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Innovative Claims Solutions - Insurance CertificateCERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) 3/30/2016 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 Andreini & Company- Stockton 2431 W. March Lane, Suite 300 Stockton CA 95207 CAMTACT Connie Lundquist PHONE 87769 -0507 F"X 650- 378 -4361 E MAIL . clundquist @andreini.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Federal Insurance Company 20281 4/1/2016 INSURED INNOV -5 INSURER B.: $1,000,000 INSURER C CLAIMS -MADE ❑X OCCUR Innovative Claim Solutions Inc Attn: Gary Archibald 11344 Coloma Rd., Suite 745 INSURER D Gold River CA 95670 INSURER E: $1,000,000 INSURER F: MED EXP (Any one person) $10,000 COVERAGES CERTIFICATE NUMBER_ 110749312 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 INSD WVD POLICY NUMBER POLICY EFF MM /DDNYYY POLICY EXP MM /DDIYYYY LIMITS -. • X COMMERCIAL GENERAL LIABILITY 35754610 4/1/2016 4/1/2017 EACHAOCURRENCE $1,000,000 CLAIMS -MADE ❑X OCCUR ,DAMAGE TO PREMISES Ea occiiE ence $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 1$2,000,000 POLICY Ea r LOC PRODUCTS - COMP /OP AGG ' slnclAgg $ OTHER: • AUTOMOBILE LIABILITY 73513506 4/1/2016 1 4/1/2017 Ea accident $1,000,000 BODILY INJURY (Per person?. I $ ANY AUTO AUTOS OOWNED SSC�HEEDULED BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS %( AUTOS X PROPERTY DAMAGE Per "accident _ $ $ • X UMBRELLA LIAB X OCCUR 79797000 4/1/2016 4/1/2017 EACH OCCURRENCE $5,000,000._ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED X I RETENTION$0 -- -- $_-- -- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER /EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N / A PER 0TH--- STATUTE ER E.L. EACH ACCIDENT _ $ E.L. DISEASE - EA EMPLOYE _$ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE. - .POLICY LIMIT 11 - A A Professional Liability Fidelity Limit 81.722762 81815467 4/1/2016 4/112016 4/1/2017 4/112017 Professional Limit $3,000,000 Fidelity Limit $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Gilroy, its officers, respentatives, agents and employees are included as additional insured as respects to the General Liability as their interest may appear per the attached Blanket Additional Endorsement Form #80 -02- 2367(05/07) where requited by written contract. This insurance Is primary and non- contibutory per the attached form #17 -02 -3080 (04/01). LK a �� a t; a Lha� > < � : L•„ �i a :� City of Gilroy HR Director /Risk Manager 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. REPRESENTATIVE o si& rinhts reserved ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD r� 0 1�1 cwuBB Liability Insurance Endorsement Policy Period APRIL 1, 2416 TO APRIL 1, 2017 Effective Date APRIL 1, 2016 Policy Number 357546 -10 WCE Insured INNOVATIVE CLAIM SOLUTIONS INC. Name of Company FEDERAL INSURANCE COMPANY Date Issued JANUARY 8, 2016 h•"f�55£t�5: ' a7C+ Y.£: H:! kV` r. �?'• i:;•`.: C•. �' 0?%: C: c',,.'•`. t�f' YGv :'t }:irr.•f.6:i•:h;65:k ?%�h. } kt�£: i!: �r:+? ic> bS: d? SSn�k�%. cb1" S' f: �: fi' G; YG•:. �:::: �.^. S:?.: iv �^:' t3L7` F, xS'. �? K• �<;:.`•:`�SS:.`•:.`,£'•.^•.�?:4 w:':?�� +. ^.2>:i: ?.t�. w::2�:::::3R'th`.:A:::2<6:::: This Endorsement applies to the following forms: GENERAL LIABILITY . e,. 0Y3 .•S22L..:...::::.::::::.....fi <.....,..,..£ e': LR�' tv:: �RalCC. S. a: b> Y�2: �9.•.:::..,:..,,,:..::..::> RdG. v, L..,.., aa,•...:. ,,.a:.::::2a:,f•'�f:�ii�;N %!i+: <5:2� <i: •.}• +;.r ••:::..:. �:::: L..�; ....: :: :+•:: : >:• .:•vv U..v:S:::4:n::,•::.,.:::u.!: �iG;}, iS::.::: �: �:?: �::::: �t: i�} rr ::::�'h� >liO:��:.U..{{+A.S..x. �:i•'.tL�'... Under Who Is An Insured, the following provision is added. Who Is An Insured Additional Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss; cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. •. i.£•:::..,:»...: k}'-0S? }.w{,..�w}.•.•eY }.,,•+Yuw h}i.:.':. $ $'9likL"i]bi .•v. x.•:::.:: '.;::::: .•: •• .'.. .. ::.w:: a„ •.:� :::• :..,,.,, :::::::..::::. ,... , '• �7H:'. 8.,,,•::. r.:::: F..•. a}: �Sf:'.'•>.;+• k:: �.^•. i�ap.0 c? �: 8.'•: }::: ;: }�5::::.,:6::u:: Sr r...� •.,•:.,,...;,•r•' +•:+•»:yr • :. ..: Liability Insurance Additional Insured - Scheduled Person Or Organizabon continued Form 80-02 -2367 (Rev. 5-07) Endorsement Page 1 Liabllity Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance —Scheduled this insurance is primary and we will not seek contribution from insurance available to.such person Person Or Organization or organization. :�:E \'�fi�v n32.: s: �k`: Y:: 7:: v? 15a::. xx:::??..:; ish': ::;'/,. a(`• S: i�:.^•.:: �fir�::: G:;. �:;:::: : �:' t4Y51SF•':.` S9Yi:.'?' 6::' tii:. i.:• S: L`: wo-Yc�:+::;^ 2: R' tii:?% k�Y. �T: 6:? CaCtx'•.,^ ac ".it:?..7;Gi.S:i.S:.Yt.f;:i�v sA% l.•: n� /,:6Rt?i ^:.�.',k'.: +icack;4�c;5 x:�N:t't'Yw ^w.&2•."s2 Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Authorized Representative Q Liability Insurance Additional Insured - Scheduled Person Or Organization last pege Form W49-2367 (Rev. 5 -07) Endorsement Page 2 0 PA 0 ctt -�uBB Conditions Legal- Action Against Us (continued) General Liability A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured obtained. after an actual: trial in a civil proceeding; or arbitration or other alternative dispute resolution proceeding; but we will not be liable for damages that are not payable under the terms and conditions of this insurance or that are in excess of the applicable Limits Of Insurance. ......... ... Other Insurance :.::.................,::::.:If other valid .:.::... .................................................... ............................... d and collectible insurance is available to the insured for loss we would otherwise cover under this insurance, our obligations are limited as follows. Primary Insurance This insurance is primary except when the Excess Insurance provision described below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by' the method described in the Method of Sharing provision described below. Excess Insurance This insurance is excess over any other insurance, whether primary, excess, contingent or on any other basis: A. that is Fire, Extended Coverage, Builders Risk, Installation Risk or similar insurance for your work; B. that is insurance that applies to property damage to premises rented to you or temporarily occupied by you with permission of the owner; C. if the loss arises out of aircraft, autos or watercraft (to the extent not subject to the Aircraft, Autos Or Watercraft exclusion); D. that is insurance: 1. provided to you by any person or organization working under contract or agreement for you; or 2. under which you are included as an insured; or E. that is insurance under any Property section of this policy. When this insurance is excess, we will have no duty to defend the insured against any suit if any other insurer has a duty to defend such insured against such 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. When this insurance is excess over other insurance, we will pay only our share of the amount of loss, if any, that exceeds the sum of the total: • amount that all other insurance would pay for loss in the absence of this insurance, and • of all deductible and self - insured amounts under all other insurance. Liability Insurance Form 17-02 -3080 (Rev. 4 -01) Contract Page 23 of 32 INNOV -5 OP ID: C8 ACORO' . CERTIFICATE OF LIABILITY INSURANCE DATE (M=O/YWY) 03/27/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE. OR PRODUCER, AND THE. CERTIFICATE HOLDER. IMPORTANT- If the certificate holder is an ADDITIONAL INSURED, the 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; holdedn lieu of such endorsement(s). PRODUCER Phone: 209 - 956 -8500 CONTACT NAME:. Connie Lund uist Andrelni & Company-Stockton Fax: 209 - 956 -8508 License 0208825 2431 W. March Lane, Suite 300 Stockton, CA 95207 Tracey Dela Riva P "� Nc 209. 956 -8500 qC, No: 209 - 956 -8508 E-11"L ADDRESS: clundquist@andreini.com INSURERS AFFORDING COVERAGE I NAIL S . INSURER A: Federal Insurance Company 120281 INSURED Innovative Claim Solution, Inc. Gary Archibald 11030 White Rock Road #210 INSURER B : p PREMISES occurrence) INSURER C : MEDMED EX� person) INSURER D: INSURER E: Rancho Cordova, CA 95670 INSURER F: rnVFRAI:FS CFRTIFIGATE NUMRFR- 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. uL15R TYPE OF INSURANCE ADDI I ! POLICY NUMBER POLICY POLICY ExP I LIMITS A rGEB, E RAL UA13MM COMMERCIAL GENERAL LIABILITY 35754610 0410112015 I 0410112016 i EACH OCCURRENCE p PREMISES occurrence) 1,000,00 MEDMED EX� person) 5 10,00 CLAIMS -MADE � OCCUR PERSONAL & ADV INJURY $ 1,000,00 HI I GENERAL AGGREGATE $ 2,000.000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG s Incl Ag $ POLICY �I PRO. LOC I AUTOMOBILE LIABILITY I � � i I I i COMBINED SINGLE LIMIT Ea accident 19000,00 BODILY INJURY (Pei person) $ A ANY AUTO ALL OW NED SCHEDULED AUTOS NON-OWNED X HIRED AUTOS X AUTOS 73513506 04/01/2015 04/01 /2016 BODILY INJURY (Per accident) I s PROPFJ2TY.DAMAGE. Per accident Is is A J( UMBRELLA UAS X OCCUR EXCESS L1AB CLAIMS -MADE 79797000 04/01/2015 04101/2016 I EACH OCCURRENCE 1$ 5;000,000 AGGREGATE Is 5,000,000 - DED I X I .RETENTION 0i Is WORKERS COMPENSATION AND EMPLOYERS' LU1BILiTY ANY PROPRIETOR/PARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Myyantlatory in NH) D ASCRIPTION OF OPERATIONS below NIA WCSTATU- IOTR E.L. EACHE.L. EACH ACCIDENT Is -L. DISEASE- FJ1 EMPLOYEE s E:L. DISEASE - POLICY LIMIT, I E • P 181722762 04101/20151 04/01 /2016 JUMit 3,000,000 • Fidelity I 81815467 04/01/2015 04/01 /2016 Limit 4000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule. If more space is required) City of Gilroy, its officers, respentatives, agents and employees are included as additional insured as respects to the General Liability as their interest may appear per the attached Blanket Additional Endorsement Form #80 -02 -2367 (08 -04) where required by written contract. This .insurance is primary and non- contibutory per the attached form #17 -02 -3086 (04/01). f_V0TICIreTS: uni nou r-ANCFI: I ATInN CITGILI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. HR Director /Risk Manager 7351 Rosanna Street Gilroy, CA 95020 I AUTHORIZED REPRESENTATIVE Cr„„ry•� 0 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD J Liability Insurance aHUBB Endorsement Policy Period APRIL 1, 2015 TO APRIL 1, 2016 Effective Date APRIL 1, 2015 Policy Number _575- 46 -lUWUC Insured INNOVATIVE CLAIM SOLUTIONS INC. Name of Company FEDERAL. INSURANCE COMPANY Date Issued MARCH 27, 2015 This Endorsement applies to the following forrns: GENERAL. (.IAHlI,I Y tinder Who Is An Insured. the following provision is added: Who Is An Insured Scheduled Person Or Subject to all of the teen: and eonditjom of tni insurance, any person or organization shown in the Organization Schedule, actinlo pursuant to a written contract or agreement between you and such person or ' organization, is an irtcured, but thev are insureds only with respect to liability arising out of your operations, or your premises, if you are obligated, pursuant to such contract or agreement, to provide them with such insurance as is afforded by this policy. However, no such person or urganizauun is an insured with respect to any: assumption of liability by them in a contract or agreement. This limitation does not apply to the liabilitv for damages for injury or damage, to which this insurance applies, that the person or or a nization would have in the absence of such contract or agreement. • danuw'es arising out of their sole llc-ligence. Schedule PERSONS OR ORGANIZATIONS THAT YOU ARE OBLIGATED, PURSUANT -1-0 WRITTEN CONTRACT OR AGREEMENT BETWEEN YOU AND SUCH PERSON OR ORGANIZATION, TO PROVIDF WITH SUCH INSURANCE AS IS AFFORDED BY TNIS Pot -i(' Y., Bi 'r'I'IIEY ARE INSUREDS ON1..Y IF AND TO THE MINIMUM EXTENT THAT SL1CI1 CONTRACT. OR AGREEMENT REQUIRES THE PERSON OR ORGANIZATION TO BE AFFORDED STA'11. .'S AS AN INSURED. HOWEVER, NO PERSON OR ORGANIZATION IS AN INSURED UNDER TIIIS PROVISION: WHO IS 1ti10RF: SPE('IFCAL,C.Y DESCRIBED UNDER ANY (} "TF1' PROVISI(:)N Liaaitity Insurance Additional Insured - Scheduled Person Or Organization Form 80 -02 72367 (Rev. 8 -04) Endorsement continued Page 1 Liability Endorsement (continued) OF THE WHO IS AN INSURED SECTION OF THIS POLICY (REGARDLESS OF ANY LIMITATION APPLICABLE THERETO) WITH RESPECT TO ASSUMPTION OF LIABILITY BY THEM IN A CONTRACT OR AGREEMENT. THIS LIMITATION DOES NOT APPLY TO THE LIABILITY FOR DAMAGES FOR INJURY OR DAMAGE, TO WHICH THIS INSURANCE APPLIES, THAT THE PERSON OR ORGANIZATION WOULD HAVE IN THE ABSENCE OF SUCH CONTRACT OR AGREEMENT WITH RESPECT TO DAMAGES ARISING OUT OF THEIR SOLE NEGLIGENCE. CITY OF GILROY, HR DIRECTOR/RISK MANAGER 7351 ROSANNA'STREET, GILROY, CA 95020 All other terms and conditions remain unchanged. Authorized Representative Liability Insurance Additional Insured - Scheduled Person Or Organizatfon last page Form 80- 02.2367 (Rev. 8-04) Endorsement Page 2 �H�sB General Liability Conditions Legal Aedon Against Us A person or organization may sue us to recover on an agreed settlement or on a final judgment (continued) against an Insured obtained after an actual: • trial in a civil proceeding; or • arbitration or other alternative dispute resolution proceeding; but we will not be liable for damages that. are not payable under the terms and conditions of this insurance or that are in excess of the applicable Limits Of Insurance. ........... r.... ............ :.. v:.nw.....r:.r.....:. xtit•r t:h-�riP'.'t:: .:.:.. ,. ,..:..:. � .., , rt. ..:0:: {"' .T.x; <>. :lv: v a�:,:..:.� -, . Other InSUranee If other valid and collectible insurance is available to the insured for loss we would otherwise cover under this insurance, our obligations are limited as follows. Primary Insurance This insurance is primary except when the Excess Instrance provision described below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is.aiso primary. Then, we will share with all that other insurance by the method described in the Method of Sharing provision described below. Excess Insurance This insurance is excess over any other insurance, whether primary, excess, contingent or on any other basis: A. that is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar insurance for your work B. that is insurance that applies to property damage to premises rented to you or temporarily occupied by you with permission of the owner, C. if the loss arises out of aircraft, autos or watercraft (to the extent not subject to the Aircraft, Autos Or Watercraft exclusion). D. that is insurance: provided to you by any person or organization working under contract or agreement for you; or under which you are included as an insured, or E that is insurance under any Property section of this policy. When this insurance is excess, we will have no duty to defend the insured against any suit if any other insurer has a duty to defend such insured against such 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. When this insurance is excess over other insurance, we will pay only our share of the amount of loss, if any, that exceeds the sum of the total: • amount that all other insurance would pay for loss in the absence of this insurance; and • of all deductible and self - insured amounts under all other insurance. UabQrty rns<,ranoa Form 17- 023080 (Rev. 4-01) Contract Page 23 of 32 INNOV -5 OP ID: C8 .acoRl7 CERTIFICATE OF LIABILITY INSURANCE F;I DATMJD D/YYYY) 0/02/2014 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 Phone: 209 - 956 -8500 NAME: CT Connie Lundquist Andreini & Company- Stockton Fax: 209 -956 -8508 License 0208825 2431 W. March Lane, Suite 300 ;NONE 209- 956 -8500 AX N,:209- 956 -8508 c No : clundquist@andreini.com Stockton, CA 95207 Tracey Dela Riva -ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Federal Insurance Company 20281 INSURED Innovative Claim Solution, INSURER 8: A INSURER c Inc. Gary Archibald 35754610 04/01/2014 11030 White Rock Road #210 INSURER D: DAMAGE RENTED PREMISES Ea occurrence INSURER E: $ 10,00 Rancho Cordova, CA 95670 INSURER F: r•nvGeer -cc rFRTIFIrATF NI IMRFR• 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 Ty PE OF INSURANCE I L ACCORDANCE WITH THE POLICY PROVISIONS. POLICY NUMBER MM /DDNYYY MM /DDNYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,00_0,0 A JC COMMERCIAL GENERAL LIABILITY 35754610 04/01/2014 04/01/2015 _ $ 1,000,00 DAMAGE RENTED PREMISES Ea occurrence MED EXP (Any one person) $ 10,00 CLAIMS -MADE a OCCUR PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ Inc[ Agg $ POLICY PRO- LOC JFCT —1 AUTOMOBILE LIABILITY A COMBINED SINGLE LIMIT Ea accident, 11000,00 BODILY INJURY (Per person) $ A ANY AUTO 73513506 04/01/2014 04/01/2015 BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 A EXCESS LIAS CLAIMS -MADE 79797000 0410112014 04/01/2015 DIED I X I RETENTION $ 0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN STATU- OTH- WC Y LIMITS I I ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) NIA E.L. DISEASE - POLICY LIMIT $ M yes, describe under DE RIPTION OF OPERATIONS below A Professional Liab 81722762 04/0112014 04/01/2015 Limit 3,000,00 A Fidelity 81815467 04/01/2014 04/01/2015 Limit 2,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of Gil r oy, its officers, t r espent at i ves, agent s and errpl ogees are i ncl uded as add! t ! onal i nsur ed as r esppect s o t he Gener al Li abi I i t y as t hei r interest may apppear per the attached Blanket Additional Endorserrent Form #80-02-2367 (08- 04) where required by written contract. This insurance i s pr i rrar y and non - cont i but or y per the attached form #17-02-3080. rFRTIFIrATF HOMER CANCELLATION CITGIL1 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. HR Director /Risk Manager 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE /J ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD Liability Endorsement (continued) OF THE WHO IS AN INSURED SECTION OF THIS POLICY (REGARDLESS OF ANY LIMITATION APPLICABLE THERETO) WITH RESPECT TO ASSUMPTION OF LIABILITY BY THEM IN A CONTRACT OR AGREEMENT. THIS LIMITATION DOES NOT APPLY TO THE LIABILITY FOR DAMAGES FOR INJURY OR DAMAGE, TO WHICH THIS INSURANCE APPLIES, THAT THE PERSON OR ORGANIZATION WOULD HAVE IN THE ABSENCE OF SUCH CONTRACT OR AGREEMENT WITH RESPECT TO DAMAGES ARISING OUT OF THEIR SOLE NEGLIGENCE. CITY OF GILROY, HR DIRECTOR/RISK MANAGER 7351 ROSANNA STREET, GILROY, CA 95020 All other terms and conditions remain unchanged. Authorized Representative Liability Insurance Additional Insured - Scheduled Person Or Organization last page Form 80-02 -2367 (Rev. 8 -04) Endorsement Page 2 Liability Insurance Endorsement Policy Period APRIL 1, 2014 TO APRIL 1, 2015 Effective Date APRIL 1, 2014 Policy Number 3575 -46-10 WUC Insured INNOVATIVE CLAIM SOLUTIONS INC. Name of Company FEDERAL INSURANCE COMPANY Date Issued MARCH 31, 2014 .,•.. -;w ;7w..- a +r.•« ,...rn • -: -ero ;. rs. :�. �. ..,- �.,... -'*.,. a. �_ .z:-., -, s.r.:..:,,. :r � ..z� _ - .v..,�, , r:v. ...: a»:,:ir�• s»,:... zxo,,...__. •,!. .+» .... ... n«.^,.1... ' _'.lAtln. .. b .: �:., za xy� «v- raM- +1 : This Endorsement applies to the following forms: GENERAL LIABILITY Under Who Is An Insured, the following provision is added: Who Is An Insured Scheduled Person Or Subject to all of the terms and conditions of this insurance, any person or organization shown in the Organization Schedule, acting pursuant to a written contract or agreement between you and such person or organization, is an insured; but they are insureds only with respect to liability arising out of your operations, or your premises, if you are obligated, pursuant to such contract or agreement, to provide them with such insurance as is afforded by this policy. However, no such person or organization is an insured with respect to any: assumption of liabili ty by them in a contract or agreement. This limitation does not apply to the liability for damages for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. damages arising out of their sole negligence. �n.- w,xv.. _- '+xa,n.,....vrn• .,�w..:� „n........ -, : r... c.- ,..;..y...,.._._n�o,y.,._iw.,. �..�........ ... -.. ,wv- .s....n n ,r , m _ _ Schedule PERSONS OR ORGANIZATIONS THAT YOU ARE OBLIGATED, PURSUANT TO WRITTEN CONTRACTOR AGREEMENT BETWEEN YOU AND SUCH PERSON OR ORGANIZATION, TO PROVIDE WITH SUCH INSURANCE AS IS AFFORDED BY THIS POLICY; BUT THEY ARE INSUREDS ONLY IF AND TO THE MINIMUM EXTENT THAT SUCH CONTRACT OR AGREEMENT REQUIRES THE PERSON OR ORGANIZATION TO BE AFFORDED STATUS AS AN INSURED. HOWEVER, NO PERSON OR ORGANIZATION IS AN INSURED UNDER THIS PROVISION: WHO IS MORE SPECIFICALLY DESCRIBED UNDER ANY OTHER PROVISION Liability Insurance Additional Insured - Scheduled Person Or Organizab6n continued Form 80-02 -2367 (Rev. 8 -04) Endorsement Page 1 C1-NE IluBB General Liability Conditions Legal Action Against Us A person or organization may sue us to recover on an agreed settlement or on a final judgment (continued) against an Insured obtained after an actual: • trial in a civil procceding; or • arbitration or other alternative dispute resolution proceeding; but we will not be liable for damages that are not payable under the terms and conditions of this insurance or that are in excess of the applicable Limits Of Insurance. ,. ..,..,,- : ..:......x..c.a+.}wr;x . 5..,...3.. :. .. : v..u:r:::.:.....{.taxx.aa •„,.,fiv ^.v"G:Yjcifc:% Sie <t`ac:�,v.a:.`•�:`i:' ..... .. ...w.�:a•: i:..•3ti:• Other Insurance If other valid and collectible insurance is available to the insured for loss we would otherwise cover under this insurance, our obligations are limited as follows. Primary Insurance This insurance is primary except when the Excess Insurance provision described below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method.described in the Method of. Sharing provision described below. Excess Insurance This insurance is excess over any other insurance, whether primary, excess, contingent or on any other basis: A. that is Fire, Extended Coverage. Builder's Risk, Installation Risk or similar insurance for your work; B. that is insurance that applies to property damage to premises rented to you or temporarily occupied by you with permission of the owner, C. if the loss arises au t of aircraft, autos or watercraft (to the extent not subject to the Aircraft, Autos Or Watercraft exclusion); D. that is insurance: 1. provided to you by any person or organization working under contract or agreement for you; or 2, under which you are included as an insured; or E. that is Insurance under any Property section of this policy. When this insurance is excess, we will have no duty to defend the insured against any snit if any other insurer has a duty to defend such insured against such 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. When this insurance is excess over other insurance, we will pay only our share of the amount of loss, if any, that exceeds the sum of the total: • amount that all other insurance would pay for loss in the absence of this insurance; and • of all deductible and self - insured amounts under all other Insurance. Liabi ily Insurance Form 17 -02 -3080 (Rev. 4 -01) Contract Page 23 of 32 . r Conditions Other Insurance We will share the remaining loss, if any, with any other insurance that is not described in this (continued) Excess Insurance provision and was not negotiated specifically to apply in excess of the Limits Of Insurance shown in the Declarations of this insurance. Method of Sharing , If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this method each insurer contributes equal amounts until it has paid its applicable limits of insurance or none of the loss remains, whichever comes fast. 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 limits of insurance to the total applicable limits of insurance of all insurers. Premium Audit We will compute all premiums for this insurance in accordance with our rules and rates. In accordance with the Estimated Premiums section of the Premium Summary, premiums shown with an asterisk ( *) are estimated premiums and are subject to audit. In addition to or in lieu of such designation in the Premium Summary, premiums may be designated as estimated premiums elsewhere in this policy. In that case, these premiums will also be subject to audit, and the second paragraph of the Estimated Premiums section of the Premium Summary will apply. Separation Of Insureds Except with respect to the Limits Of Insurance, and any rights or duties specifically assigned in this insurance to the first named insured, this insurance applies: • as if each named insured were the only named insured; and separately to each insured against whom claim is made or suit is brought. i•?' !.•ri {6 ?iil:t:!q ?:• ?Yi:� ? ?ii:•: �:. ?ii ?:!.�i:� n ?: <.:t. i:•i:i �: ?::!qi:! viii: ^ ?:4 }i ?:•.r::•ii::!! ^ } ?: ii: i:•i:: i: ii >. ?ii:!. iii: ?:<. ?ii::i::.:i ?ii ?Y.i`i':i:�ij ....... ... .. .........................:....... ............................... :::x:.. :...�:::.,.:::J..J:::.v .................... .•:: nom: ;•.�:: :::. �:::::::::: ::•::. � ::::::::::. �:. :•: ;•.: n�: n::::::::::::. �::.:::: :::::::::::.::n:.:.....::::.v.: �.:..:::.....:.. :... Transfer Or Waiver Of We will waive the right of recovery we would otherwise have had against another person or Rights Of Recovery organization, for loss to which this insurance applies, provided the insured has waived their rights Against Others of recovery against such person or organization in a contract or agreement that is executed before such loss. To the extent that the insured's rights to recover all or part of any payment made under this V Q insurance have not been waived, 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. •. HO `•2tt.1 :41r 2 1 1:>r1. ..^'{,.�dJ:v#Ylitu:^: iR2�7Mt:Y ^ «a•`.;x. F:q;•ki4'rY.:sb bl.•:Jk"/•trk:: <;•:u:•r5:%r: ",.!RYS.•2;f'c;:: J?. k:, X`•? Fn:: t. 4'.£'. ^JADR';'!::'Sfi'C�:;v`. <.:'::k'. `R>.'t: is2' ttvS'./: R; GS'i' x` ic2",.`," fn« cvtT`.:. wC:'.#.' s: Sd:' t> .:S•iY'G:'!•`.':::^. "s:•:wt•:'t Liabrrty Insurance Form 17 -02 -3080 (Ray. 4 -01) Contract Page 24 of 32