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West Coast Code Consultants - Insurance CertificateS ACo!� ®® CERTIFICATE OF LIABILITY INSURANCE DATE(MMDD/YYY1� 4/27/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Dealey, Renton & Associates 199 S Los Robles Ave Ste 540 Pasadena, CA 91101 'NAMME: AE: Marie Swaney PHONE 626 844 -3070 FAX E-MAIL -ADn . m_swaney @dealeyrenton.com INSURERS AFFORDING COVERAGE NAIC # Lic #0020739 INSURER A: Hartford Accident & Indemnity 22357 4/28/2016 INSURED WESTCOAST5 INSURER B : Hartford Fire Ins. Co. 119682 INSURER C: Continental Casualty Company 20443 West Coast Code Consultants, Inc. 2400 Camino Ramon, Ste. 240 San Ramon, CA 94583 INSURER D :Trumbull Insurance Company 27120 925 - 275 -1700 INSURER E X INSURER F $10,000 COVERAGES CERTIFICATE NUMBER: 946599936 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. ILTR TYPE OF INSURANCE INSD WVD POLICY NUMBER I MM DDY e� MMIDD EXP LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y 57SBARI7696 4/28/2016 4/2812017 EACH OCCURRENCE $2,000,000 CLAIMS -MADE � OCCUR RENTED PREM SES Ea occurrence $1,000,000 X MED EXP (Any one person) $10,000 Contractual Liab PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 PRODUCTS - COMPIOP AGG $4,000,000 POLICY ❑ JECOT- F—] LOC Is OTHER: D AUTOMOBILE LIABILITY Y 57UEGZM2523 4/28/2016 4/28/2017 Ea accident $1,000,000 ANY AUTO X BODILY INJURY (Per person) $ AUTOS NED AUTOSULED HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ %< PROPERTY DAMAGE Per accident $ I Is B X UMBRELLA LIAB X OCCUR Y Y 57SBARI7696 4/28/2016 4/28/2017 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $10,000 $ A WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIErORIPARTNERIEXECUTIVE Y /❑ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA Y 57WEGKU8419 4/28/2016 4/28/2017 STATUTE ERH E.L. EACH ACCIDENT XI $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 FE . DISEASE - POLICY LIMIT 1 $1,000,000 H -yes, describe under DESCRIPTION OFDPERATIONSbelow. C Professional Liability Claims Made Form MCH591900192 4/28/2016 4/28/2017 $1,000,000 per claim $2,000,000 Annual Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Umbrella Policy is follow form to underlying GL/AUTO /Employers Liability Policies City of Gilroy its officers, employees, councils and employees are named as an additional insured as respects general & auto liability for claims arising from the operations of the named insured as required per written contract or agreement, per the Blanket Business Liability Coverage Policy Form SSOO 08 04 05, attached CERTIFICATE HOLDER CANCELLAIIUN oU Udy IVtJU/ IV Udy tvr INUHr-dy VI r-rt:m City of Gilroy 7351 Rosanna Gilroy CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE- EXPIRATION DATE THEREOF, NOTICE -WILL - BE- -DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WORKERS' COMPENSATION BROAD FORM ENDORSEMENT EXTENDED OPTIONS Policy Number: 57 WEG KU84.19 Endorsement Number: Effective Date: 04/28/16 Effective hour is the same as. stated on the Information Page of the policy. Named Insured and Address: WEST COAST CODE CONSULTANTS 2400 CAMINO RAMON ,STE 240 SAN RAMON CA 94583 Section I of this endorsement expands coverage provided under WC 00 00 00: Section ll of this endorsement jprovides additional coverage usually only provided by endorsement. Section .Ill of this endorsement is a Schedule of Covered States. You may use the index to locate :these coverage features quickly: - SUBJECT PAGE' SECTION I 2_ PARTS ONE and TWO 2 91 We "Will Also Pay 2 PART - THREE 2 02 'How This Insurance Works 2 PART - SIX 2 03 Transfer of Your Rights and Duties 2 04 .Liberalization 2 SECTION :11 2 VOLUNTARY COMPENSATION INSURANCE, 2 05 'Voluntary Compensation Insurance 5 A. ' How This Insurance .Applies 2 B. We Will Pay 2 C. Exclusions 3 D. 'Before We Pay 3 E. .Recovery From Others 3 F. Employers' 'Liability Insurance 3' EMPLOYERS' LIABILITY STOP GAP 3 ENDORSEMENT 3 .06 'iEmployers' Liability Stop Gap Coverage 3 A: Stop Gap Coverage Limited to Montana, North Dakota, Ohio, 3 Washington, West Virginia and Wyoming Form WC 99 03,03 ,6 Printed in U.S.A..(Ed..8100) .Process Date: 03:/12./16 SUBJECT PAGE B. Part One Does Not Apply 3' C. Application of Coverage 3 D. Additional Exclusions 3 E. West Virginia 3 EXTENDED OPTIONS' 4 01 Employers' .Liability Insurance 4 02 Unintentional Failure to Disclose 4 Hazards 03 Waiver of Our Right to Recover from 4 Others 04 Foreign Voluntary' Compensation 4 A.., How This Reimbursement Applies 4 B. We Will Reimburse 4 C. Exclusions D. Before We Pay 5 E. Recovery From Others 5 - F. Reimbursement For Actual Loss' 5 Sustained - G. Repatriation 5 H. Endemic Disease 5 05 Longshore and Harbor Workers' 5 Compensation Act Coverage Endorsement 'SECTION 111 6 01 Schedule of Covered States 6 Page 1 of 6 PolicyExpiration'Date: 04,,/,28/17 Z'2000, The':Hartford SECTION I PARTS ONE and TWO PART THREE 1. WE WILL ALSO PAY 2. How This Insurance Applies D. We Will Also Pay of 'Part One (WORKERS' Paragraph 4. of A. How This Insurance Applies COMPENSATION INSURANCE); and of Part 3 (Other States Insurance) is .replaced by the following: E. We Will Also Pay of Part Two (EMPLOYERS' LIABILITY ,INSURANCE) is replaced by the 4. If you have work on the effective date of this following: policy in any state not listed in Item 3.A. of the Information Page„ coverage will not be We Will Also Pay afforded for that state unless we are notified We will also pay these costs; in addition to within sixty days. other amounts payable under this insurance, as part; of any claim, proceeding, or suit we PARTS D( defend: 3. Transfer Of Your Rights and Duties 1. reasonable expenses incurred at our C. Transfer Of YourRights and Duties of Part 6 request, INCLUDING oss of earnings; (Conditions) is replaced by the following; 2.- for bonds to release attachments and for'appeal bonds in bond Your rights or duties under this ,policy may not amounts up to the limit of our liability, be transferred without our written consent: under this 'insurance; If you die and we receive notice within :sixty . 3. litigation: costs taxed against you; days after your death, we will cover your legal representative as insured. 4. interest on a judgment as required by 'law until we offer the amount due under this 4. Liberalization law; and If we adopt a change in this form that would 5. expenses we incur. broaden the coverage of this form without, extra . charge, the broader coverage will apply to this policy. It will apply when the change becomes.. effective in your "state. SECTION II VOLUNTARY' COMPENSATION AND EMPLOYERS' LIABILITY COVERAGE 5. Voluntary Compensation Insurance A. How This Insurance Applies This . insurance applies to bodily injury by accident or bodily injury by disease. Bodily injury 'includes resulting death. 1. The bodily injury must be sustained by any officer or employee not subject to the workers' compensation law of any state shown in Item 3.A. of the Information Page. 2; The bodily injury must arise out of and in the course of employment or incidental to work in a state shown in Item 3.A. of the Information Page. Form WC 99 03 03 B Printed in U.S.A. (Ed. 8 /00) 3. The !bodily injury ;must occur, in the "United States of America, its territories or - possessions, or Canada, and may occur elsewhere if the employee is a :United 'States or Canadian citizen, or otherwise' legal resident, and legally employed, 'in the United States or Canada' and temporarily away from those places: 4. Bodily injury by accident must occur during the policy .period. 5. Bodily :injury by disease :must ;be caused or aggravated by the conditions of the Page:2of 6 officer's or employee's employment. The officer's or employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. B. We Will Pay pay q its We will a an amount equal to the benefits that would be required of you as if you and your employees were subject to the workers' compensation law of any state shown in Item 3.A. of the Information Page. We will ,pay . those amounts to the persons who would be entitled to them under the law. C. Exclusion This :insurance does not cover: 1. any obligation imposed by workers' compensation or occupational disease law or any similar law. 2. bodily injury intentionally caused or aggravated by you. 3. officers or employees who have elected not to be subject to the state workers' compensation law. 4. partners or sole proprietors not covered under the Standard:" Sole Proprietors, Partners, Officers and Others Coverage Endorsement. D. 13ef6re We Pay. Before we pay benefits to the persons entitled to them, they must: 1: Release you and ius,. in writing, of all responsibility for the injury or death. 2. Transfer to us their right to recover from others who may ,be responsible for the injury or death, 3. Cooperate with us and do .everything - necessary to, enable us to enforce the right to. recover from others. If the persons entitled to the benefits of this insurance. fail: do those things, our duty to pay ends at once. if they -claim damages from you orfrom us for the injury or death, our duty 'to pay ends at once. E. ,:Recovery From Others If we :make a recovery from others, we will keep an amount equal to our expenses of recovery and the :benefits we :paid. We will pay the balance. to the persons entitled to it. Form'.WC°9903M.13 :Printed in ;U.S.A. (Ed. .8/00.) If the persons entitled to the benefits of this insurance make a recovery from others, they must reimburse us for the benefits We paid them. F. Employers' Liability Insurance Part Two (Employers' Liability Insurance) applies to bodily injury- covered by this endorsement as though the State of Employment was shown in Item. 3.A. of the Information Page. This. provision 5. does not apply in New - Jersey or Wisconsin. EMPLOYERS' LIABILITY STOP GAP COVERAGE 6. Employers' Liability Stop Gap Coverage. A. This coverage only ,applies . in Montana,' North Dakota, Ohio, Washington, West Virginia and Wyoming. B. Part One (Workers' , Compensation Insurance) , does not apply tor work in states shown in.. Paragraph A above. C. Part Two (Employers' Liability - Insurance) applies in the states, shown in Paragraph A., as though they were shown in Item 3.A. of the Information Page. D. Part Two, 'Section C. Exclusions is changed by adding these exclusions. This insurance does not cover; 5. bodily injury intentionally 'caused or aggravated by you or in Ohio bodily injury resulting from an act which is determined by an Ohio court , of law to have been - committed by you with the 'belief than an injury I its substantially 'certain to occur.. However, the cost, of defending„ such claims or suits din Ohio is covered. 13. , bodily injury: sustained' by any member of the flying crew of any aircraft. 14. an claim for bodily y injury With respect to which you are deprived of any defense or defenses or are otherwise subject , to penalty because of default in ',premium under the provisions of the workers' compensation law or Taws of a state shown in Paragraph A; E. This insurance- applies to damages for which you are liable under West Virginia Code Annot. 8.2344 2. EXTENDED OPTIONS 1. Employers' Liability Insurance Item 3.13. of the Information Page is replaced by the following: B. Employers' Liability insurance: 1. Part Two of the policy applies to work in each state listed in Item 3.A. The Limits of Liability under Part . Two are the higher of: Bodily. Injury, by Accident $500,000 Each Accident _. Bodily Injury. . by Disease $500,000 Policy Limit Bodily Injury by Disease __$500,000 Each Employee_ OR. 2 The. amount shown in the Information Page. This ,provision 11 of EXTENDED OPTIONS does not apply in New York, because,, the Limits Of Our. Liability are unlimited. In this provision the limits are changed from $500,000 to $1,000,000 in California. 2. Unintentional Failure to Disclose Hazards If you; unintentionally should fail to disclose. all existing hazards at the inception date of your policy;- We shall not deny coverage under. this : - pohpy because of such failure. 3. ` Waiver of Our Right To Recover From Others A. 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 any person or organization for whom you perform . work under a written contract that requires you to obtain this agreement from US. This agreement shall not operate directly or .indirectly to benefit anyone not ,named in the agreement. B. This provision 3. does not apply in the states of Pennsylvania. and Utah., Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) 4. Foreign Voluntary Compensation and Employers' Liability Reimbursement A. How This Reimbursement Applies This reimbursement provision applies to bodily injury by accident or bodily injury by disease. , Bodily injury includes resulting death. 1. The bodily injury must be sustained by an officer or employee. 2. The bodily injury must occur in the course of employment necessary or incidental to work in a country not listed in Exclusion C.1. of this provision. 3; Bodily injury by accident must occur during the policy period. 4. Bodily injury by disease must 'be caused or aggravated by the conditions of your employment. The officer' or employee's last exposure to those conditions of your employment must occur during the policy period. B. We Will'Reimburse We will reimburse you for all amounts paid by you whether such amounts are: 1.. voluntary payments for the benefits that would be required of,;you if you and, Your officers or employees were subject to any workers' compensation law of the state of hire of the individual employee. 2. sums to which Part Two (Employers' Liability 'Insurance) would apply if the Country of Employment were . shown in Item 3.A. of the Information Page.. C. Exclusions This insurance does not cover: 1. any occurrences in the 'United States,: .. Canada, and any country or juiisdiction which is the subject of trade or economic sanctions imposed by the laws or regulations of the United States Hof. America in effect as of the inception date of this policy. 2. any obligation imposed by a. workers' compensation or occupational disease law, or similar law. 3. . bodily injury intentionally caused or aggravated by you. Page 4 of 6 4. liability for any consequence, whether of America necessarily incurred as a direct direct or indirect, of war, invasion, act of result of bodily injury. Foreign enemy, hostilities (whether war be Our reimbursement shall be limited as follows: declared or not), civil war, rebellion, revolution, insurrection or military or 1. to the amount by which such expenses usurped power. No endorsement now or exceed the normal cost of returning the subsequently attached to this policy shall officer or employee if in good health,: or be construed as overriding or waiving this 2. in the event of death, to the amount by limitation . unless. specific reference is which such expenses exceed the normal' made thereto. cost of returning the officer or employee if D. Before We Pay alive and in good health. Before we reimburse you for the benefits to the In no event shall our reimbursement exceed persons entitled to them, you must have them: the bodily injury by accident limit shown in Item 33. of the Information Page as respects 1. release. , you and us, in writing, of all any one such officer or employee whether responsibility for the injury or death, dead or alive. 2. transfer to us their right to recover from H. Endemic Disease others who may be responsible for their injury or.de.ath, The word "disease" 'includes any endemic diseases. 3. cooperate with - us and do everything necessary to enable us to enforce the right The coverage applies as if endemic diseases to recover from others. were included in the provisions of the workers' compensation law. If the persons entitled to the benefits paid fall to do these things, our duty to reimburse ends 5. Longshore and Harbor Workers' Compensation at once. If they claim damages from us for the Act Coverage injury or death, our duty to reimburse ends at General Section C. Workers' Compensation once. Law is replaced by the following: E. Recovery From Others C. Workers' Compensation Law If we make a recovery from others, we will Workers' Compensation Law means the keep an amount equal' to our expenses of workers or workers', compensation law and recovery and the benefits we reimbursed. We occupational disease law of each state or will pay the balance to the persons entitled to territory named in Item 3.A. of the Information it. If ,persons entitled to the benefits make a Page and the Longshore and 'Harbor'Workers' recovery from others, they must repay us for Compensation Act (33 USC Sections 901 - the amounts that we have :reimbursed you. 950). It i'ncl'udes any amendments to' those 'F. Reimbursement for.Actual'Loss Sustained laws that are in effect during the policy period. It does not include any oth "er federal 'workers This endorsement provides only for `'tile Pr workers' compensation. , law, other. federal reimbursement for loss you actually occupational disease law or the provisions of sustain. 1n" order for you to 'recover loss or any law that provide nonoccul5ational disability expenses under this reimbursement you must: benefits. 1. actually sustain and pay the loss or Part Two (Employers' Liability Insurance),. C. expense in money after trial, or Exclusions, exclusion 8, does not apply to 2. secure our consent for the payment of the work subject to the Longshore and Harbor loss or expense. Workers' Compensation Act. G. Repatriation This coverage does not apply to work subject Our reimbursement includes the additional to the,. Defense Base .Act, ., 't_he Outer expenses of repatriation to the United States Continental'. Shelf. Lands­ _Act, _ - or....._ the_ Nonappropriated Fund Instrumentalities Act. Form 'WC 99 03 03 B <Printed in U.S.A. (Ed. 8 /00) Page 5 of 6 A . SECTION III 1. SCHEDULE OF COVERED STATES B. If ,a state, shown in Item 3.A. of the Information A. This endorsement only applies in the states Page, approves this endorsement after the listed in this Schedule of Covered States. effective date of this policy, this endorsement will apply to this policy. The coverage will apply in the new state on the effective date of the state approval. C. Schedule of Covered States: CA Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Pagel of 6 1 West Coast Code Consultants, Inc. EXCERPTS FROM: Hartford Form SS 00 08 04 05 BUSINESS LIABILITY COVERAGE FORM C. WHO IS AN INSURED 6. Additional Insureds When Required By Written Contract, Written Agreement Or Permit The person(s) or organization(s) identified in Paragraphs a. through f. below are additional insureds when you have agreed, in a written contract, written agreement or because of a permit issued by a state or political subdivision, that such person or organization be added as an additional insured on your policy, provided the injury or damage occurs subsequent to the execution of the contract or agreement, or the. issuance of the permit. A person or. organization is an additional insured under this provision only for that period of time required by the contract, agreement or permit. f Any Other Party (1) 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 r whole or in part. by your acts or omissions or the acts or omissions of those acting on yourbehalf: (a) :In the performance of your ongoing operations; (b) In connection with your premises owned by or rented to you; or (c) In connection with "your work" and included within the " products - completed operations hazard, but`only if (i) The written contract or written agreement requires you to provide such coverage to such additional insured; and (ii) This Coverage Part provides coverage for "bodily injury" or "property damage" included within the ` ;products - completed operations hazard. (2) With respect to the insurance afforded to these additional insureds, 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: inspection, or engineering E.S. Separation of Insureds Expt with respect to the Limits of Insurance, and any rights or duties specifically assigned in this "policy to the first Named Insured, this insurance applies: a. As if each. Named Insured were the only Named Insured: and b. Separately to each insured against whom a claim is made or "suit" is brought. ( I (b) ry ry en.Required By ' Contract b .Prima And Non- Contributo To Other Insurance Wh If you have agreed in a written contract, written agreement or permit that this insurance:is, primary and non - contributory with the additional'insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. E.8.1b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organ ization;forall or part. of any payment, including Supplementary'Payments, we have made under this Coverage Part, we also waive that right. provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. EXCERPT FROM Hartford Form SS 04 38 06 01 HIRED: AUTO AND NOWOWNED AUTO B. With.respect to the operation of a "non- owned auto ". WHO IS AN. INSURED is re,Placed'bythe following: The following are "insureds'; d. Anyone liabile for the conduct of an "insured ", but only to the extent of that liability. Ac ®eeo® CERTIFICATE OF LIABILITY INSURANCE �... - -. 1/2015 (MMIDDNYM 4/2DATE 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 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 Dealey, Renton & Associates CONTACT M NAME arie Swaney PHONE FAX 1.99 S Los Robles Ave Ste 540 Pasadena, CA 91101 E-MAIL ADDRESS. mswaney @dealeyrenton.com INSURERS AFFORDING COVERAGE NAIC # Lic #0020739 INSURER A: Hartford Accident & Indemnity 22357 /28/2016 INSURED WESTCOAST5 INSURERB:Hartford Fire Ins. Co. 19682 INSURER C: Hiscox Insurance Company 10200 West Coast Code Consultants, Inc.; dba: Kimball Eng; dba: Eagle Eye Consulting Eng 2400 Camino Ramon, Ste. 240 INSURER D DAMAGE TO RENT-Eff- PREMISES Ea occurrence San Ramon, CA.94583 INSURER E: MED EXP Any one person) INSURER F: 925-275 -1700 r_nVFRAC.FC f_FRTIFICATF NIIMRFR• 617755335 RFVISIAN NIIMRFR- 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 JNSD WVD POLICY NUMBER POLICY EFF MM/DD . POLICY EXP MM/DD LIMITS B x COMMERCIAL GENERAL LIABILITY Y Y 57SBAIC7265 /19/2015 /28/2016 EACH OCCURRENCE $2,000,000 CLAIMS -MADE Fx� OCCUR DAMAGE TO RENT-Eff- PREMISES Ea occurrence $1,000,000_ X MED EXP Any one person) $10,000 0 PERSONAL & ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY PRO - JECT LOC PRODUCTS - COMP /OP AGG $4,000,000 $ OTHER: B AUTOMOBILE LIABILITY y 57UEGZC5464 /2312015 /28/2016 B N IN 'L Li, I (E, cc $ ,000,000 BODILY INJURY (Per person) _ $ X ANY AUTO AUTOSNED SCHEDULED BODILY INJURY (Per accident) $ HIRED AUTOS X NON -OWNED AUTOS PROPER DAMAGE Per accident $ B X I UMBRELLA LIAB X OCCUR Y Y 57SBAIC7265 /19/2015 /28/2016 EACH OCCURRENCE $3,000,000 AGGREGATE $3,000,000 EXCESS LIAB CLAIMS -MADE DED X I RETENTION $10,000 $ A WORKERSCOMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE Y 57WEGKU8419 /28/2015 /28/2016 X STATUTE ER E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L. DISEASE - EA EMPLOYEd $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $1,000,000 C Professional Liability Claims Made Form ANE109990915 /28/2015 /28/2016 $1,000,000 per claim $2,000,000 Annual Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached II more space Is required) General Liability policy excludes claims arising out of the performance of professional services. City of Gilroy its officers, employees, councils and employees are named as an additional insured as respects general & auto liability for claims arising from the operations of the named insured as required per contract or agreement, per the Business Liability Coverage Policy Form SS0008, attached CERTIFICATE HOLDER CANCELLATION ou uav NUL;IIU uav Tor Nonrav or rrem City of Gilroy 7351 Rosanna Gilroy CA 95020 ACORD 25 (2014101) 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 ©1 The ACORD name and logo are registered marks of ACORD reserved. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WORKERS' COMPENSATION BROAD FORM ENDORSEMENT EXTENDED OPTIONS Policy Number: 57WEGKU8419 Effective hour is the same as stated on the Information Page of the policy. Named Insured and Address: West Coast Code Consultants, Inc dba :.Kimball Engineering dba: Eagle Eye Consulting Engineering 2400 Camino Ramon, Ste. 240 San Ramon, CA 94583 Section I of this endorsement expands coverage provided under WC 00 00 00. Section II of this endorsement provides additional coverage usually only provided by endorsement. Section III of this endorsement is a Schedule of Covered States. You may use the index to locate these coverage features quickly: INDEX SUBJECT PAGE SUBJECT PAGE SECTION 1 2 B. Part One Does Not Apply 3 PARTS ONE and TWO 2 C. Application of Coverage 3 01 We Will Also Pay 2 D. Additional Exclusions 3 PART - THREE 2 E. West Virginia 3 02 How This Insurance Works 2 EXTENDED OPTIONS 4 PART - SIX 2 01 Employers' Liability Insurance 4 03 Transfer of Your Rights and Duties 2 02 Unintentional Failure to Disclose 4 04 Liberalization 2 Hazards SECTION II 2 03 Waiver of Our Right to Recover from 4 VOLUNTARY COMPENSATION 2 Others INSURANCE 04 Foreign Voluntary Compensation 4 05 Voluntary Compensation Insurance 2 A. Now This Reimbursement Applies 4 A. How This Insurance Applies 2 B. We Will Reimburse 4 B. We Will Pay 3 C. Exclusions 4 C. Exclusions 3 D. Before We Pay 5 D. Before We Pay 3 E. Recovery From Others 5 E. Recovery From Others 3 F. Reimbursement For Actual Loss 5 F. Employers' Liability Insurance 3 Sustained EMPLOYERS' LIABILITY STOP GAP 3 G. Repatriation 5 ENDORSEMENT H. Endemic Disease 5 06 Employers' Liability Stop Gap 3 05 Longshore and Harbor Workers' 5 Coverage Compensation Act Coverage A. Stop Gap Coverage Limited to 3 Endorsement Montana, North Dakota, Ohio, SECTION III 6 Washington, West Virginia and 01 Schedule of Covered States 6 Wyoming Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Page 1 of 6 0 2000, The Hartford SECTION I PARTS ONE and TWO PART THREE 1. WE WILL ALSO PAY 2. How This Insurance Applies D. We Will Also Pay of Part One (WORKERS' Paragraph 4. of A. How This Insurance COMPENSATION INSURANCE); and Applies of Part 3 (Other States Insurance) is replaced by the following: E. We Will Also Pay of Part Two (EMPLOYERS' LIABILITY INSURANCE) is 4. If you have work on the effective date of this replaced by the following: policy in any state not listed in Item 3.A. of the Information Page, coverage will not be We Will Also Pa Y afforded for that state unless we are notified We will also pay these costs, in addition to within sixty days. other amounts payable under this insurance, as part of any claim, proceeding, or suit we PART SIX defend: 3. Transfer Of Your Rights and Duties 1. reasonable expenses incurred at our request, INCLUDING loss of earnings; C. Transfer Of Your Rights and Duties of Part 6 (Conditions) is replaced by the 2. premiums for bonds to release P following: attachments and for appeal bonds in bond amounts up to the limit of our Your rights or duties under this policy may liability under this insurance; not be transferred without our written consent. 3. litigation costs taxed against you; If you die and we receive. notice within sixty 4. interest on a judgment as required by after your death, we will cover your days a law until we offer the amount due under legal representative as insured. this law; and 4. Liberalization 5. expenses we incur. If we adopt a change in this form that would broaden the coverage of this form without extra charge, the broader coverage will apply to this policy. It will apply when the change becomes effective in your state. SECTION II VOLUNTARY COMPENSATION AND 3. The bodily injury must occur in the EMPLOYERS' LIABILITY COVERAGE United States of America, its territories S. Voluntary Compensation Insurance or possessions, or Canada, and may occur elsewhere if the employee is a A. How This Insurance Applies United States or Canadian citizen, or This insurance applies to bodily injury by otherwise legal resident, and legally accident or bodily injury by disease. Bodily employed, in the United States or injury includes resulting death. Canada and temporarily away from 1. The bodily injury must be sustained by those places. any officer or employee not subject to 4. Bodily injury by accident must occur the workers' compensation law of any during the policy period. state shown in Item 3.A. of the 5. Bodily injury by disease must be caused Information Page. or aggravated by the conditions of the 2. The bodily injury must arise out of and in the course of employment or incidental to work in a state shown in Item 3.A_ of the Information Page. Form WC 99 03 03 B Printed in U.S.A. (Ed. 8 /00) Page 2 of 6 officer's or employee's employment. The officer's or employee's last day of last exposure to the conditions causing or aggravating such bodily injury by disease must occur during the policy period. B. We Will Pay We will pay an amount equal to the benefits that would be required of you as if you and your employees were subject to the workers' compensation law of any state shown in Item 3.A. of the Information Page. We will pay those amounts to the persons who would be entitled to them under the law. C. Exclusion This insurance does not cover 1. any obligation imposed by workers' compensation or occupational disease law or any similar law. 2. bodily injury intentionally caused or aggravated by you. 3. officers or employees who have elected not to be subject to the state workers' compensation law. 4. partners or sole proprietors not covered under the Standard Sole Proprietors, Partners, Officers and Others Coverage Endorsement. D. Before We Pay Before we pay benefits to the persons entitled to them, they must: 1. Release you and us, in writing, of all responsibility for the injury or death. 2. Transfer to us their right to recover from others who may be responsible for the injury or death. 3. Cooperate with ,us and do _everything necessary to enable us to enforce the right to recover from others. If the persons entitled to the benefits of this insurance fail to do those things, our duty to pay ends at once. If they claim damages from you or from us for the injury or death, our duty to pay ends at once. E. Recovery From Others If we make a recovery from others, we will keep an amount equal to our expenses of recovery and the benefits we paid. We will pay the balance to the persons entitled to it. If the persons entitled to the benefits of this insurance make a recovery from others, they must reimburse us for the benefits we paid them. F. Employers' Liability Insurance Part Two (Employers' Liability Insurance) applies to bodily injury covered by this endorsement as though the State of Employment was shown in Item 3.A. of the Information Page. This provision 5. does not apply in New Jersey or Wisconsin. EMPLOYERS' LIABILITY STOP GAP COVERAGE 6. Employers' Liability Stop Gap Coverage A. This coverage only applies in Montana, North Dakota, Ohio, Washington, West Virginia and Wyoming. B. Part One (Workers' Compensation Insurance) does not apply to work in states shown in Paragraph A above. C. Part Two (Employers' Liability Insurance) applies in the states, shown in Paragraph A., as though they were shown in Item 3.A. of the Information Page. D. Part Two, Section C. Exclusions is changed by adding these exclusions. This insurance does not cover; 5. bodily injury intentionally caused or aggravated by you or in Ohio bodily injury resulting from an act which is determined by an Ohio court of law to have been committed by you with the belief than an injury is substantially certain to occur. However, the cost of defending such claims or suits in Ohio is covered. 13. bodily injury sustained by any member of the flying crew of any aircraft: 14. any claim for bodily injury with respect to which you are deprived of any defense or defenses or are otherwise subject to penalty because of default in premium under the provisions of the workers' compensation law or laws of a state shown in Paragraph A. E. This insurance applies to damages for which you are liable under West Virginia Code Annot. S 23 -4 -2. Form WC 99 03 03 B Printed in U.S.A. (Ed. 8 /00) Page 3 of 6 EXTENDED OPTIONS 1. Employers' Liability Insurance This reimbursement provision applies to Item 3.B. of the Information Page is replaced bodily injury by accident or bodily injury by by the following: disease. Bodily injury includes resulting death. B. Employers' Liability Insurance: 1. The bodily injury must be sustained by 1. Part Two of the policy applies to work in an officer or employee. each state listed in Item 3.A. 2. The bodily injury must occur in the course of employment necessary or The Limits of Liability under Part Two incidental to work in a country not listed are the higher of: in Exclusion C.1. of this provision. 3. Bodily injury by accident must occur Bodily Injury during the policy period. by Accident $500,000 Each Accident 4. Bodily injury by disease must be caused or aggravated by the conditions of your Bodily Injury y 1 ry employment. The officer or employee's by Disease $500,000 Policy Limit last exposure to those conditions of your employment must occur during the Bodily Injury policy period. by Disease $500,000 Each Employee B. We Will Reimburse OR We will reimburse you for all amounts paid by you whether such amounts are: 2. The amount shown in the Information 1. voluntary payments for the benefits that Page. would be required of you if you and your This provision 1 of EXTENDED OPTIONS does officers or employees were subject to workers' compensation law of the not apply New York because the Limits Of Our state of hire of the individual employee. Liability are unlimited. In this provision the limits are changed from 2• sums to which Part Two {Employers' Liability Insurance). would apply if the $500,000 to $1,000,000 in California. Country of Employment were shown in 2. Unintentional Failure to Disclose Hazards Item 3.A. of the Information Page. If you unintentionally should fail to disclose all C. Exclusions existing hazards at the inception date of your This insurance does not cover: policy, we shall not deny coverage under this policy because of such failure. 1. any occurrences in the United States, 3. Waiver of Our Right To Recover From Others Canada, and any country or jurisdiction which is the subject of 'trade or A. We have the right to recover our payments economic sanctions imposed by the from anyone liable for an injury covered by laws or regulations of the United States this policy. We will not enforce our right of America in effect as of the inception against any person or organization for whom date of this policy. you perform work under a written contract 2_ any obligation imposed by a workers' that requires you to obtain this agreement compensation or occupational disease from us. law, or similar law. This agreement shall not operate directly or 3. bodily injury intentionally caused or indirectly to benefit anyone not named in the aggravated by you. agreement. B. This provision 3. does not apply in the states of Pennsylvania and Utah. 4. Foreign Voluntary Compensation and Employers' Liability Reimbursement A. How This Reimbursement Applies Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Page 4 of 6 4. liability for any consequence, whether direct or indirect, of war, invasion, act of Foreign enemy, hostilities (whether war be declared or not), civil war, rebellion, revolution, insurrection or military or usurped power. No endorsement now or subsequently attached to this policy shall be construed as overriding or waiving this limitation unless specific reference is made thereto. D. Before We Pay Before we reimburse you for the benefits to the persons entitled to them, you must have them: 1. release you and us, in writing, of all responsibility for the injury or death, 2. transfer to us their right to recover from others who may be responsible for their injury or death, 3. cooperate with us and do everything necessary to enable us to enforce the right to recover from others. If the persons entitled to the benefits paid fail to do these things, our duty to reimburse ends at once. If they claim damages from us for the injury or death, our duty to reimburse ends at once. E. Recovery From Others If we make a recovery from others, we will keep an amount equal to our expenses of recovery and the benefits we reimbursed. We will pay the balance to the persons entitled to it. If persons entitled to the benefits make a recovery from others, they must repay us for the amounts that we have reimbursed you. F. Reimbursement for Actual Loss Sustained This endorsement provides only for reimbursement for the loss you actually sustain. In order for you to recover loss or expenses under this reimbursement you must: 1. actually sustain and pay the loss or expense in money after trial, or 2. secure our consent for the payment of the loss or expense. G. Repatriation Our reimbursement includes the additional expenses of repatriation to the United States of America necessarily incurred as a direct result of bodily injury. Our reimbursement shall be limited as follows: 1. to the amount by which such expenses exceed the normal cost of returning the officer or employee if in good health, or 2. in the event of death, to the amount by which such expenses exceed the normal cost of returning the officer or employee if alive and in good health. In no event shall our reimbursement exceed the bodily injury by accident limit shown in Item 3.B. of the Information Page as respects any one such officer or employee whether dead or alive. H. Endemic Disease The word "disease" includes any endemic diseases. The coverage applies as if endemic diseases were included in the provisions of the workers' compensation law. 6. Longshore and Harbor Workers' Compensation Act Coverage General Section C. Workers' Compensation Law is replaced by the following: C. Workers' Compensation Law Workers' Compensation Law means the workers or workers' compensation law and occupational disease law of each state or territory named in Item 3.A. of the Information Page and the Longshore and Harbor Workers' Compensation Act (33 USC Sections 901 -950). It includes any amendments to those laws that are in effect during the policy period. It does not include any other federal workers or workers' compensation law, other federal occupational disease law or the provisions of any law that provide nonoccupational disability benefits. Part Two (Employers' Liability Insurance), C. Exclusions, exclusion 8, does not apply to work subject to the Longshore and Harbor Workers' Compensation Act. This coverage does not apply to work subject to the Defense Base Act, the Outer Continental Shelf Lands Act, or the Nonappropriated Fund Instrumentalities Act. Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Page 5 of 6 SECTION III 1. SCHEDULE OF COVERED STATES A. This endorsement only applies in the states listed in this Schedule of Covered States. C. Schedule of Covered States: B. If a state, shown in Item 3.A. of the Information Page, approves this endorsement after the effective date of this policy, this endorsement will apply to this policy. The coverage will apply in the new state on the effective date of the state approval. Form WC 99 03 03 B Printed in U.S.A. (Ed. 8/00) Page 6 of 6 West Coast Code Consultants, Inc; dba: Eagle Eye Consulting Engineers; and Kimball Engineering EXCERPTS FROM: Hartford Form SS 00 08 04 05 BUSINESS LIABILITY COVERAGE FORM C. WHO IS AN INSURED 6. Additional Insureds When Required By Written Contract, Written Agreement Or Permit The person(s) or organization(s) identified in Paragraphs a. through f. below are additional insureds when you have agreed, in a written contract, written agreement or because of a permit issued by a state or political subdivision, that such person or organization be added as an additional insured on your policy, provided the injury or damage occurs subsequent to the execution of the contract or agreement, or the issuance of the permit. A person or organization is an additional insured under this provision only for that period of time required by the contract. agreement or permit. f. Any Other Party (1) 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: (a) In the performance of your ongoing operations; (b) In connection with your premises owned by or rented to you; or (c) In connection with "your work" and included within the "products- completed operations hazard, but only if (i) The written contract or written agreement requires you to provide such coverage to such additional insured: and (ii) This Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products- completed operations hazard. (2) With respect to the insurance afforded to these additional insureds, 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: inspection, or engineering E.5. Separation of Insureds Except with respect to the Limits of Insurance, and any rights or duties specifically assigned in this policy to the first Named Insured, this insurance applies: a..As if each Named Insured were the only Named Insured; and b.. Separately to each insured against whom a claim is made or "suit" is brought. E.7.16.(7).(b) Primary And Non - Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that this insurance is primary and non - contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. E.8.b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. EXCERPT FROM Hartford Form SS 04 38 06 01 HIRED AUTO AND NON -OWNED AUTO B. With respect to the operation of a "non -owned auto ", WHO IS AN INSURED is replaced by the following: The following are "insureds ": d. Anyone liabile for the conduct of an "insured "., but only to the extent of that liability. CERTIFICATE.OF LIABILITY.INS.URANCE DATE °''°"�DD'r"") 03/02/2015 THIS'CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGH73 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. M the certlftcate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WANED, subject to the terms and condltlons of the policy, certaln policies may require. an endorsement. A statement on this cedlficate does not confer rights to the cerliflcate holder In lieu of such endorsemen4s). PRODUCER Omega Pacific Insurance Solutions 1165 Sonic Drive, Suite A Modesto CA 95350 Eve Bautista _ PH .N 209= 478 -44:74 FAX No.'209- 338 -5'507 ``dADDRESS: certificates trusto a com 4PORDINO COVERAGE NAIL #.' DI.RURERA : Hartford Casualty Insuranoe ConVany. 29424 INSURED West Coast Code Consultants, Inc Kimball Engineering. 2400 Camino Ramon Ste 240 San Ramon CA 94583 -4373 mwRERa: Nationwide Mutual Insurance Company 23787 JUSURER C;, Republie.1ndemni Company of America '22179 JNSURER D: u d's of London XXxxX INSURER E: $ 110001000 S 10,00 INSURER F., COVERAGES CERTIFICATE NUMBER; REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED. NAMED A40VE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EX�i SIONS AND CONDITIONS OF SUCH POLICIES. LIMITS INSURANCE HOWVN MAY HAVE BEEN REDUCED BY PAID CLAIM HEREIN 13 SUBJECT TO ALL THE TERMS, .._. -._ _ LORD' TYPE.OF.INSURANCE POLK:Y NUMBER POLICY OFF Ulm A X I COMMERCIAL GENERAL LIABILITY CLAIM&MADE I • ` I OCCUR Y N 57SBAIC7265 03/19/2015 03/19/201 EACH OCCURRENCE 2,000,000 DAMAGE To RaWmr- Me 9cmaeftoel $ 110001000 S 10,00 MEDEXP are user PEkwNALeADU1N,lURY $__ 2-OW-OW GEN'L AGGREGATE LIMIT APPLIES PER: x POLICY ❑ , Loc OTHER: OENERALAOOREGATE $ 4,000,000 PRODUCTR- COMPIOPAGG $ 4,000,000 Fire L ai LiabUi " $ Bx AUTONIORILELIABILnv ANY AUTO AUTO A�UTM AmOwN Dg x �O.OWMED HIRED N N ACPBA78' "740036' 10/16/2014 10/16/201 ED $ 1,000,000 x BODILY MdURY (Per person)- $ BODILY IMURY (Per eccldero $ 1 PERTYDAMAGE. $ $ A X EXCESSLUAB X OCCUR CLAIMS -MADE N N 57SBAIC7265 03/19/2015 03/19/201 EACH OCCURRENCE $ 2,000000 AGGREGATE 5 4,000 ;000 DED I I RETENTM $ sl CANY NfORI(ERSCOMPENSATION AND EMPLOYERS' LIABILITY YIN PROPRIETORIPARTNERIEXECUTIVE OMCERNB4BER EXCLUDED' ❑ IpMysnotafory in N! under of Gs eRlPrlo OF gWATIONS tudaro NIA A N 16911709 04 &2014 04128/201 X STER ETH- T �E, E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,00 EL DISEASE - POLIfw Luelr $ 1 000 000 D Professional Liaborty N N ANE109990914 04/28/E014 04128/2015 r"a"m General Aggregate- $2,000,000' DBSCRIPnON OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addldenal Rwnmft Schedule, In" be ahacbed If dwre space Is required) Those usual to the Insured's Operations. City ofGilroy, its officers, employees,councits and agents are named as Additional Insured, per the' Business Liability Coverage Form SS0008 attached to the policy. 30 Days Notice of Cancellation. 10 Days Cancellation Notice for Non -pay. City of Gilroy Attn: David Chung 7351 Rosanna 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 r ., 01988-2014 ACORD CORPORATION. AU Nahts nnarved- ACORD 26 (2014)011) The ACORD name and logo are registered marks of ACORD BUSINESS LIABILITY COVERAGE FORM This Paragraph f. applies separately to you and any additional insured. 3. Financial Responsibiilty Laws a. When this poky is certified as, proof of financial responsibility for the future under the provisions of any motor vehide, financial responsibility law, the Insurance provided by the. policy for "bodily Injury" lability and ° proparty damage" liability will comply with the provisions of the law to the extent of the coverage and - limits of insurance required by that law. b. With respect to "mobile equipment" to which this Insurance apples, we will provide any Liability, uninsured motorists, underinsured motorists, no-fault or other coverage required by any motor vehicle .law. We will provide the required limits for those coverages. 4.. Legal Action Against Us No person or organization has a right under this Coverage Form: a. To jot us as a part y or otherwise bring us Into a "suit" asking for damages from an insured; or b. To sue us on this Coverage Form unless all of its tam have been fully compiled with. A person or organization may sue us to recover on an agreed settlement or on a Ifinal judgment against an Insured; but we will. not be &able for damages that are not payable under the terms of this insurance or that are In excess. of the applicable Imit or insurance. An agreed sent: means a settlement and release of fiablity signed by us, the Insured. and the claimant or the daimanfs legal r epr asentative. 5. Separation Of insureds Except with respect to the Limits of insurance, and any rights or duties, specifically assigned In thi0 policy to the first Named Insured, this insurance applies: . a. As if each Named Insured were the only Named Insured; and b.. Separately to each insured against whom a Bairn is made or "suit" is brought. S. Representations a. When You Accept This Policy By accepting this policy, you agree: (1) The statements In the Declarations are accurate and complete; (2) Those statements are - based upon representations you made to us; and (3) We have issued this policy: in reliance upon your representaticm b. Unintentional pallure To Disclose Hazards If unintentionally you should fall to disclose all hazards relating to the conduct of your business at the Inception date of this Coverage Part, we shall not deny any coverage ' under this Coverage Part because of such failure. 7. Other insurance If other vald and collectible insurance is available for a loss we cover under this Coverage Part, our obilgations are Imfted as follows: a. Primary insurance This insurance is primary except when b. below applies. If other insurance Is also primary, we will share with all that other Insurance by the method described in c. below. b. Excess Insurance This insurance Is excess over any of the other insurance, whether primary, excess, contingent or on any other basis: (1) Your Work That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for ."your work"; (2)- Premises Rented To You That is fire, lightning or explosion Insurance for premises rented to you or temporarily occupied by you with pemrission of the owner; (3) Tenant Liability That Is Insurance purchased by you to cover your liability as a tenrrnt for "property damage, to premises rented to you,or temporafiy occupied by you with permission of the owner, (4) Alr=W% Auto Or Watercraft 0 the loss arises out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of Sec&on A.— Coverages. (5) Property Danurge To Borrowed Equipment Or Use Of Elevators If the loss arises out of "properly damage" to borrowed equipment or the .use of elevators to the extent not subject -to Exclusion k. of Section A. — Coverages. Page 16 of 24 Form SS 00 08 04 05 (8) When You Are Added As An Additional Insured To Other Insurance That is other Insurance available to you covering liability for damages arising out of the premises or operations, or products and completed operations, for which you have been added as an additional insured by that Insurance; or (7) When You Add Others As An Additional Insured To This Insurance That Is other insurance available to an additional Insured. However, the following . provisions apply to other Insurance available to any person or organization who is an additional Insured under this Coverage Part: (a) Primary Insurance When Required By Contract This insurance Is primary if you have agre ed in a written contract written agreement or permit that this. insurance be primary. If other Insurance is also primary, we will share with all that other insurance by the method described in c. below. (b) Primary And Non4ontribuhn To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that. this insurance Is primary and non -oon dbutory with the additional insured's own Insurance, this Insurance is primary and we will not seek contribution from that other Insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional Insured When this insurance Is excess, we will have no duty under this Coverage.Part to defend the insured against any "suit" if any other insurer has a duty to defend the Insured against that "suit ". If no other Insurer defends, we will undertake to do so, but we will be entitled to the Insureds, rights against all those other insurers. BUSINESS LIABILITY COVERAGE FORM When this Insurance is. excess over other Insurance, we will pay only our share of the amount of the loss, If any, that exceeds the sum of (1) -The total amount that all such other Insurance would pay for the loss In the absence of this Insurance; and (2) The total of all deducible and self - insured amounts under all that other Insurance. We will sure the remaining loss, if any, .with any other Insurance that Is not described In this Excess insurance provision and was not bought specifically to apply In excess of the Limits of Insurance shown in the Declaratlons of this Coverage Part. c. MoUnd Of Sharing If all 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 wip contribute by limits. Under this method, each insurer's share Is based on the .railo of Its applicable limit of insurance to the total applicable halts of insurance of all insurers. 8. Transtfer, Of Rights Of Recovery Against Others To Us a. Transfer Of Rights Of Recovery if the insured has rights to recover all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them At our request, the .Insured will bring "suit" or transfer those rights to us and .help us enforce them This condition does not apply to Medical Expenses Coverage. b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person. or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Park, we also waive that right, provided the Insured waived their rights of recovery against such person or organization In a contract, agreement or permit that was. executed prior to the Injury ordemage. Forth 88 00 08 04 05 Page 17 of 24 BUSINESS LiABWTY COVERAGE FORM F. OPTIONAL ADDITIONAL INSURED 3. Additional. insured - Grantor Of Franchise COVERAGES WHO IS AN INSURED under Section C. Is If listed or shown as applicable in the Declarations, amended to .include as an additional insured one or more of the following Optional Additional the person(&) or organization(s) shown in the Insured Coverages also apply.. When any of these Declarations as an Additional Insured - . Optional Additional Insured Coverages apply, Grantor Of Franchise, but only with ,respect to Paragraph S. ( Additonal Insureds When Required their liability as grantor of franchise to you. by Written Contract, Written Agreement or Permit) 4. Additional insured - Lessor 'Of Leased of Section C., Who Is An Insured, does not, apply Equipment , to the person or organization shown In the a. WHO IS AN INSURED underSection.C. Is Declarations. These coverages are subject th the amended to Include as an additional terms and conditions applicable to Business Insured the person(s) or organization(s) Liability. Coverage In this' policy, except as shown In the Declarations as an Additional provided below: Insured — Lessor of Leased. Equipment, 1. Additional Insured - Designated Person Or but only with respect- to liability for "bodily Organization. injury", "property damage" or "personal WHO IS AN INSURED under Section C. is and advertising injury" caused, In whole or amended to include as an additional insured in part, by your maintenance, operation or -the person(s).or organization(s).shown in the use of equipment leased to you by such Declarations, . but only with respect to liability person(s) or orgartizatlon(s). for "bodily Injury°, "property damage" or b. With respect to the insurance afforded to "personal and advertising Injury" caused, in these additional insureds, this Insurance whole or in part, by your acts or omissions or does not apply to any "occurrence° which the ads or omissions of those acting on your taken place after you cease to lease that behalf: equipment. a. In . the performance of your ongoing S. Additional insured - Owners Or Other operations; or Interests. From Whom Land Has Been b. In connection with your premises owned Leased by or rented to you. a. WHO IS AN INSURED under Section C. is 2. Additional Insured - Managers Or Lessors amended to include . as an additional Of Premises Insured the person(s) or organization(s) shown In the Declarations as an Additional a, WHO IS AN INSURED under Section C. Is Insured — Owners Or Other Interests From amended to Include as an additional insured Whom Land Has Been Leased, but only the person(s) or organization(s). shown In the with rasped to liability arising out of the Declarations as an Additional .Insured - ownership, maintenance or usti'of that part Designated Person Or Organization; but only of the land leased to you and shown In the with respect to liabifty arising out of the Declarations. ownership' maintenance or use of that part of the premises leased to you and shown In the b. With respect to the Insurance afforded to Declarations. these additional insureds, the following additional exclusions apply. b. With respect to the Insurance afforded to This insurance does not apply to: additional insureds, the following additional exclusions apply: (1) Any "occurrence" that takes place This Insurance does not apply to: after you cease to lease that land; or (1) Any " occurrence" which takes .place (2) Structural alterations, new after you cease to be a tenant in that construction or demolition operations premises; or performed by or on: behalf of such person or organization. (2) Structural alterations, new construction or demolition operations 6, Additional Insured - State. Or. 'Political, . form performed by or on behalf of such Subdivision - Permits person or organization. a. WHO IS AN INSURED under Section C. Is amended to include as an additional insured the state or political subdivision shown in the Declarations as an Additional Page 18 of 24 Form 88 00 08 04 05 BUSINESS LIABILITY COVERAGE FORM Insured — State Or Political .Subdivision - (a) Arry failure to make such Permits, but only ' with rasped to inspections, .adjustments, tests or operations performed by you. or on your servicing as the vendor has agreed behalf for which the state or political lb make or rxffnafly undertakes to subdivision has issued a pemdL make In the .usud. course of b: With respect to the insurance afforded to business, In connection with the these additional insureds, the following distribution or sale of the products; additional exclusions apply: (fj Demonstration, installation. This does not apply to: servicing or repair operations, .insurance except such operations performed (1) . Bodpy ir�ury; "property. damage" or at the vendor's premises in "personal . and advertising . injury" with the sale of the arising out of operations perbT ned for produ� 'product the state or rrttrnicl papty; or (g) Products which, after distribution (2) "Bodily Injury° or "property damage" or sale by you, have been labeled included In the 'product - completed or relabeled or used as a operations" hazard. container, part or ingredient of any 7. Additional Insured — Vendors other thing *or substance by or for a. WHO IS AN INSURED under Section C. Is the vendor, or- amended to Include as an additional (h) "Bodily Injury' or "property Insured the person(s) or organizmtion(s) damage" arising out of the sole (referred to below as vendor) shown In the negligence of the vendor for. its Declarations as an Additional insured - own ads or omissions or those of Vendor, but only with rasped to "bodily its employees or anyone else injury" or "property damage° arising out of acting on its behalf.. However; this "your products" . which are distributed or exclusion does not apply to: sold in the regular course of the vendor's (n The exceptions contoured to business and only If this Coverage Part Subparagraphs {d) or or provides coverage for "bodily In jury" or "property a io (m �� inspections, damage" included within the "pi oducts-completed operations hazard ". adjustments, tests or servicing as the vendor has agreed to b. The instunenoe afforded b the vendor is make none undertakes subject to the following additional exclusions: b make In the usual course of a us (1) This Insurance does not apply to: business, in connection with (a) "Bodily injury" or "property the distribution or sale of the damage° for which the vendor Is products. obligated to pay damages by (2) This insurance does not apply to any reason of the assumption of Insured person or organization from liability In a contract or agreement. whom you have acquired such This exclusion does, not apply to products, or any ingredient, part or liability for . damages that the container, entering into, vendor would have in the absence accompanying or containing such of the contract or agreement; products. (b) 'Any express warranty . S. Additional- Insured— Controlling Interest unauthorized by you; WHO IS AN INSURED under Section C. Is (c) Any physical or chendcal change amended to include as an additional Insured In the product made intentionally the.person(s) or organization(s) shown in the by the vendor,' Declarations as. an. Additional Insured — (d) Repackaging,. unless unpacked Controllinig Interest; but only with respect to solely for the Wye of Inspection, their liability arising out of: demonstration, testing, or the a. Their financial control of you; or substitution of parts under b. Premises they own, maintain or control Instructions from the manufadtuer, white you lease or occupy these premises. and then repackaged In the original container, Form SS 00 08 0405 Page 19 of 24 WESTC -3 OP ID: DJ CERTIFICATE OF LIABILITY INSURANCE 702;m2712014 M/DDIYYYY) 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 Rossi & Ward Insurance Service Pacific Interstate Ins Brokers P. O. Box 7037 Stockton, CA 95267 CONTACT NAME: Gary Rossi PHONE 2U9- 478 -4474 i X No : 2O9- 478-0484 A/c No Ext E-MAIL ADDRESS: GENERAL LIABILITY Gary Rossi INSURERS AFFORDING COVERAGE NAIC # INSURER A: Republic Indemnity Co. of Amer 22179 $ 2,000,00 INSURED West Coast Code Consultant Inc INSURER B: Hartford Casualty Insurance Co 29424 2400 Camino Ramon Ste. 240 San Ramon, CA 94583 -4373 INSURER C: Nationwide Mutual Ins Co 23787 INSURER D: t -IOydS Of London AMAGE R N PREMISES T Ea occurrence INSURER E: CLAIMS -MADE a OCCUR INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE AD DL U POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM/DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 B X COMMERCIAL GENERAL LIABILITY X 57SBAIC7265 03/19/2014 03/19/2015 AMAGE R N PREMISES T Ea occurrence $ 300,001 CLAIMS -MADE a OCCUR MED EXP (Any one person) $ 10,00 PERSONAL & ADV INJURY $ 2,000,00 GENERAL AGGREGATE $ 4,000,00 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 4,000,00 $ POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ C ANY AUTO ACP BA 7834740036 10/16/2013 1011612014 X ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ 1,000,00 PROPERTY DAMAGE PER ACCIDENT $ NON -OWNED HIRED AUTOS AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,00 AGGREGATE $ B EXCESS LIAB CLAIMS -MADE 57SBAIC7265 03/19/2014 03119/2015 _TDED7 I RETENTION $ $ WORKERS COMPENSATION WC STATU- I JOTH - TORY LIMITS i ER A AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE YIN 169117 -08 04/28/2013 04/28/2014 E.L. EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A $ 1,000,00 E.L. DISEASE - EA EMPLOYEE If Yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 DOD DD $ , , D Professional Liab ANE 1099909 -13 04128/2013 04/28/2014 Each Occu 1,000,00 Aggregate 2,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) City of Gilroy, its officers, officials, employees, council, volunteers and agents are named as Additional Insured per attached SS0008 attached to the policy. Additional Insured Endt CG D3 82 09 07 and CG DO 37 04 05 are the equivalent forms on form SS0008 attached on the policy. CITYOFG City of Gilroy Building Department Attn: David Chung 7351 Rosanna Street Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESEbKMWE + Gary Rossi Cc) 1989 -2010 ACORIb CORPORATION. All rights reserved ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD (6) When You Are Added As An Additional Insured To Other Insurance That is other insurance available to you covering liability for damages arising out of the premises or operations, or products and completed operations, for which you have been added as an additional insured by that insurance; or (7) When You Add Others As An Additional Insured To This Insurance That is other insurance available to an additional insured. However, the following provisions apply to other insurance available to any person or organization who is an additional insured under this Coverage Part: (a) Primary Insurance When Required By Contract This insurance is primary if you have agreed in a written contract, written agreement or permit that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in c. below. (b) Primary And Non - Contributory To Other Insurance When Required By Contract If you have agreed in a written contract, written agreement or permit that this insurance is primary and non - contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. Paragraphs (a) and (b) do not apply to other insurance to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty under this Coverage Part to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit ". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. BUSINESS LIABILITY COVERAGE FORM When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (1) The total amount that all such other insurance would pay for the loss in the absence of this insurance; and (2) The total of all deductible and self - insured amounts under all that other insurance. We will share the remaining loss, if any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Method Of Sharing If all 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. 8. Transfer Of Rights Of Recovery Against Others To Us a. Transfer Of Rights Of Recovery If the insured has rights to recover all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring "suit" or transfer those rights to us and help us enforce them. This condition does not apply to Medical Expenses Coverage. b. Waiver Of Rights Of Recovery (Waiver Of Subrogation) If the insured has waived any rights of recovery against any person or organization for all or part of any payment, including Supplementary Payments, we have made under this Coverage Part, we also waive that right, provided the insured waived their rights of recovery against such person or organization in a contract, agreement or permit that was executed prior to the injury or damage. Form SS 00 08 04 05 Page 17 of 24 BUSINESS LIABILITY COVERAGE FORM F. OPTIONAL ADDITIONAL INSURED COVERAGES If listed or shown as applicable in the Declarations, one or more of the following Optional Additional Insured Coverages also apply. When any of these Optional Additional Insured Coverages apply, Paragraph 6. (Additional Insureds When Required by Written Contract, Written Agreement or Permit) of Section C., Who Is An Insured, does not apply to the person or organization shown in the Declarations. These coverages are subject to the terms and conditions applicable to Business Liability Coverage in this policy, except as provided below: 1. Additional Insured - Designated Person Or Organization WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations, 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: a. In the performance of your ongoing operations; or b. In connection with your premises owned by or rented to you. 2. Additional Insured - Managers Or Lessors Of Premises a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured - Designated Person Or Organization; but only with respect to liability arising out of the ownership, maintenance or use of that part of the premises leased to you and shown in the Declarations. b. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: (1) Any 'occurrence" which takes place after you cease to be a tenant in that premises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 3. Additional Insured - Grantor Of Franchise WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured - Grantor Of Franchise, but only with respect to their liability as grantor of franchise to you. 4. Additional Insured - Lessor Of Leased Equipment a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured — Lessor of Leased Equipment, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use of equipment leased to you by such person(s) or organization(s). b. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any 'occurrence" which takes place after you cease to lease that equipment. 5. Additional Insured - Owners Or Other Interests From Whom Land Has Been Leased a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured — Owners Or Other Interests From Whom Land Has Been Leased, but only with respect to liability arising out of the ownership, maintenance or use of that part of the land leased to you and shown in the Declarations. b. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: (1) Any 'occurrence" that takes place after you cease to lease that land; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. 6. Additional Insured - State Or Political Subdivision — Permits a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the state or political subdivision shown in the Declarations as an Additional Page 18 of 24 Form SS 00 08 04 05 BUSINESS LIABILITY COVERAGE FORM Insured — State Or Political Subdivision - (e) Any failure to make such Permits, but only with respect to inspections, adjustments, tests or operations performed by you or on your servicing as the vendor has agreed behalf for which the state or political to make or normally undertakes to subdivision has issued a permit. make in the usual course of b. With respect to the insurance afforded to business, in connection with the these additional insureds, the following distribution or sale of the products; additional exclusions apply: (f) Demonstration, installation, This insurance does not apply to: servicing or repair operations, except such operations performed (1) "Bodily injury", "property damage" or at the vendor's premises in "personal and advertising injury" connection with the sale of the arising out of operations performed for product; the state or municipality; or (g) Products which, after distribution (2) "Bodily injury" or "property damage" or sale by you, have been labeled included in the "product- completed or relabeled or used as a operations" hazard. container, part or ingredient of any 7. Additional Insured —Vendors other thing or substance by or for a. WHO IS AN INSURED under Section C. is the vendor; or amended to include as an additional (h) "Bodily injury" or "property insured the person(s) or organization(s) damage" arising out of the sole (referred to below as vendor) shown in the negligence of the vendor for its Declarations as an Additional Insured - own acts or omissions or those of Vendor, but only with respect to "bodily its employees or anyone else injury" or "property damage" arising out of acting on its behalf. However, this "your products" which are distributed or exclusion does not apply to: sold in the regular course of the vendor's (i) The exceptions contained in business and only if this Coverage Part Subparagraphs d () or (fl; or provides coverage for "bodily injury" or "property damage" included within the (ii) Such inspections, "products- completed operations hazard ". adjustments, tests or servicing as the vendor has agreed to b. The insurance afforded to the vendor is make or normally undertakes subject to the following additional exclusions: to make in the usual course of (1) This insurance does not apply to: business, in connection with (a) "Bodily injury" or "property the distribution or sale of the damage" for which the vendor is products. obligated to pay damages by (2) This insurance does not apply to any reason of the assumption of insured person or organization from liability in a contract or agreement. whom you have acquired such This exclusion does not apply to products, or any ingredient, part or liability for damages that the container, entering into, vendor would have in the absence accompanying or containing such of the contract or agreement; products. (b) Any express warranty 8. Additional Insured — Controlling Interest unauthorized by you; WHO IS AN INSURED under Section C. is (c) Any physical or chemical change amended to include as an additional insured in the product made intentionally the person(s) or organization(s) shown in the by the vendor; Declarations as an Additional Insured — (d) Repackaging, unless unpacked Controlling Interest, but only with respect to solely for the purpose of inspection, their liability arising out of: demonstration, testing, or the a. Their financial control of you; or substitution of parts under b. Premises they own, maintain or control instructions from the manufacturer, while you lease or occupy these premises. and then repackaged in the original container; Form SS 00 08 04 05 Page 19 of 24 BUSINESS LIABILITY COVERAGE FORM This insurance does not apply to structural alterations, new construction and demolition operations performed by or for that person or organization. 9. Additional Insured — Owners, Lessees Or Contractors — Scheduled Person Or Organization a. WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Additional Insured — Owner, Lessees Or Contractors, 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 the additional insured(s); or (2) In connection with "your work" performed for that additional insured and included within the "products - completed operations hazard ", but only if this Coverage Part provides coverage for "bodily injury" or "property damage" included within the "products- completed operations hazard ". b. With respect to the insurance afforded to these additional insureds, this insurance does not apply to "bodily injury", "property damage" or "personal an 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 failure to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders, designs or drawings and specifications; or (2) Supervisory, inspection, architectural or engineering activities. 10. Additional Insured — Co -Owner Of Insured Premises WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or Organization(s) shown in the Declarations as an Additional Insured — Co- Owner Of Insured Premises, but only with respect to their liability as co -owner of the premises shown in the Declarations. The limits of insurance that apply to additional insureds are described in Section D. — Limits Of Insurance. How this insurance applies when other insurance is available to an additional insured is described in the Other Insurance Condition in Section E. — Liability And Medical Expenses General Conditions. G. LIABILITY AND MEDICAL EXPENSES DEFINITIONS 1. "Advertisement" means the widespread public dissemination of information or images that has the purpose of inducing the sale of goods, products or services through: a. (1) Radio; (2) Television; (3) Billboard; (4) Magazine; (5) Newspaper; b. The Internet, but only that part of a web site that is about goods, products or services for the purposes of inducing the sale of goods, products or services; or c. Any other publication that is given widespread public distribution. However, "advertisement" does not include: a. The design, printed material, information or images contained in, on or upon the packaging or labeling of any goods or products; or b. An interactive conversation between or among persons through a computer network. 2. "Advertising idea" means any idea for an "advertisement ". 3. "Asbestos hazard" means an exposure or threat of exposure to the actual or alleged properties of asbestos and includes the mere presence of asbestos in any form. 4. "Auto" means a land motor vehicle, trailer or semi - trailer designed for travel on public roads, including any attached machinery or equipment. But "auto" does not include "mobile equipment". 5. 'Bodily injury" means physical: a. Injury; b. Sickness; or c. Disease sustained by a person and, if arising out of the above, mental anguish or death at any time. 6. "Coverage territory" means: Page 20 of 24 Form SS 00 08 04 05 BUSINESS LIABILITY COVERAGE FORM This insurance does not apply to structural The limits. of Insurance that apply to. additional alterations, new construction and demolition insureds are described in Section D. — Limits Of operations performed by or for that person or insurance. organbmMon. How this Insurance applies when other Insurance 9. Additional Insured — Owners, Lessees Or is available to an additional insured is described in Contractors — Scheduled - Person Or. the Other Insurance Condition 'in Section E. — Organization Liability And Medical Expenses General a. WHO IS AN INSURED under Section C. Is Conditions. amended to include as an additional G. LIABILITY AND MEDICAL EXPENSES Insured the person(s) or organization(s) DEFINITIONS shown In the Declarations as an Additional Insured — Owner, Lessees Or Contractors, 1. "Advertisement" means the widespread public but only with respect to liability for "bodily dissemination of infomaation or Images that injury`, "property damage" or "personal has the purpose of induang.the sale of goods, and advertising injury" caused, In whole or products or services through: In part, by your ads or omissions or the ai (1) Radio; acts or omissions of those acting on your . T (Z) Television; �� (3) Billboard; (1) In the performance of your ongoing (4) Magazine; operations for the additional (5) Newspaper; insured {s); or (2) In connection with "your work" b• The Internet, but only that part of a web performed for that additional insured site that Is about goods, products or and Included within the "products - services for the purposes of inducing the completed operations hazard", but sale of goods, products or- services; or only N this Coverage Part provides a Any other publication that is given coverage .. for "bodily injury" or widespread public distribution. "property damage" included within the However, "advertisement" does not Include: "products - completed operations hazard". a. The design, printed material, information or images or in, on upon the b. With respect to the insurance afforded to packaging or labeling of any goods or libeling y these additional insureds, this insurance products; � does not a to °bodil Injury", apply Y j ry", "Property b. An Interactive conversation between or damage" or "personal an advertising . among permits trough a computer network Injury" arising out of the rendering of, or the fallure to render, any professional 2. "Advertising idea" means any idea for an architectural, engineering or surveying "adverdserneriV. services, Including: 3. "Asbestos hazard" means an exposure or (1) The preparing. approving, or failure to threat of exposure to the actual or alleged prepare or approve, maps, shop properties of asbestos and includes the mere drawings, opinions, reports, surveys, presence of asbestos in any fom% field orders, change orders, designs or 4, "Auto" means a land motor vehicle, trailer or drawings and specifications; or semi - trailer designed for travel on public (2) Supervisory, Inspection, architectural roads, including any attached machinery or or engineering activities, equipment. But "auto" does not include 10. Additional insured — Co-owner Of Insured "ale equipment". Premises S. "Bodily injury" means physical: WHO IS AN INSURED under Section C. is a. Injury; amended to Include , as an additional Insured b. Sidcness; or the person(s) or Organlzation(s) shown In the a Disease Declarations: as an Additional Insured — Co- Owner Of Insured Premises, but only with sustained by a person and, if arising out of the rasped to their liability as co -owner of the above, mental anguish or death at any time. premises shown in the Declarations. 6. "Coverage territory" means: Page 20 of 24 Form SS 00 08 04 05. WESTC-3 OP ID: DJ CERTIFICATE OF LIABILITY INSURANCE D0511412013 05/14/2013 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. Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement (s). PRODUCER Phone: 209 -478 -4474 5A0.NTAcT Rossi Insurance Services Fax: 209 -478 -4484 Pacific Interstate Ins Brokers P. O. Box 7037 Stockton, CA 95267 Gary Rossi PHDNE FAX A/C No Ext : A/C Ni ADDRESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA: Republic Indemnity Co. of Amer 22179 INSURED West Coast Code Consultant Inc INSURER a: Hartford Casualty Insurance Co 29424 2400 Camino Ramon Ste. 240 San Ramon, CA 94583 -4373 INSURER C: Lloyds of London INBURER D: 03/1912013 INSURER E: -DAMAGE RENTED PREMISES Ea occurrence $ .,300,00 INSURER F: $ 10 ,00 nvorrcIrATO wlAanco. RFVISIr)NNIIMRFR- vTHIS,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 ADD SUB POLICY NUMBER MMtDD EFF MMIDDYIYYYY LIMITS Attn: David Chung GENERAL LIABILITY 7351 Rosanna Street Gary Rossi Gilroy, CA 95020 EACH OCCURRENCE 11 - 2,000,00 B X COMMERCIAL GENERAL LIABILITY X 57SBAIC7265 03/1912013 03/19/2014 -DAMAGE RENTED PREMISES Ea occurrence $ .,300,00 MED EXP(Any one Person) $ 10 ,00 CLAIMS -MADE OCCUR PERSONAL &ADV INJURY $ 2,000,00 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PERT PRODUCTS - COMP /OP AGG S 4,000,00 $ X POLICY F7 PRO LOC AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT Ea accidentY $ 2,000,00 BODILY INJURY (Per person) $ B ANY AUTO 57SBAIC7265 0311912013 0311912014 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Peraccident $ _ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000.00 AGGREGATE $ B EXCESS LMB CLAIMS -MADE 57SBA IC7266 0311912013 0311912014 DELI I X I RETENTION$ 10,00 1 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN 169117 -08 04/26/2013 04128/2014 X WCSTATU- OTH- TORY LI T ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) NIA E.L. DISEASE- POLICY LIMIT $ 1,000.00 If yea, describe under DESCRIPTION OF OPERATIONS below C PROFESSIONAL LIAB ANE1099909 -13 0412812013 04/2812014 1,000,00 AGGREGATE 2,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Atlaeh ACORD tOt, Additional Remad Schedule, Wmemspace is mauimd) City of Gilroy, its officers, officials, employees, council, volunteers and agents are named as Additional Insured per attached SS0008 attached to the policy. Additional Insured Endt CG D3 82 09 07 and CG DO 37 04 05 are the - equivalent forms on form SS0008 attached on the policy. un' nvn CAMCFI I ATlnld CITYOFG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. Building Department Attn: David Chung AUTHORIZED REPRESE E P 7351 Rosanna Street Gary Rossi Gilroy, CA 95020 V 1986 -"ZUIU AGUtiC/ OUKPUKAI IUN. An rlgms reserveo. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD