule shall impose no obligation or liability of any kind upon us, our agents or representatives, will not extend any Policy cancellation date and will not negate any cancellation of the Policy. G. We are not responsible for verifying any information provided to us in any Schedule, nor are we responsible for any Incorrect information that you or your representative provide to us. If you or your representative does not provide us with a Schedule, we have no responsibility for taking any action under this endorsement. In addition, if neither you nor your representative provides us with e-mail address information with respect to a particular person or organization, then we shall have no responsibility for taking action with regard to such person or entity under this endorsement. H. We may arrange with your representative to send such notice in the event of any such cancellation. 1. You will cooperate with us in providing the Schedule, or in causing your representative to provide the Schedule. J. This endorsement does not apply In the event that you cancel the Policy. All other terms and conditions of this Policy remain unchanged. This Endorsement is not applicable in the states of AZ, RL, ID, ME, NC, NJ, NM,TX and WI. Authorized Representative WC 99 03 68 (01/11) Page 1 ��1 ® .ACORU CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 0412612016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE GERTIFlCATE 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 endomement(s). - - - --- . PRODUCER MARSH USA INC. 122517TH STREET, SUITE 1300 DENVER, CO 80202 -5534 CONTACT NAME: PHONE FAX A/C No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC 0 X INSURER A.. Greenwich Insurance Company 22322 15114 - 12345 -5EX2P -16/17 013427 BK INSURED OPERATIONS MANAGEMENT INTERNATIONAL INC. 9193 SOUTH JAMAICA STREET, SUITE 400 INSURER B: N/A NIA INSURER C : XL Specialty Insurance Company 37885 INSURER 0: N/A N/A ENGLEWOOD, CO 80112 -5946 INSURER E: 05/0112017 INSURER F: $ 1,500;000 X wwv e�:i+rc� 1+C0T1C1r`ATC LI1ItU12000 SEA- 002834511 -47 REVISION NUMBtK: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 CORTRACT 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. INgR LTR TYPE, OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF =D/YYYY POLICY EXP MM/DD/YYYY OMITS of Marsh USA Inc. X COMMERCIAL GENERAL LIABILITY X EACH OCCURRENCE $ 1,500,000 A CLAIMS-MADE OCCUR ❑ RGE500025505 05/01/2016 05/0112017 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,500;000 X MED EXP (Any one person) $ $500,000 SIR. PERSONAL 8 ADV INJURY $ 1,500,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE - $ 5,000,000 PRODUCTS - COMP /OP AGG $ 5,000,000 X POLICY ❑I JEC F LOC $ OTHER: - . . AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT Ea accident $ 2,000,000- BODILY INJURY (Per person) $ A X ANY AUTO RAD500025405 0510112016 05/0112017 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ -- $ C C WORKERS COMPENSATION AND EMPLOYERS! LIABILITY YIN ANY PROPRIETOR /PARTNER/EXEGUTIVE � (Mandatory in H) EXCLUDED? (Mandatory in NH) If . es, describe under DESCRIPTION OF OPERATIONS below NIA A (ADS) RWD500025205 ADS RWR500025305 (WI) 05101/2016 05/01/2016 05/0112017 05/01/2017 _ X ST TUTE E_ ER E.L. EACH ACCIDENT 1,000;000 $ _ E.L. 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) RE`. GAVILAN COLLEGEPUMP STATION. THE CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED ON.THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES INCLUDE A WAIVER OF SUBROGATION. ^C 'r10I^AT0 L f%l MCn CANCEL I. ATinN 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. Sharon A. Hammer V 7`Jiiif =LUl4 AI.VKU �.VRf VIw11V1r. rut uyuia reraarveru. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD ENDORSEMENT # 003 This endorsement, effective 1.2:01 am., May 1, 2016 forms a part of Policy No.RAD500025405 issued to CH2M HILL COMPANIES, LTD. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY ADDITIONAL INSURED— Y MERE. REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following:. BUSINESS AUTO COVERAGE FORM Section II. A. 1. WHO IS AN INSURED is amended to include: Any entity, person, or organization you are required or have agreed in a contract, permit, access agreement.and any other written agreement to provide insurance. However, the insurance provided shall not exceed the scope of coverage and/or limits of this policy. Notwithstanding the foregoing sentence., in no event shall the insurance provided exceed the scope of coverage and/or limits required by said contract or agreement. (Authorized Representative] MANUS ce) 2016 X.L. America, Inc. All Rights Reserved. May not be copied without permission. ENDORSEMENT # 007 This endorsement, effective 12 :01 a.m., May 1, 2016 forms a part of Policy No.RAD500025405 issued to CH2M HILL COMPANIES, LTD. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled.or non renewed for any statutorily permitted reason or if coverage is materially reduced, or coverage is cancelled for non- payment of premium advanced written notice will be mailed to the person or entity according to the notification schedule shown below: For the purpose of this endorsement, non- renewal shall mean solely non - renewal of the Policy.and shall not 'include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self- insured retention, except where specific contract or project retentions are.requested and agreed to by You and Us-, or • the application of a new policy exclusion not contemplated at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged (Authorized Representative) MANUS U 2016 X.L. America, Inc. All .Rights Reserved, May not be copied without. permission.. Number of Days Number of Advanced Days Notice of Advanced Cancellation or Notice. of Name of Person or Entity Mailinq Address: Statutorily for Non- Permitted Payment of Reasons or if Premium Coveraqe is Materially Reduced Any entity, person or TBA organization where required by any contract, permit or access 60 days 10 days agreement For the purpose of this endorsement, non- renewal shall mean solely non - renewal of the Policy.and shall not 'include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self- insured retention, except where specific contract or project retentions are.requested and agreed to by You and Us-, or • the application of a new policy exclusion not contemplated at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged (Authorized Representative) MANUS U 2016 X.L. America, Inc. All .Rights Reserved, May not be copied without. permission.. ENDORSEMENT # 026 This endorsement, effective 12:01 a.m., May 1, 2016 forms .a part of Policy No.RGE5000255 -05 issued to CH2M HILL COM PAN IES, LTD. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In the event coverage is cancelled.or non renewed for any statutorily permitted reason or if coverage is materially reduced, or coverage is cancelled for non - payment of premium advanced written notice will be mailed to the person or entity according to the notification schedule shown below.- For the purpose of this endorsement, non - renewal shall mean solely non- renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with. the Insured'sagreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self- insured retention, except where specific contract or project . retentions are.requested: and agreed to by You and Us; or • the application of a new policy.exclusion not contemplated at.inception except as required per state rules and regulations. All other termsand conditions of the Policy remain unchanged. (Authorized Representative) MANUS O 2016 X. L. America, Inc. All Rights Reserved, May not be copied without permission. Number of Days Number of Advanced Days Notice of Advanced Cancellation or Notice of Name of Person or Entity Mailinq Address: Statutorily for Non - Permitted Payment of Reasons or if Premium Coverage is Materially Reduced Any entity, person or organization where required by any contract, permit or access TBA 60 days 10 days agreement For the purpose of this endorsement, non - renewal shall mean solely non- renewal of the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with. the Insured'sagreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self- insured retention, except where specific contract or project . retentions are.requested: and agreed to by You and Us; or • the application of a new policy.exclusion not contemplated at.inception except as required per state rules and regulations. All other termsand conditions of the Policy remain unchanged. (Authorized Representative) MANUS O 2016 X. L. America, Inc. All Rights Reserved, May not be copied without permission. ENDORSEMENT # 037 This endorsement, effective 12:01 a.m., 05-01 -2016 forms a park of Policy No.RGE5000255 -05 issued to CH2M Hill Companies, Ltd. .by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY AUTOMATIC ADDITIONAL INSUREWS PRIMARY COVERAGE This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART With respect to coverage provided by this endorsement,.the provisions of the Coverage Part apply unless modified by this endorsement. SCHEDULE Name Of Additional Insured Persons Or Or anization Locations of Covered Operations Any entity, person or organization you are required by any contract, permit, access agreement, execxited prior to any loss to,promde additional r st s. uoder this Policy. All Locations A. Section II —Who is an Insured is amended to include as an additional insured the person(s) or Organization (s) shown in the schedule and any other person(s) or organization(s) you are required to add as an additional insured under the contract, permit or access agreement described in the schedule but only with respect to liability for 'bodily injury" or "property damage" or "personal and advertising injury caused, in whole or in. part by: 1. "Bodily Injury ", "property damage" or "personal and advertising injury" caused by your operations on the additional insured's premises; or 2. "Your work" for the additional insured and included in the "products- completed operations hazard'; or 3. Your acts or omissions; or 4. The acts or omissions of those acting on your behalf. As respects 2, 3, and 4 the following also applies in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. MANUS C, 2016 X.L. America, Inc. All Rights Reserved. Page 1 of 2 May not be copied without permission. B. Only when required by a contract, permit or access agreement this insurance applies to: 1. (a) All work on the project including service, maintenance or repairs to be performed by or on behalf of the additional insured(s) at4he site of the covered operations has been completed; or (b) That portion of your work out ofwhichthe 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 fora principal as part. of the same project. 2. `Bodily Injury" or "Property Damage arising out of any act or omission of the additional insured(s) or any of their employees, other than the general supervision of work performed for the additional insured(s) by you. However the following applies to A and B above: The insurance afforded to such additional insured(s) only applies to the extent permitted by lave If coverage.provided to the additional insured(s) is required by acontract, permit or access agreement the insurance afforded to: such additional insured(s) will not be broaderthan that which you are required by the contract, permit or access agreement to provide for such additional insured(s). C. Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured(s) whether primary, excess, contingent or on any other basis unless contract specifically required that this insurance be primary. In the absence of primary wording on the contract, we will agree to providing primary status to.the Additional Insured in the event.there is a Master Service.Agreement with Primary. coverage required. When this in applies on a primary basis for the additional insureds described above, it shall apply only to "bodily injury ", "property damage" or 'personal and advertising injury" caused by your work for that additional insured by or for-you. Other Insurance afforded to those additional insuredswill apply as excess: and not contribute as primary to the insurance afforded by this endorsement. The limits of insurance with respect to each person, organization or entity shall not exceed the limits of liability of the named insured. All insuring agreements, exclusions and Conditions of this: policy. apply. In no event, shall the coverage or limits of insurance in this coverage form be increased by such contract, permit or access agreement. All other terms and conditions remain the same. .(Authorized Representative) MANUS O 2016 X.L. America, Inc. All Rights Reserved. Page 2 of 2 May not be copied without permission. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 9906 77 (Ed. 0515) NOTICE OF CANCELLATION, NONRENEWAL OR MATERIAL COVERAGE REDUCTION TO DESIGNATED PERSONS OR ORGANIZATIONS The following is added to PART SIX — CONDITIONS: Notice Of Cancellation, Nonrenewal Or Material Coverage Reduction To Designated Persons Or Organizations If we cancel or non -renew this policy for any reason other than non - payment of premium by you, we will provide notice of such cancellation or non- renewal to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address the number of days shown for that person or organization before the cancellation or nonrenewal is to take effect. In the event of a change that materially reduces or restricts the coverage .afforded by this policy, other than reduction of limits of liability through payment of claims, we will provide notice of such coverage reduction to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address the number of days shown for that person or organization before the reduction is to take effect. You are responsible for providing us with the information necessary to accurately complete the Schedule below. If we cannot mail or deliver a notice of cancellation, nonrenewal or material reduction in coverage to a designated person or organization because the name or address of such designated person or organization provided to us is not accurate or complete, we have no responsibility to mail, deliver or otherwise notify such designated person or organization of the cancellation, nonrenewal or reduction. SCHEDULE Name and Address of Designated. Persons or Organizations: Number of Days Notice Any entity, pe..rson or organization where required by contract, permit 60 or access agreement. 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: May 1, 2016 Policy No.: RWD5000252 -05 Endorsement. No. Insured: CH2M HILL COMPANIES, LTD. Premium: $ Included Insurance Company: XL Specialty Insurance Company Countersigned By: WC 99 06 77 Ed. 0515 O 2015 X.L. America, Inc. All Rights Reserved. Page 1 of 1 May not be copied without permission �`� °® CERTIFICATE OF LIABILITY INSURANCE DATE 04rMO1DD/YYYY) 04/22/2015 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 policy0es) 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. 122517TH STREET, SUITE 1300 CONTACT NAME: PHONE FAX No): E-MAIL ADDRESS: DENVER, CO 80202 -5534 INSURE S AFFORDING COVERAGE NAIC / RGE500025504 INSURER Greenwich Insurance Company 22322 15114_- 12345- 5EX2P- 15116 013428 CA INSURED OPERATIONS MANAGEMENT INTERNATIONAL INC. 9193 SOUTH JAMAICA STREET, SUITE 400 INSURER e : National Union Fire Ins Cc Pittsburgh PA 19445 INSURER C XL Insurance America, Inc. 24554 INSURER D: N/A N/A ENGLEWOOD, CO 80112 -5946 INSURER E: INSURER F: MED EXP (Any one person) _ : $ COVERAGES CERTIFICATE NUMBER: SEA -002058949.41 RFVISInN NUMBER A 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 AD L UBR POLICY NUMBER POLICY EFF I MM /DD /YYYY1 POLICY EXP (MMIDD/YYYYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY X RGE500025504 05/01/2015 05/01/2016 EACH OCCURRENCE $ 1,500;000 DAMAGE TO RENTED PREMISES E 000u $ 1,500,000 CLAIMS -MADE a OCCUR MED EXP (Any one person) _ : $ PERSONAL & ADV INJURY $ 1,500,000 X $500,000 SIR GENERAL AGGREGATE $ 51000,000 GEN'L AGGREGATE LIMB APPLIES PER PRODUCTS - COMP /OP- AGG $ 5,000,000 X POLICY PRO- LOC AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT Ea accident) 2,000,000 X BODILY INJURY( Per person) $ A ANY AUTO RAD500025404 05/01/ 2015 05/01/2016 ALL OWNED i SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE P r d n $ HIRED AUTOS NON -OWNED AUTOS $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 B EXCESS LIAR CLAIMS- BE 31131560 05/0112015 05/01/2016 AGGREGATE $ 5,000,000 _E DED I I RETENTION $ WORKERS COMPENSATION WC STATU- OTH- C C AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN iiOFFICER/MEMBER EXCLUDED4 ❑N (Mandatory in NH) Wyyees, describe under DESCRIPTION OVOPERATIONS below N /A'' RWD500025204 (AOS) RWR500025304 WI ( ) 05/01/2015 05/01/2015 0510112016 05/01/2016 EL. EACH $ 1;000,000 E.L. : DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional. Remarks Schedule, If more space Is required) RE: OPERATION, MAINTENANCE AND MANAGEMENT SERVICES FOR THE SOUTH COUNTY REGIONAL WASTEWATER AUTHORITY. THE CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. nvL-ur-f% SOUTH COUNTY REGIONAL WASTEWATER AUTHORITY 7351ROSANNA 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. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Sharon A. Hammer �✓., Q _�N�r�+- -� �+ ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD ENDORSEMENT # 009 This endorsement, effective 12:01 a.m:, May 1, 2015 forms a part of Policy No.RAD500025404 issued to CH2M HILL COMPANIES, LTD. by'Greernaich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY, P.LEASEREAD IT CAREFULLY CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT In.the event coverage is cancelled or non renewed for any statutorily permitted reason or if coverage is materially reduced,:or coverage is cancelled for non - payment of premium advanced written notice will be mailed to the person or entity according to the notification schedule shown below For the purpose of this'endorsement, non - renewal shall mean solely non - renewal of the Policy and shall not include expiration or Notice of Conditional.Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self- insured retention, except where specific contract or project retentions are requested and agreed to by You and Us; or • the application of a new policy exclusion not contemplated at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (Authorized Representative) MANUS C 2015 X.L. America, Inc. All Rights Reserved, May not be copied without permission. Number of Days Number of :Advanced Days Notice of Advanced; Cancellation or Notice of Name of Person or Entity Mailina Address: Statutorily for Non- Permitted Pavment of Reasons or if Pre_ mium Coverage is Materially Reduced Any entity, person or TBA organization where required by Any contract,,lpeumI or access 60 days 10 days agreement For the purpose of this'endorsement, non - renewal shall mean solely non - renewal of the Policy and shall not include expiration or Notice of Conditional.Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self- insured retention, except where specific contract or project retentions are requested and agreed to by You and Us; or • the application of a new policy exclusion not contemplated at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (Authorized Representative) MANUS C 2015 X.L. America, Inc. All Rights Reserved, May not be copied without permission. ENDORSEMENT # 027 This endorsement, effective 12:01 a.m.; May 1, 2015 form s:a part of Policy No.RGE500025504 rued to CH2M HILL COMPANIES, LTD. by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY CANCELLATION NOTIFICATION TO OTHERS ENDORSEMENT' In the event coverage is cancelled or non renewed for any statutorily permitted reason or if coverage is materially reduced; or coverage is cancelled for non- payment of premium advanced written notice will be mailed to the person or entity. according to the notification schedule shown below: For the purpose of this endorsement, non - renewal shall mean solely non - renewal of-the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self- insured retention, except where specific contract or project retentions are requested and agreed to by You and Us; or • the application of a new policy exclusion not contemplated at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (Authorized Representative) MANUS © 2015 X.L. America, Inc.. All Rights Reserved, May not be copied without permission. Number of Days Number of Advanced Days Notice of Advanced Cancellation or Notice of Name of Person or Entity Mailing Address: Statutorily for Non - Permitted Payment of Reasons or Premium Coverme is Materially Reduced Any entity, person or organization where required by any contract, permit or access TBA 60 days 10 days agreement For the purpose of this endorsement, non - renewal shall mean solely non - renewal of-the Policy and shall not include expiration or Notice of Conditional Renewal. Material reduction in coverage shall mean, with the Insured's agreement: • policy limits shown in the declarations page get amended; or • change in the deductible or self- insured retention, except where specific contract or project retentions are requested and agreed to by You and Us; or • the application of a new policy exclusion not contemplated at inception except as required per state rules and regulations. All other terms and conditions of the Policy remain unchanged. (Authorized Representative) MANUS © 2015 X.L. America, Inc.. All Rights Reserved, May not be copied without permission. WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WC 42 06.01 (Ed. 7 -84) TEXAS NOTICE OF MATERIAL CHANGE ENDORSEMENT This endorsement changes, the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause need be completed only when this endorsement is Issued subsequent to preparation of.the policy.) This endorsement, effective on May 1, 2015 at 12:01 A.M. standard time, forms a part of (DATE) Policy No. RWD500025204 Endorsement No. of the (NAME OF INSURANCE COMPANY) )L Insurance Arneriea, Inc. issued to CH2M HILL COMPANIES, LTD Premium (if any) $ Included Authorized Representative This endorsement applies only to the insurance provided by the policy because Texas is shown in item 3.A of the Information Page. In the event of cancelation or other material change of the policy, we will mail advance notice to the person or organization named in the'Schedule. The number of days advance'notioe is.shown in the'Schedule. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule 1. Number of days advance notice: 60 days 2 'Notice will be mailed to: Any entity_ , person or organization where required by any contract, permit or access agreement WC 276 (7$4) WC 42 06 01 (Ed. 7 - -84) Page 1 of 1 AoNR,SK SERVICES April 1, 2015 South County Wastewater Authority, SCRWA (`the Agency ") 7351 Rosanna St. Gilroy, CA 95020 Attn: Risk Manager RE: Myers & Sons Construction, LP Policy # 61 WNQU2064; 61 CSEQU2061; 61 UENQU2062; BE18255658 3/1/2015 Dear Certificate Holder, Please note the attached certificate of insurance is issued as a matter of information only and confers no rights upon you. • This document does not amend, extend or alter the coverage terms, exclusions and conditions afforded by the referenced policies. • This document does not specify all endorsements, coverages, terms, conditions, and exclusions of the policies shown. All limits shown are as requested, and a self insured retention may apply to the limits shown per terms and conditions of the policy. • The policies of insurance are in effect only for the policy periods indicated, and aggregate limits shown in the certificate may have been reduced by paid claims. /Since abcock Account Executive - Broker Aon Risk Services Southwest, Inc. Construction Services Group 5555 San Felipe Suite 1500 Houston, TX 77056 Ph.: 832 - 476 -5680 Business Unit Name (Optional) I Practice Group Name (Optional) I Legal Company Name (Optional) Address Line One I Address Line Two I Address Line Three t: +X.XXX.XXX.XXXX I f: +X.XXX.XXX.XXXX w: aon.com I Miscellaneous 3/28/2012 Edition SECTION 00630 CERTIFICATE OF INSURANCE Return Completed Certificate to: South County Regional Wastewater Authority, SCRWA ( "the Agency ") 7351 Rosanna Street Gilroy, CA 95020 Attn: Risk Manager This certifies to the Agency that the following described policies have been issued to the Insured named below and are in force at this time. Insured Myers & Sons Construction, L.P. Address 4600 Northgate Ste 100, Sacramento CA 95834 Description of operations /locations/products insured (show contract name and/or number, if any): POLICIES AND INSURERS Bodily LIMITS Property POLI EXPIRATION Injury Damage CY DATE Workers' Compensation Employers Liability 1 WNQU2064 03/01%2016 Property & Casualty Ins Co. of Hartford $ 1,000,000 (Name of Insurer) (Best's Rating) Check policy type: "Claims Made" _ _ Occurrence COMPREHENSIVE GENERAL Each Each LIABILITY or Occurrence Occurrence 61 CS EQU2061 03/01 /2016 COMMERCIAL GENERAL $ $ 2,000,000 LIABILITY Aggregate Aggregate Property & Caualty Ins Co of Hartford $ $ 4,000,000 (Name of Insurer) or Combined Single Limit (Best's Rating) Aggregate$ BUSINESS AUTO POLICY Each Each Accident Liability Coverage Person Symbol 1 $ Hartford Fire insurance Co. Each Accident 61UENQU2062 03/01/2016 r, om me gle Limit $ 2,000,000 UMBRELLA LIABILITY "Claims Made" _ _ Occurrence Nat'l Union Fire Ins of Pittsburgh (Name oflnsurer) Occurrence /Aggregate $ 25,000,000 BE18255658 03/01/2016 (Best's Rating) Self - Insured Retention $ N/A 15 -PW -219 CERTIFICATE OF INSURANCE Plant Maintenance Projects PAGE 00630 - 1 The following coverage or conditions are in effect: Yes No The Agency, its officials, and employees are named on all liability policies described above as insureds as respects: (a) activities performed for the Agency by or on behalf of X the Named Insured, (b) products and completed operations of the Named Insured, and (c) premises owned, leased or used by the Named Insured. Products and Completed Operations X The undersigned will mail to the Agency 30 days written notice of cancellation or X reduction of coverage or limits Cross Liability Clause (or equivalent wording) X Personal Injury, Perils A, B and C X Broad Form Property Damage X X, C, U& Hazards included X Contractual Liability Coverage applying to this Contract X Host Liquor Liability X Coverage afforded the Agency, its officials, employees and volunteers as Insureds applies as primary and not excess or contributing to any insurance issued in the name of the X Agency Waiver of subrogation from Workers' Compensation Insurer X This certificate IS Issued as a matter of information. This certificate IS not an msurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance 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. Aon Risk Services Southwest.. Inc. Agency or Brokerage .,. Inhn C R;ihrnrk Arrmint FxPrnjtivPJRrnkPr Name of Person to be Contacted RAJ- 47F, -56RQ Telephone No. Aon Risk Services Southwest. Inc. Insurance Agent 77056 l I k-s> IS Date Note: Authorized signatures may be the agent's if the agent has placed insurance through an agency agreement with the insurer. If insurance is brokered, authorized signature must be that of official of insurer. 15 -PW -219 CERTIFICATE OF INSURANCE Plant Maintenance Projects PAGE 00630 - 2 GENERAL LIABILITY ENDORSEMENT South County Regional Waste Authority ( "the Agency ") 7351 Rosanna Street Gilroy, CA 95020 Attn: Risk Manager A. POLICY INFORMATION Endorsement No.. 1. Insurance Compan y Hartford Fire Insurance Company Policy No. 61 CSEOU2061 2. Policy Term (from) 03/01/2015 (to) 03/01/2016 3. Named Insured Myers & Sons Construction, L.P. 4. Address of Named Insured 4600 Northgate Ste 100, Sacramento CA 95834 5. Limit of Liability Any One Incident /Aggregate$. 2,000,000/4,000,000 6. Deductible or Self - Insured Retention: (Nil unless otherwise specified): $1,000 7. Coverage is equivalent: Comprehensive General Liability form GL0002 (Ed 1/73) Yes Comprehensive General Liability "occurrence" form CG0001 Yes _ Comprehensive General Liability "claims- made" form CG0002 N/A 8. Bodily Injury and Property Damage Coverage is: "slates made"— "occurrence" if claims -made, the retroactive date is: N/A NOTE: The Agency's standard insurance requirements specify "occurrence" coverage. "Claims- made" coverage requires special approval. B. POLICY AMENDMENTS This endorsement is issued in consideration of the policy premium. Notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any other endorsement attached thereto, it is agreed as follows: 1. INSURED. The Agency, its elected and appointed officers, officials, employees and volunteers are included as insureds with regards to damages and defense of claims arising from: (a) activities performed by or on behalf of the Named Insured, (b) products and completed operations of the Named Insured, or (c) premises owned, leased or used by the Named Insured. 2. CONTRIBUTION NOT REQUIRED. As respects: (a) work performed by the Named Insured for or on behalf of the Agency; or (b) products sold by the Named Insured to the Agency, or (c) premises leased by the Named Insured from the Agency, the insurance afforded by this policy shall be primary insurance as respects the Agency, its elected or appointed officers, officials, employees or volunteers; or stand in an unbroken chain of coverage excess of the Named Insured's scheduled underlying primary coverage. In either event, any other insurance maintained by the Agency, its elected or appointed officers, officials, employees and volunteers shall be in excess of this insurance and shall not contribute with it. 3. SCOPE OF COVERAGE. This coverage, if primary, affords coverage at least as broad as: (1) Insurance Services Office form number GL 002 (Ed. 1/73), Comprehensive General Liability Insurance and Insurance Services Office form number GL 0404 Broad Form comprehensive General Liability endorsement: or (2) Insurance Services Office Commercial General Liability Coverage, "occurrence" form CG 0001 or "claims- made" form CG 0002; or (3) If excess, affords coverage which is at least as broad as the primary insurance forms referenced in the preceding sections (1) and (2). 15 -PW -219 Plant Maintenance Projects CERTIFICATE OF INSURANCE PAGE 00630 - 3 3. SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separately to each insured who is seeking coverage or against whom a claim is made or a suit is brought, except with respects to the Company's limit of liability. 4. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. Any failure to comply with reporting provisions of the policy shall not affect coverage provided to the Agency, its elected or appointed officers, officials, employees or volunteers. 5. CANCELLATION NOTICE'. The insurance afforded by this policy shall not be suspended, voided, cancelled, reduced in coverage or in limits except after thirty (30) days prior written notice by certified mail return receipt requested has been given to the Agency. Such notice shall be addressed as shown in the heading of this endorsement. ►► :► 1XII W41 131"A'ahm ; 01 1 Incidents and claims are to be reported to the insurer at: ATTN: Robert Izlar Risk Control & Claims (Title) (Department) Aon Risk Solutions (Company) 2711 North Haskell Ave Ste 800 Dallas TX 75204 (Address) 214- 989 -2139 (Telephone) t ► : i ton) 05 to wI ;LDI ;ZfJ;r IJ 0.0)',A VA 303 ',4 W',A W1 NCO 1141 N LIA M) III VIA 1►F.Y11.; ; I, John Babcock (print/type name), warrant that I have authority to bind the below listed insurance company and by my signature hereon do so bind this�gaany. OF AUTHORIZEDMPRESENTATIVE (original signature required on endorsement furnished to the Agency) ORGANIZATION Aon Risk Services Southwest, Inc. TITLE. Account Executive - Broker ADDRESS 5555 San Felipe Suite 1500, Houston, TX 77056 TELEPHONE 1- 832 -476 -5680 15 -PW -219 Plant Maintenance Projects CERTIFICATE OF INSURANCE PAGE 00630 - 4 WORKER'S COMPENSATION/EMPLOYERS LIABILITY ENDORSEMENT South County Regional Wastewater Authority, SCRWA ( "the Agency ") 7351 Rosanna Street Gilroy, CA 95020 Attn: Risk Manager A. POLICY INFORMATION Endorsement # 1. Insurance Company: Property & Casualty Ins Co. of Hartford ( "the Company ") Policy Number: 61 W N O U 2 0 6 4 2. Effective Date of This Endorsement: 3. Named Insured: Myers & Sons Construction, L.P. 4. Employer's Liability Limit (Coverage B):. $1,000,000 B. POLICY AMENDMENTS In consideration of the policy premium and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any other endorsement attached thereto, it is agreed as follows: L Cancellation Notice. The insurance afforded by this policy shall not be suspended, voided, cancelled, reduced in coverage or in limits except after thirty (30) days prior written notice by certified mail return receipt requested has been given to the Agency. Such notice shall be addressed as shown in the heading of this endorsement. 2. Waiver of Subrogation. The Insurance Company agrees to waive all rights of subrogation against the Agency, its elected or appointed officers, officials, agents and employees for losses paid under the terms of this policy which arise from work performed by the Named Insured for the Agency. C. SIGNATURE OF INSURER OR AUTHORIZED REPRESENTATIVE OF THE INSURER [, John Babcock, warrant that I have authority to bind the below listed insurance company and by my signature hereon do so bind th' an . NATURE OF AUTHORIZED REPRESENTATIVE original signature required on endorsement furnished to the Agency) ORGANIZATION Aon Risk Services Southwest, Inc TITLE. Account Executive - Broker ADDRESS 5555 San Felipe Suite 1500, Houston, TX 77056 TELEPHONE, 1 -832- 476 -5680 15 -PW -219 WORKERS' COMPENSATION INSURANCE CERTIFICATE Plant Maintenance Projects PAGE 00630 - 5 This page intentionally left blank. 15 -PW -219 WORKERS' COMPENSATION INSURANCE CERTIFICATE Plant Maintenance Projects PAGE 00630 - 6 POLICY PROVISIONS: WC 00 00 00 B NCCI COMPANY NO. INFORMATION PAGE NCCI COMPANY NO. INSURER: Hartford Accident and Indemnity Company 10448 Hartford Insurance Company of Illinois Hartford Casualty Insurance Company Hartford Insurance Company of the Midwest 06 -5 B L R P Hartford Fire Insurance Company 13269 Hartford Insurance Company of the Southeast 0627 nd o F I Hartford Underwrtters Insurance Company 10456 01 Twin City Fire Insurance Company 14974 ADDRESS:HARTFORD, CT. 06155 SUFFIX POLICY NO. 161 WN QU2.064 enewa Previous Policy N0.161 WN QU2064 ® 001 o. o e Items 5 1. Named Insured and Mailing Address MYERS & SONS CONSTRUCTION, LP (No.,Street,Town,COunty,State) 4600 NORTHGATE BLVD. SUITE 100 Individual ® Corporation X❑ SACRAMENTO, CA 95834 Partnership Other---------- - -- Other workplaces not shown above: 2. The Policy Period is from 03/01/2015 to 03/01/2016 12:01 A.M.,standard time at the insured's mailing address Producer's Name Producer's Code Issuing Regional Office AON RISK SERVICES SOUTHWEST, 611412 THE HARTFORD 5555 SAN FELIPE ONE HARTFORD PLAZA (ISUITE 1500 HARTFORD, CT 06155 L�QUSTON, TX 77056 3. A. Workers' Compensation Insurance:Part One of the Policy applies to the Workers' Compensation Law of the states listed here: CA B. Employers' Liability lnsurance:Part Two of the policy applies to work in each state listed in Item 3A. The Limits of our Liability under Part Two are: Bodily Injury by Accident $1, o o o , o o o Each accident Bodily Injury by Disease $1,000,000 Policy Limit Bodily Injury by Disease $1,000,000 each employee C. Other States Insurance: Part Three of the policy applies to the states, if any, listed here: ALL STATES EXCEPT NORTH DAKOTA, OHIO, WASHINGTON, WYOMING AND ANY STATES DESIGNATED IN ITEM 3A OF THE INFORMATION PAGE D. This policy includes these endorsements and schedules: wc990005 AND SEE LISTING OF ENDTS 4. The premium for this policy will be determined by our manuals of Rules, Classifications, Rates and Rating Plans. All information required below is subject to verification and change by audit. Premium Basis Rate Per Classifications Code Total Estimated $100 of Estimated Annual Number Annual Remuneration Remuneration Premium SEE SCHEDULE OF OPERATIONS $89,564 TERRORISM 9740 $1,889 =EIN NO. 27- 1829007 Interstatelintrastate ID No. 918042784 NAICS: 237310 Total Estimated Annual Premium $91,453 Minimum Premium: $1,256 CA Deposit Premium $91,453 Audit Period: QAnnual Semi- Annual []Quartedy Monthly 03/20/2015 Countersigned by Form WC 00 00 01 A Printed in U.S.A. Authorized Agent Date F� THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA Policy Number: 61 WN QU2064 Endorsement Number: 12 Effective Date: 03 / 01 / 2 015 Effective hour is the same as stated on the Declarations of the policy. Named Insured and Address: MYERS & SONS CONSTRUCTION, LP 4600 NORTHGATE BLVD. SUITE 100 SACRAMENTO, CA 95834 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be otherwise due on such remuneration. Person or Organization ANY PERSON OR ORGANIZATION FROM WHOM YOU ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT TO OBTAIN THIS WAIVER OF RIGHTS FROM US. Form WC 04 03 06 Printed in U.S.A. 9 SCHEDULE % of the California workers' compensation premium Job Description Countersigned by Authorized Representative THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) Policy Number: 61 WN QU2064 Endorsement Number: 18 Effective Date:03 /01/2 -015 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: MYERS & SONS CONSTRUCTION, LP 4600 NORTHGATE BLVD. SUITE 100 SACRAMENTO, CA 95834 This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for non - payment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. B. If this policy is cancelled by the Company for non - payment of premium, or by the insured, notice of such cancellation will be provided within ten (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. Form WC 99 03 94 Printed in U.S.A. Process Date: If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Failure to provide such notice to the certificate holder(s) will not amend or extend the date the cancellation becomes effective, nor will it negate cancellation of the policy. Failure to send notice shall impose no liability of any kind upon the Company or its agents or representatives. © 2011, The Hartford Policy Expiration Date: COMMERCIAL GENERAL LIABILITY COVERAGE PART - DECLARATIONS DECLARATIONS POLICY NO. 61 CSE QU2061 Previous Policy No. 61 CSE QU2061 This COMMERCIAL GENERAL LIABILITY COVERAGE PART consists of: A. This Declarations; B. Commercial Liability Schedule, if applicable; C. Commercial General Liability Coverage Form; and D. Any Endorsements issued to be part of this Coverage Part and listed below. 1. Audit Period is the Policy Period unless otherwise herein stated: 0 Semi - Annual 0 Quarterly 0 Monthly J Annual Q Not subject to Audit 2. Advance Premium $413,484 which is Q A Flat Charge Per Each Policy Period Q x Adjustable at the end of each Audit Period, Per Premium Computation Endorsement Minimum Retained Audit Premium $327,512 Minimum Retained Premium $327,512 not subject to adjustment in the event of cancellation by you. Applicable State Surcharges: REFER TO SCHEDULE HC1210 Note: charges, if any, are included in item 2. above 3. Limits of Insurance The Limits of Insurance, subject to all the terms of this policy that apply, are: Each Occurrence $2,000,000 Personal and Advertising Injury Limit $2,0U0,000 Damage to Premises Rented To You Limit -Any One Premises $30.0,000 Medical Payments Coverage Limit -Any One Person $10,000 General Aggregate Limit (Other than Products- Completed Operations) $4,000,000 Products - Completed Operations Aggregate Limit $4,000,000. 4. Classifications, if any: REFER TO EXTENSION SCHEDULE. 5. Business Description UTILITY CONTRACTOR -GC 6. Form Numbers of Coverage Forms and Endorsements forming a part of this policy: SEE LISTING OF POLICY PROVISIONS AND ENDORSEMENTS FORMING A PART OF THE POLICY AT ISSUE. 03/10/2015 Form HS 00 02 06 05 (c) 2005, The Hartford POLICY NUMBER: 61 CSE QU2061 F� THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL PERSONS OR ORGANIZATIONS DESIGNATED AS NAMED INSUREDS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART OWNERS AND CONTRACTORS PROTECTIVE LIABILITY COVERAGE PART The following person(s) or organizations(s) are added as Named Insureds under this policy: STERLING CONSTRUCTION COMPANY, INC. TEXAS STERLING CONSTRUCTION CO. RDI FOUNDATION DRILLING STERLING HOUSTON HOLDINGS, INC. RHB PROPERTIES, LLC ROAD AND HIGHWAY BUILDERS, LLC ROAD AND HIGHWAY BUILDERS, INC. ROAD AND HIGHWAY BUILDERS OF CALIFORNIA, INC. RALPH L. WADSWORTH CONSTRUCTION COMPANY, LLC RALPH L. WADSWORTH CONSTRUCTION COMPANY CO. LP J. BANICKI CONSTRUCTION, INC. MYERS & SONS CONSTRUCTION, LP C & J MYERS, INC. STERLING HAWAII ASPHALT, LLC TEXAS CRUSHED CONCRETE STERLING CONSTRUCTION COMPANY, INC. DBA STERLING DELAWARE HOLDING COMPANY, INC. MYERS AND SONS / ACC JV Form HC 20 3112 10 O 2010, The Hartford Page 1 of 1 POLICY NUMBER: 61 CSE QU2061 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION OR NON - RENEWAL TO DESIGNATED PERSON(S) OR ORGANIZATION(S) OTHER THAN THE NAMED INSURED This policy is subject to the following conditions. SCHEDULE Number of Days Notice 3 0 Name of Person(s) or Organization(s) Mailing Address ALL CERTIFICATE HOLDERS WITH VALID POSTAL MAILING ADDRESSES ON FILE WITH AGENT OF RECORD OR THE COMPANY. If this policy is cancelled or non - renewed, we agree that the person(s) or organization(s) listed in the Schedule above will be notified at least: a. 10 days before the effective date of cancellation if we cancel for non - payment of premium; or b. The number of days shown in the Schedule above before the effective date of cancellation or non - renewal if we cancel or non -renew for any other reason. In no event, however, will notice of cancellation or non - renewal be less than the minimum number of days required by the jurisdiction to which this endorsement applies. If notice is mailed, proof of mailing to the address shown in the Schedule above will be sufficient proof of notice. Form IH 03 02 06 08 Page 1 of 1 © 2008, The Hartford POLICY NUMBER: 61 CSE QU2061 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS BROAD FORM ENDORSEMENT - TEXAS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART INDEX 1. Alienated Premises Coverage ......................................................................................................... ..............................1 2. Damage To Your Work .................................................................................................................... ..............................1 3 Contractors Limited Professional Liability ........................................................................................ ..............................1 4. General Aggregate Limits Of Insurance (Per Project) ..................................................................... ..............................2 5. Motor Vehicle Laws .......................................................................................................................... ..............................2 6. Medical Payments Coverage — Including Products - Completed Operations ................................. ............................... 3 7. Insured Contract — Construction Operations And Municipal Work ................................................. ............................... 3 8. Injury To Employee's Reputation With Respect To Incidental Medical Malpractice ....................... ..............................3 9. Bodily Injury Employee Suits ........................................................................................................... ............................... 3 10. Limited Products - Completed Operations Coverage In Connection With A Consolidated Insurance (Wrap -Up) Program.......................................................................................................................................... ............................... 3 11. Electronic Data Liability .................................................................................................................... ..............................4 12. Contractual Liability Coverage For Personal And Advertising Injury ............................................... ............................... 4 13, Supplementary Payments ............................................................................................................... ............................... 5 1. ALIENATED PREMISES COVERAGE Exclusion j. Damage To Property of Section 1 — Coverage A is amended as follows: a. The following exception to the exclusion is deleted: Paragraph (2) of this exclusion does not apply if the premises are "your work" and were never occupied, rented or held for rental by you. b. This exception is replaced by the following: Paragraph (2) of this exclusion does not apply if the premises are "your work ". 2. DAMAGE TO YOUR WORK Exclusion 1. Damage To Your Work of Section I - Coverage A is replaced by the following: I. Damage to Your Work "Property damage" to that particular part of "your work" out of which damage arises and included in the "products - completed operations hazard ". Form HS 24 24 02 10 This exclusion does not apply if the damaged work or the work out of which the damage arises was performed on your behalf by a subcontractor. This provision does not apply if exclusion 1. Damage To Your Work has been otherwise modified by endorsement. 3. CONTRACTORS LIMITED PROFESSIONAL LIABILITY The following exclusion is added to Paragraph 2., Exclusions of Section I - Coverage A - Bodily Injury And Property Damage Liability, and to Paragraph 2., Exclusions of Section I - Coverage B - Personal And Advertising Injury Liability: This 'insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or failure to render any professional services by you with respect to your providing engineering, architectural or surveying services in your capacity as an engineer, architect or surveyor. © 2009, The Hartford (Includes copyrighted material of Insurance Services Office, Inc. with its permission.) Page 1 of 5 Professional services include: (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 or inspection activities performed as a part of any related architectural or engineering activities. This exclusion does not apply to "bodily injury" or "property damage" arising out of your providing the professional services described above for or in connection with construction work performed by you or on your behalf. However, this exception to the exclusion will not apply if you are in the business or profession of providing the professional services described above independent from the construction work performed by you or on your behalf. The insurance afforded by reason of this provision is excess over any other valid and collectible professional liability insurance (including any deductible portion thereof) available to the insured whether primary, excess, contingent or on any other basis. 4. GENERAL AGGREGATE LIMITS OF INSURANCE (PER PROJECT) A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which can be attributed only to ongoing operations at a single project; 1. A separate General Aggregate Limit applies to each project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A. except damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard ", and for medical expenses under Coverage C regardless of the number of; a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits ". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the General Aggregate Limit for that project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other General Aggregate Limit for any other project. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I Coverage A and for all medical expenses caused by accidents under Section 1 - Coverage C , which cannot be attributed only to ongoing operations at a single project; 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products- Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any project General. Aggregate Limit. C. When coverage for liability arising out of the "products- completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard" will reduce the Products- Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the project General Aggregate Limit. D. If the applicable project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same project. E. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. This provision does not apply if the General Aggregate Limit Per Project has been otherwise modified by endorsement. 5. MOTOR VEHICLE LAWS The following are added to Section IV - Commercial General Liability Conditions: 1. With respect to "mobile equipment" to which this insurance applies„ the insurance provided by the coverage part for Bodily Injury Liability or Property Damage Liability will comply with the provisions of the law to the extent of the coverage and limits of insurance required by that law. Page 2 of 5 Form HS 24 24 0210 2. With respect to "mobile equipment" to which this insurance applies, we will provide any liability, uninsured motorists, underinsured motorists, no- fault or other coverages required by any motor vehicle insurance law. We will provide the required limits for those coverages. This provision applies only when there is no other valid or collectable insurance. 6. MEDICAL PAYMENTS COVERAGE — INCLUDING PRODUCTS- COMPLETED OPERATIONS Paragraph 1.a. of the Insuring Agreement — Coverage C is replaced by the following: 1. Insuring Agreement a. We will pay medical expenses as described below for "bodily injury" caused by an accident: (1) On premises you own or rent; (2) On ways next to premises you own or rent; (3) Because of your operations; or (4) Included within the definition of the "products- completed operations hazard;" provided that: (1) The accident takes place in the "coverage territory" and during the policy period; (2) The expenses are incurred and reported to us within three years of the date of the accident; and (3) The injured person submits to examination, at our expense, by physicians of our choice as often as we reasonably require. 7. INSURED CONTRACT — CONSTRUCTION OPERATIONS AND MUNICIPAL WORK Paragraph d. of the definition of "insured contract" in Section V - Definitions is deleted and replaced by the following: d. An obligation, as required by ordinance, to indemnify a municipality. 8. INJURY TO EMPLOYEE'S REPUTATION WITH RESPECT TO INCIDENTAL MEDICAL MALPRACTICE A The following is added to paragraph 1.e. of the Insuring Agreement— Coverage A (3) With respect to incidental medical malpractice, "bodily injury" includes damages claimed for injury to emotions or reputation of an "employee" arising out of the rendering or failure to render professional health care services as a physician, dentist, nurse, emergency medical technician or paramedic services. B. The following exclusion is added to Coverage B - Personal and Advertising Injury: "Personal and advertising injury arising out of the rendering or failure to render professional health care services as a physician, dentist, nurse, emergency medical technician or paramedic. 9. BODILY INJURY EMPLOYEE SUITS A "Bodily injury" as listed in paragraph 2.a.(1) of Section II - Who Is An Insured, does not apply to 2.a.(1)(a) through 2.a.(1)(c). B. Part a. of Paragraph 4. Mobile Equipment in Section II - Who Is An Insured does not apply. C. Part a. of Paragraph 5. Nonowned Watercraft in Section II Who Is An Insured does not apply. 10. LIMITED PRODUCTS - COMPLETED OPERATIONS COVERAGE IN CONNECTION WITH A CONSOLIDATED INSURANCE (WRAP -UP) PROGRAM The following exclusion is added to Section Coverage A: Any injury or damage arising out of any operations performed by you or on your behalf on or from all premises which are subject to a "consolidated insurance (wrap -up) program ". This exclusion applies even if the policy covering such "consolidated insurance (wrap -up) program" is exhausted or provides coverage narrower in scope to that provided by this Coverage Part. This exclusion does not apply to "bodily injury" or "property damage" within the "products- completed operations hazard" if all coverage available to the insured for the "products - completed operations hazard" in a "consolidated insurance (wrap -up) program" or other similar insurance program is no longer in effect. However, coverage under this Coverage Part for such "bodily injury" or "property damage" will not be broader than that provided for the "products- completed operations hazard" by the "consolidated insurance (wrap -up) program" or other similar program. For the purposes of this provision, "consolidated insurance (wrap -up) program" means any agreement or arrangement under which all the contractors and the owner working on a specified project are, insured under one or more general liability policies issued by a specified carrier for injury or damage arising out of operations conducted in connection with or necessary or incidental to the project. This provision does not apply if the coverage in connection with a Consolidated Insurance (Wrap -Up) Program has been otherwise modified by endorsement. Form HS 24 24 02 10 Page 3 of 5 11. ELECTRONIC DATA LIABILITY A. Exclusion p. of Section I — Coverage A is replaced by the following: p. Electronic Data Damages arising out of the loss of, loss of use of, damage to, corruption of, inability to access, or inability to manipulate "electronic data" that does not result from physical injury to tangible property. B. The following paragraph is added to Section III — Limits Of Insurance: Subject to Paragraph 5. Each Occurrence Limit, the most we will pay under Coverage A for "property damage" because of all loss of "electronic data" arising out of any one "occurrence" is $100,000. C. The following definition is added to Section V - Definitions: "Electronic data" means information, facts or programs: a. Stored as or on; b. Created or used on; or c. Transmitted to or from; computer software, . (including systems and applications software) hard or floppy disks, CD- ROMS, tapes, drives, cells, data processing devices or any other media which are used with electronically controlled equipment. D. For the purposes of the coverage provided by this provision, the definition of "property damage" in Section V - Definitions is replaced by the following: "Property damage" means: a. Physical injury to tangible property, including all resulting loss of use of that property. All such loss of use shall be deemed to occur at the time of the physical injury that caused it; b. Loss of use of tangible property that is not physically injured. All such loss of use shall be deemed to occur at the time of the "occurrence" that caused it; or c. Loss of, loss of use of, damage to, corruption of, ,inability to access, or inability to properly manipulate "electronic data ", resulting from physical injury to tangible property. All such loss of "electronic data" shall be deemed to occur at the time of the "occurrence" that caused it. For the purposes of this insurance, "electronic data" is not tangible property. This provision does not apply if exclusion p. Electronic Data has been otherwise modified by endorsement. 12. CONTRACTUAL LIABILITY COVERAGE FOR PERSONAL AND ADVERTISING INJURY A. Exclusion e. of Section I - Coverage B — Personal And Advertising Injury Liability is replaced by the following: This insurance does not apply to: e. Contractual Liability "Personal and advertising injury" for which the insured has assumed liability in a contract or agreement.This exclusion does not apply to liability for damages: (1) That the insured would have in the absence of the contract or agreement; or (2) Assumed in a contract or agreement that is an "insured contract ", provided the "personal and advertising injury" occurs subsequent to the execution of the contract or agreement. Solely for the purposes of liability assumed in an "insured contract", reasonable attorney fees and necessary litigation expenses incurred by or for a party other than an insured are deemed to be damages because of "personal and advertising injury", provided: (a) Liability to such party for, or for the cost of, that party's defense has also been assumed in the same "insured contract "; and (b) Such attorney fees and litigation expenses are for defense of that party against a civil or alternative dispute resolution proceeding in which damages to which this . insurance applies are alleged. B. Subparagraph f. of the definition of "insured contract" (Section V — Definitions) is replaced by the following: f. That part of any other contract or agreement pertaining to your business (including an indemnification of a municipality in connection with work performed for a municipality) under which you assume the tort liability of another party to pay for "bodily injury', "property damage ", or "personal and advertising injury' to a third person or organization, provided the "bodily injury", "property damage ", or "personal and advertising injury" is caused, in whole or in part, by you or by those acting on your behalf. Tort liability means a liability that would be imposed by law in the absence of any contract or agreement. Page 4 of 5 Form HS 24 24 02 10 Paragraph f. includes that part of any contract or agreement that indemnifies a railroad for "bodily injury", "property damage ", or "personal and advertising injury" arising out of construction or demolition operations, within 50 feet of any railroad property and affecting any railroad bridge or trestle, tracks, road- beds, tunnel, underpass or crossing. However, Paragraph f. does not include that part of any contract or agreement: (1) That indemnifies an architect, engineer or surveyor for injury or damage arising out of: (a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or (b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or damage; or (2) Under which the insured, if an architect, . engineer or surveyor, assumes liability for an injury or damage arising out of the insured's rendering or failure to render professional services, including those listed in (1) above and supervisory, inspection, architectural or engineering activities. 13. SUPPLEMENTARY PAYMENTS In the Supplementary Payments — Coverages A and B provision: The limit for the cost of bail bonds in increased to $2,500. Form HS 24 24 02 10 Page 5 of 5 POLICY NUMBER: 61 CSE QU2061 owl' tuJl THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - OPTION I This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Designated Project(s) Or Location(s) Of Covered Operations: Information required to complete this Schedule if not shown above will be shown in the Declarations. A. With respect to those person(s) or organization(s) shown in the Schedule above when you have agreed in a written contract or written agreement to provide insurance such as is afforded under this policy to them, Subparagraph f., Any Other Party, under the Additional Insureds When Required By Written Contract, Written Agreement Or Permit Paragraph of Section II — Who Is An Insured is replaced with the following: f. Any Other Party Any other person or organization who is not an insured under Paragraphs a. through e. above, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (1) In the performance of your ongoing operations for such additional insured at the project(s) or location(s) designated in the Schedule; (2) In connection with your premises owned by or rented to you and shown in the Schedule; or Form HS 24 80 07 13 (3) In connection with "your work" for the additional insured at the project(s) or location(s) designated in the Schedule and included within the "products - completed operations hazard ", but only if: (a) The written contract or written agreement requires you to provide such coverage to such additional insured at the project(s) or location(s) designated in the Schedule; and (b) This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products- completed operations hazard ". The insurance afforded to the additional insured shown in the Schedule applies: (1) Only if the "bodily injury" or "property damage" occurs, or the "personal and advertising injury" offense is committed: (a) During the policy period; and (b) Subsequent to the execution of such written contract or written agreement; and © 2013, The Hartford (Includes copyrighted material of Insurance Services Office, Inc., with its permission.) Page 1 of 2 (c) Prior to the expiration of the period of time that the written contract or written agreement requires such insurance be provided to the additional insured. (2) Only to the extent permitted by law; and (3) Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. With respect to the insurance afforded to the person(s) or organization(s) that are additional insureds under this endorsement, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: (1) The preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or specifications; or (2) Supervisory, inspection, architectural or engineering activities. The limits of insurance that apply to the additional insured shown in the Schedule are described in the Limits Of Insurance section. How this insurance applies when other insurance is available to the additional insured is described in the Other Insurance Condition in Section IV — Commercial General Liability Conditions, except as otherwise amended below. B. With respect to insurance provided to the person(s) or organization(s) that are additional insureds under this endorsement, the When You Add Others As An Additional Insured To This Insurance subparagraph, under the Other Insurance Condition of Section IV — Commercial General Liability Conditions is replaced with the following: When You Add Others As An Additional Insured To This Insurance (a) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract or written agreement that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in Paragraph (c) below. This insurance does not apply to other insurance to which the additional insured in the Schedule has been added as an additional insured. (b) Primary And Non- Contributory To Other Insurance When Required By Contract This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (i) The additional insured in the Schedule is a Named Insured under such other insurance; and (ii) You have agreed in a written contract or written agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured in the Schedule. (c) (Method Of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this approach, each insurer contributes equal amounts until it has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable limits of insurance of all insurers. All other terms and conditions in the policy remain unchanged. Page 2 of 2 Form HS 24 80 0713 rn Completed Certificate to: South County Regional Wastewater Authority, SCRWA ( "the Agency ") SECTION 00630 CERTIFICATE OF INSURANCE 7351 Rosanna Street Gilroy, CA 95020 Attn: Risk Manager This certifies to the Agency that the following described policies have been issued to the Insured named below and are in force at this time. Insured Myers & Sons Construction, L.P. Address 4600 Northgate Ste 100, Sacramento CA 95834 Description of operations/locations /products insured (show contract name and/or number, if any): POLICIES AND INSURERS Bodily LIMITS Property POLI EXPIRATION Injury Damage CY DATE Workers' Compensation Employers Liability I WNQU2064 03/01/2016 Property & Casualty Ins Co. of Hartford $ 1,000,000 (Name of Insurer) (Best's Rating) Check policy type: "Claims Made" _ _ Occurrence COMPREHENSIVE GENERAL Each Each LIABILITY , or Occurrence Occurrence 61CSEQU2061 03/01/2016 COMMERCIAL GENERAL $ $ 2,000,000 LIABILITY Aggregate Aggregate Property & Caualty Ins Co of Hartford $ $ 4,000,000 (Name of Insurer) or Combined Single Limit (Best's Rating) Aggregate$ BUSINESS AUTO POLICY Each Each Accident Liability Coverage Person Symbol 1 $ Hartford Fire Insurance Co. Each Accident 61UENQU2062 03/01/2016 r, om me . ngle Limit $ 2,000,000 UMBRELLA LIABILITY "Claims Made" _ _ Occurrence Nat'l Union Fire Ins of Pittsburgh (Name oflnsurer) Occurrence/Aggregate $ 25,000,000 BE 11215651 03/01/2016 (Best's Rating) Self- Insured Retention $ N/A 15 -PW -219 Plant Maintenance Projects CERTIFICATE OF INSURANCE PAGE 00630 - 1 The following coverage or conditions are in effect: Yes No The Agency, its officials, and employees are named on all liability policies described above as insureds as respects: (a) activities performed for the Agency by or on behalf of X the Named Insured, (b) products and completed operations of the Named Insured, and (c) premises owned, leased or used by the Named Insured. Products and Completed Operations X The undemigaed will mail to the Agency 30 days written notice of cancellation or x_1# X reduction of coverage or limits Cross Liability Clause (or equivalent wording) (per X Personal Injury, Perils A, B and C �,�R`�" X Broad Form Property Damage Vo X X, C, U& Hazards included X Contractual Liability Coverage applying to this Contract X Liquor Liability ���f ; f� X Coverage afforded the Agency, its officials, employees and volunteers as Insureds applies as primary and not excess or contributing to any insurance issued in the name of the X Agency �- Waiver of subrogation from Workers' Compensation Insurer X This certificate IS Issued as a matter of information. This certificate IS not an msurance policy and does not amend, extend or alter the coverage afforded by the policies listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance 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. Aon Risk 4e44ierrsJ1� • S �.c Agency or Brokerage SSSS San Falip,P StP 1500, Houston TX 77056 Address Ftta Mnrhlau, Sr_ Arrnunt Snarialist Name of Person to be Contacted Insurance C1tTsny A�Z�� Home Office Authorized Signature ;;� Date '� ?I" 832- 476 -561n Telephone No. Note: Authorized signatures may be the agent's if the ag has placed insurance through an agency agreement with the insurer. If insurance is brokere , authorized signature must be that of official of insurer. 15 -PW -219 CERTIFICATE OF INSURANCE Plant Maintenance Projects PAGE 00630 - 2 GENERAL LIABILITY ENDORSEMENT South County Regional Waste Authority ( "the Agency ") 7351 Rosanna Street Gilroy, CA 95020 Attn: Risk Manager A. POLICY INFORMATION Endorsement No. 1. Insurance Company Hartford Fire Insurance Company Policy No. 61 CSEOU2061 2. Policy Term (from) 03/01/2015 (to) 03/01/2016 3. Namedlnsured Myers & Sons Construction, L.P. 4. Address ofNamed Insured 4600 Northgate Ste 100, Sacramento CA 95834 5. Limit of Liability Any One Incident /Aggregate$. 2,000,000/4,000,000 6. Deductible or Self- Insured Retention: (Nil unless otherwise specified): $1,000 7. Coverage is equivalent: Comprehensive General Liability form GL0002 (Ed 1/73) Yes Comprehensive General Liability "occurrence" form CG0001 Yes Comprehensive General Liability "claims- made" form CG0002 N/A 8. Bodily Injury and Property Damage Coverage is: 4laifas- ate" - "occurrence" if claims -made, the retroactive date is: N/A NOTE: The Agency's standard insurance requirements specify "occurrence" coverage. "Claims- made" coverage requires special approval. B. POLICY AMENDMENTS This endorsement is issued in consideration of the policy premium. Notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any other endorsement attached thereto, it is agreed as follows: 1. INSURED. The Agency, its elected and appointed officers, officials, employees and volunteers are included as insureds with regards to damages and defense of claims arising from: (a) activities performed by or on behalf of the Named Insured, (b) products and completed operations of the Named Insured, or (c) premises owned, leased or used by the Named Insured. 2. CONTRIBUTION NOT REQUIRED. As respects: (a) work performed by the Named Insured for or on behalf of the Agency; or (b) products sold by the Named Insured to the Agency; or (c) premises leased by the Named Insured from the Agency, the insurance afforded by this policy shall be primary insurance as respects the Agency, its elected or appointed officers, officials, employees or volunteers; or stand in an unbroken chain of coverage excess of the Named Insureds scheduled underlying primary coverage. In either event, any other insurance maintained by the Agency, its elected or appointed officers, officials, employees and volunteers shall be in excess of this insurance and shall not contribute with it. 3. SCOPE OF COVERAGE. This coverage, if primary, affords coverage at least as broad as: (1) Insurance Services Office form number GL 002 (Ed. 1/73), Comprehensive General Liability Insurance and Insurance Services Office form number GL 0404 Broad Form comprehensive General Liability endorsement: or (2) Insurance Services Office Commercial General Liability Coverage, "occurrence" form CG 0001 or. "claims- made" form CG 0002; or (3) If excess, affords coverage which is at least as broad as the primary insurance forms referenced in the preceding sections (1) and (2). 15 -PW -219 Plant Maintenance Projects CERTIFICATE OF INSURANCE PAGE 00630 - 3 3. SEVERABILITY OF INTEREST. The insurance afforded by this policy applies separately to each insured who is seeking coverage or against whom a claim is made or a suit is brought, except with respects to the Company's limit of liability. 4. PROVISIONS REGARDING THE INSURED'S DUTIES AFTER ACCIDENT OR LOSS. Any failure to comply with reporting provisions of the policy shall not affect coverage provided to the Agency, its elected or appointed officers, officials, employees or volunteers. 5. CANCELLATION NOTICE. The insurance afforded by this policy shall not be suspended, voided, cancelled, reduced in coverage or in limits except after thirty (30) days prior written notice by certified mail return receipt requested has been given to the Agency. Such notice shall be addressed as shown in the heading of this endorsement. rdWFfk!Mu 51a WIN Me RNKRETWOolta \ ': 1 1 Incidents and claims are to be reported to the insurer at: ATTN: Robert Izlar Risk Control & Claims (Title) (Department) Aon Risk Solutions (Company) 2711 North Haskell Ave Ste 800 Dallas TX 75204 (Address) 214- 989 -2139 (Telephone) rolorrm,21 : lRat)0sel n5of- ,a$)manP5)RVA3112R0IWNIf.'f11 owvV►9O[I)aI :I I�f.`IIIC I, (print/type name), warrant that I have authority to bind the below listed insurance company and by my signature hereon do so bind this company. ORGANIZA ADDRESS 15 -PW -219 Plant Maintenance Projects SIGNATURE OF AUTHORIZED REPRESENTATIVE (original signature required on endorsement furnished to the Agency) 11111 TELEPHONE CERTIFICATE OF INSURANCE PAGE 00630 - 4 WORKER'S COMPENSATION /EMPLOYERS LIABILITY ENDORSEMENT South County Regional Wastewater Authority, SCRWA ( "the Agency ") 7351 Rosanna Street Gilroy, CA 95020 Attn: Risk Manager A. POLICY INFORMATION Endorsement # 1. Insurance Company: Property & Casualty Ins Co. of Hartford ( "the Company ") Policy Number: 61 W NO U 2 0 6 4 2. Effective Date of This Endorsement: 3. Named Insured:.Myers & Sons Construction, L.P. 4. Employer's Liability Limit (Coverage B):. $1,000,000 B. POLICY AMENDMENTS In consideration of the policy premium and notwithstanding any inconsistent statement in the policy to which this endorsement is attached or any other endorsement attached thereto, it is agreed as follows: 1. Cancellation Notice. The insurance afforded by this policy shall not be suspended, voided, cancelled, reduced in coverage or in limits except after thirty (30) days prior written notice by certified mail return receipt requested has been given to the Agency. Such notice shall be addressed as shown in the heading of this endorsement. 2. Waiver of Subrogation. The Insurance Company agrees to waive all rights of subrogation against the Agency, its elected or appointed officers, officials, agents and employees for losses paid under the terms of this policy which arise from work performed by the Named Insured for the Agency. C. SIGNATURE OF INSURER OR AUTHORIZED REPRESENTATIVE OF THE INSURER I, (print/type name), warrant that I have authority to bind the below listed insurance company and by my signature hereon do so bind this company. SIGNATURE OF AUTHORIZED REPRESENTATIVE (original signature required on endorsement furnished to the Agency) ORGANIZATION TITLE. ADDRESS TELEP 15 -PW -219 WORKERS' COMPENSATION INSURANCE CERTIFICATE Plant Maintenance Projects PAGE 00630 - 5 This page intentionally left blank. 15 -PW -219 WORKERS' COMPENSATION INSURANCE CERTIFICATE Plant Maintenance Projects PAGE 00630 - 6 Etta Marbley From: Brooks, Kimberly (Large Commercial) <Kim.Brooks @thehartford.com> Sent: Tuesday, March 31, 2015 2:02 PM To: Etta Marbley Cc: Roberge, Joshua (Operations); Flood, Roberta S (Middle Market + UW Support) Subject: RE: Sterling Construction/ BILLING CONTACT - Good afternoon Etta... Please come directly to me with any premium billing questions. The premiums will be billed to the insured, and I will be sure to copy you on my welcome email. Have a nice day. Thank you, Kim Brooks Sr Billing Analyst Specialty Construction The Hartford Financial Services Group, Inc. One Hartford Plaza I T -21 Hartford, Connecticut 06155 Direct: 860 - 547 -4371 Fax: 860 - 547 -5712 kim. brooks(cDthehartford.com Toll Free 1- 888 - 346 -3119 ext. 2203186 From: Roberge, Joshua (Operations) Sent: Tuesday, March 31, 2015 2:57 PM To: Brooks, Kimberly (Large Commercial) Subject: FW: Sterling Construction/ From: Etta Marbley [mailto:etta.marbleyl @ aon.com] Sent: Tuesday, March 31, 2015 2:55 PM To: Roberge, Joshua (Operations) Cc: Flood, Roberta S (Middle Market + UW Support) Subject: Sterling Construction/ Josh Would you please provide me with Hartford's invoice for the $550,000? Regards, Etta Marbley I Sr. Account Specialist Aon Risk Solutions I Aon Risk Solutions I Construction Services Group 5555 San Felipe, Suite 1500 1 Houston, Texas 77056 t +1.832.476.5630 1 f +1.800.953.4542 THE HARTFORD Business toman ee Employee Besets A&= Home etta.marblevla- aon.com I aon.com Aon Risk Services Southwest, Inc. I License #147299 This communication, including attachments, is for the exclusive use of addressee and may contain proprietary, confidential and /or privileged information. If you are not the intended recipient, any use, copying, disclosure, dissemination or distribution is strictly prohibited. If you are not the intended recipient, please notify the sender immediately by return e -mail, delete this communication and destroy all copies. .4COR0® CERTIFICATE OF LIABILITY INSURANCE DATE 181201DD /YVYY) 0411812013 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. 122517TH STREET, SUITE 2100 CONTACT NAME: PHONE No. Et : A/C No): E -MAIL ADDRESS: DENVER, CO 80202 -5534 INSURERS AFFORDING COVERAGE NAIL# INSURER A: Greenwich Insurance Company 22322 15114 - 12345 -5EX2P -13114 013427 INSURED OPERATIONS MANAGEMENT INTERNATIONAL INC. 9193 SOUTH JAMAICA STREET, SUITE 400 INSURER B: NIA NIA INSURER C : XL Specialty Insurance Co. 37885 INSURE D: NIA NIA ENGLEWOOD, CO 80112 -5946 INSURER E, 1,500,000 $ MED EXP(My one person) INSURER F: PERSONAL a ADV INJURY $ 1,500,000 COVERAGES CERTIFICATE NUMBER: SEA - 001981225 -39 REVISION NUMBER:8 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 rypE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF MWOD/YYYY ) POLICY EXP (MM/DDIYYYYI LIMITS Sharon A. Hammer /R ,. Gi -oV GENERAL LIABILITY X EACH OCCURRENCE $ 1,500,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR RGE500025502 0510112013 05101/2014 DAMAGE TO RENTED PREMISES Ea occurrence 1,500,000 $ MED EXP(My one person) $ PERSONAL a ADV INJURY $ 1,500,000 X $500,000 SIR GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS- COMP /OP ADS $ 5,000,000 POLICY PRO. LOG $ AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT Ea accident 2,000,000 X BODILY INJURY (Per person) $ A ANY AUTO RAD500025402 (ADS) 0510112013 0510112014 A ALL OWNED SCHEDULED AUTOS AUTOS RAD500025602(MA) 0510112013 0510112014 BODILY INJURY accitlent) $ PROPERTY DAMAGE Per accitlent $ HIRED AUTOS NON�OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS-MADE DED I I RETENTIONS $ WORKERS COMPENSATION X I STATU- OTH- C C AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNBR/EXECUnvE YIN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A RWD500025202(ADS) RWR500025302 (WI) 05/0112013 0510112013 0510112014 0510112014 TWO Y LIMITS ER R ER E.L. EACH ACCIDENT 1,000,000 $ EL. DISEASE- EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: GAVILAN COLLEGE PUMP STATION. THE CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES INCLUDE A WAIVER OF SUBROGATION. CERTIFICATE HOLDER CANCELLATION 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. Sharon A. Hammer /R ,. Gi -oV ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD ACUR" CERTIFICATE OF LIABILITY INSURANCE `�..,►�. DATE ( /2012 YYYY) 04118/2012 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). PRODUCER MARSH USA, INC. 122517TH STREET, SUITE 2100 CONTACT NAME: PHONE FAX -(A/C. No. E A/c No E -MAIL ADDRESS: DENVER, CO 80202 -5534 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Greenwich Insurance Company 22322 15114 - 00124 -GAWC -12/13 OMI INSURED OPERATIONS MANAGEMENT INTERNATIONAL INC. INSURER B: XL Specially Insurance Co. 37885 INSURER C: 9193 SOUTH JAMAICA STREET, SUITE 400 INSURER D: 05/01/2013 ENGLEWOOD, CO 80112 -5946 INSURER E: CLAIMS -MADE FXI OCCUR INSURER F: COVERAGES CERTIFICATE NUMBER: SEA - 001981225 -36 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 SUER POLICY NUMBER POLICY EFF MWDD/YYYY POLICY EXP % Y MM/DDYY LIMITS Sharon A. Hammer GENERAL LIABILITY X EACH OCCURRENCE $ 1,500,000 A X COMMERCIAL GENERAL LIABILITY RGE500025501 05/01/2012 05/01/2013 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,500,000 CLAIMS -MADE FXI OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,500,000 X $500,000 SIR GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 5,000,000 POLICY PRO LOC $ AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT Ea accident 2,000,000 X _ BODILY INJURY (Per person) $ A. ANY AUTO RAD500025401 (AOS) 05/01/2012 05/01/2013 A ALL OWNED SCHEDULED AUTOS AUTOS RAD500025601 (MA) 05/01/2012 05/01/2013 BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAR DED RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- B B AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE Y / N OFFICER /MEMBEREXCL.UDED? (Mandatory in NH) N/A RWD500025201 (AOS) RWR500025301 I �) 05/01/2012 05/01/2012 05/01/2013 05/01/2013 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE 1,000,000 $ It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 1 $ DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: GAVILAN COLLEGE PUMP STATION. THE CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES INCLUDE A WAIVER OF SUBROGATION. CERTIFICATE HOLDER CANCELLATION 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. Sharon A. Hammer ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AC<>Ra CERTIFICATE OF LIABILITY INSURANCE °04/22/201, ° "YY"' 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. 122517TH STREET, SUITE 2100 CONTACT NAME: PHONE FAX No): E -MAIL ADDRESS: DENVER, CO 80202 -5534 05/01/2011 PRODUCER 15114 -00124 -GAWC -11/12 OMI INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Greenwich Insurance Company 22322 OPERATIONS MANAGEMENT INTERNATIONAL INC. 9193 SOUTH JAMAICA STREET, SUITE 400 INSURER B : XL Specialty Insurance Co. INSURER C: GENERAL AGGREGATE ENGLEWOOD, CO 80112 -5946 INSURER D: PRODUCTS - COMP /OP AGG $ 5,000,000 INSURER E: $ A A INSURER F: LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X COVERAGES CERTIFICATE NUMBER: SEA -001637318 -34 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 SUBR POLICY NUMBER MM/DD/YYYY MM/ POLICY /YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE M OCCUR X $500,000 SIR X RGE5000255 05/01/2011 05/01/2012 EACH OCCURRENCE $ 1,500,000 DAMAGE T RENTED PREMISES Ea occurrence $ 1,500,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,500,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- IOC PRODUCTS - COMP /OP AGG $ 5,000,000 $ A A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS X RAD5000254 (ADS) RAD5000256 (MA) 05/01/2011 05101/2011 05/0112012 05/01/2012 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBEREXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A RWD5000252 (ADS) RWR5000253 WI ( ) 05/0112011 05101/2011 05/0112012 0510112012 X WC STATU• OTH- LIMIJ E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 1 7 1 F DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) RE: GAVILAN COLLEGE PUMP STATION. THE CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY POLICY BUT ONLY WITH RESPECT TO LIABILITY ARISING OUT OF THE NAMED INSUREDS ONGOING OPERATIONS PERFORMED FOR THAT ADDITIONAL INSURED. THE CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED ON THE AUTOMOBILE LIABILITY AS REQUIRED BY CONTRACT OR AGREEMENT. GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES INCLUDE A WAIVER OF SUBROGATION. CITY OF GILROY 7351ROSANNA 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. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Sharon A. Hammer <2_l1q_,.,. ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ACOREP CERTIFICATE OF LIABILITY INSURANCE DATE /2014 ,YYYY) o4/2v2o1a 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 terns 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. 122517TH STREET, SUITE' 1300 CONTACT NAME` PHONE FA//C No): E -MAIL ADDRESS: DENVER, CO 80202 -5534 INSURER(S) AFFORDING COVERAGE NAIC q INSURER A: Greenwich Insurance Company 22322 15114 - 12345 -5EX2P -14115 013428 CA INSURED OPERATIONS MANAGEMENT INTERNATIONAL INC. 9193 SOUTH JAMAICA STREET, SUITE 400 INSURER 8: Na60nal Union Fife Ins Co Pittsburgh PA 19445 INSURER C XL Insurance America, Inc. 24554 INSURER D: WA NIA ENGLEWOOD, CO 80112 -5946 INSURER E: $ 1,500,000 INSURER F: CLAIMS -MADE FTI OCCUR COVERAGES CERTIFICATE NUMBER: SEA - 002058949 -38 REVISION NUMBER:8 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. TYPE OF INSURANCE L R POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DD OMITS GENERAL LIABILITY X EACH OCCURRENCE $ 1,500.000 rA X COMMERCIAL GENERAL LIABILITY RGE500025503 05/01/2014 05/01/2015 DAMAGE TO RENTE15- a occurrence PREMISES $ 1,500,000 CLAIMS -MADE FTI OCCUR MED EXP (Any one person) $ X. $500,000 SIR PERSONAL & ADV INJURY $ 1;500,000 GENERAL AGGREGATE $ 5,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 5,000,0.00 POLICY PRO LOC $ AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT Ea accident 2,000,000 X BODILY INJURY (Per person) $ A ANY AUTO RAD500025403 (AOS) 05/01/2014 05/0112015 A ALL OWNED SCHEDULED AUTOS AUTOS . RAD500025603 (MA) 05/0112014 05/0112015 BODILY INJURY (Per accident)L $ PROPERTY DAMAGE Per accident $ HIRED AUTOS NON -OWNED AUTOS $, X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 B EXCESS LIAR CLAIMS -MADE BE 31131547 05/01/2014 05/01/2015 DED_ _ _' . RETENTION $ $ WORKERS COMPENSATION X I WC STATU- 0TH- C C AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE' Y / N OFFICER/MEMBER EXCLUDE N (Mandatory in NH) NIA RWD500025203 (AOS) RWR500025303(WI) 05/0172014 05/01/2014 05/01/2015 05/01/2015 I413) ER E.L. EACH ACCIDENT 1,000,000 E.L. DISEASE - EA EMPLOYE , $ 1,000,000 f yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional. Remarks Schedule, If more space Is required) RE: OPERATION, MAINTENANCE AND MANAGEMENT SERVICES FOR THE SOUTH COUNTY REGIONAL WASTEWATER AUTHORITY. THE CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. SOUTH COUNTY REGIONAL WASTEWATER AUTHORITY 7351 ROSANNA STREET GILROY, CA 95020 u @1�J 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 of Marsh USA Inc. Sharon A. Hammer <2/0qe_-_ a_C;0VCx ,'F_c__;' All rights reserved. ACORD 25 (201.0/05) The ACORD name and logo are registered marks of ACORD