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Youth Alliance - Insurance Certficate
YOUTALL -01 KIM CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 10/05/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or 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 License # 0504035 _ Pacific Diversified Insurance, Inc. 15005 Concord Circle,-Suite 110- 408- 842 -2131 - _ - � Morgan Hill,'CA 95037 ' - CONTACT Kimberly D. White, CISR - -- - , • - - _NAME._____ PHONE 408 842 -2131 2179 ' FAX 408 842 -0867- - (Arc, No, Ext) ( ) (A/C, Nor( ) dins.com ADDRESS E -MAIL kwhite@pdins.com _ _ INSURER(S) AFFORDING COVERAGE NAIC # __ INSURER Nonprofits' Ins Alliance of CA- — ;11845 - INSURED INSURER B INSURER C Youth Alliance Diane Ortiz Post Office Box 1291 Hollister, CA 95024 -1291 _ INSURER D INSURER E 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 ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP MM /DD✓YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000'000 DAMAGE TO RENTED SQO,000 PRE-MISES_(Ea_occurrence) $_ _ MED EXP (Any one person)_ $ 20'000 II CLAIMS -MADE ❑ OCCUR LIQUOR LIAB•$1 MILL X 2016- 06291NPO 11116/2016 11/16/2017 - - _ _ _ PERSONAL & ADV INJURY $ _ 1,000'000 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY _� •jE _ LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 ISOCIAL SRVC PRO -$- 1,000,000 !?_ I— AUTOMOBILE X LIABILITY _ ANYAUTO _ 'OWNED SCHEDULED AUTOS ONLY AUTOS I�— HIRED X NON -OWNED AUTOS ONLY l_ —I AUTOS ONLY 2016- 06291NPO - 11/16/2016 11116/2017 I EO aBIINdEeDtSINGLE LIMIT [wa BODILY INJURY (Per ep rsbn) $ 1,000,000 $ BODILY INJURY (Per accident ' $ PROPERTY DAMAGE (Per accdent $ - EACH OCCURRENCE $ H EXCESS L ABAB a CLAIMS-MADE AGGREGATE_ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y LSTATUTE�L�RH ANY PROPRIETOR /PARTNER /EXECUTIVE i� OFFICER /MEMBER EXCLUDED (Mandatory in NH) It yos, describe under DESCRIPI ION OF OPLRATIONS below N / A E L EACH ACCIDENT $ E L DISEASE =EA EMPLOYEES EL DISEASE - POLIC Y LIMll $_ j 1 $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached Amore space Is required) Jobs As Per Written Contract or Agreement The City of Gilroy, Its officers, representatives, agents and employees are named as additional Insured, as per written contract or agreement and per carrier blanket endorsements attached. 10 Days notice of cancellation for non payment and 30 days for all other notifications. I City of Gilroy 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 REPRESENTATIVE ACORD 25 (2016103) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER 2016 -06291 COMMERCIAL GENERAL LIABILITY Named Insured Hollister Youth Alliance CG 20 26 04 13 THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY ADDITIONAL INSURED = DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): The City of Gilroy,lts Officers, Representatives ,Agents,Employees Jobs As Per Written Contract or Agreement Information required to complete this Schedule, if not shown above, will be shown in the Declarations A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, 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, or 2. In connection with your premises owned by or rented to you However 1. The insurance afforded to such additional insured only applies to the extent permitted by law, and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance 1. Required by the contract or agreement, or 2. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations CG 20 26 04 13 © Insurance Services Office, Inc , 2012 Page 1 of 1 YOUTALL -01 W11 � CERTIFICATE OF LIABILITY INSURANCE D 09 15 /201 YY) 09/15/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(Ies) must have ADDITIONAL INSURED provisions or 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 License # 0504035 Pacific Diversified Insurance, Inc. 15005 Concord Circle, Suite 110 408 - 842 -2131 Kimberly D. White, CISR _NAMEACT PHONE 408 842 -2131 2179 I (A/C, No) (408) 842 -0867 E :p (_) E M DR I ADESS kwhite @pdins.com INSURER( ( ) AFFORDING COVERAGE NAIC # Morgan Hill, CA 95037 INSURER Zurich American Insurance Co 16535 S INSURED INSURER B _ INSURER C $ Hollister Youth Alliance INSURER D S Post Office Box 1291 Hollister, CA 95024 -1291 INSURER E I S INSURER F I 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 ILT R r TYPE OF INSURANCE ADDp SUER WVD POLICY NUMBER POLICY EFF POLOICOY EXP LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR U EACH OCCURRENCE S DAMAGE TO RENTED PREMI$ES_(Ea ocarrence)� MED EXP An one erson) S GEN'L $ PERSONAL 1, ADV INJURY S AGGREGATE LIMIT APPLIES PER POLICY ❑ PECT n LOC OTHER GENERAL AGGREGATE I S PRODUCTS - COMP /OP AGG S II AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY IJ AUTOS AUTOS ONLY H AUUTO� ONLOY (EOMaBI NEODt SINGLE LIMIT BODILY INJURY (Per person)_ S S BODILY INJURY (Per accident) Peraeadent) AMAUMBRELLA S LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE S DED I I RETENTIONS S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE YIN oFFICER/MEMg�� EXCLUDED (Mantlatory m NH) If es descnbe under DESCRIPTION O° OPERATIONS bolcw NIA WC571027101 04/01/2017 04/01/2018 �I Y PER �OTH- STATUTE_ ER_ E L EACH ACCIDENT 1,000,000 S E L DISEASE - EA EMPLOYEE 1 000 OQQ S E 1. DISEASE - POL �rY LIMIT I S 1,000,000 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Jobs or Events, As Per Written Contract The City of Gilroy, its officers, representatives, agents, and employees are named as additional insured as per carrier specific blanket endorsement attached 10 Days notice of cancellation for non payment and 30 days for all other notices City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 Arson za ron•isrrizl 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 CE) 19RR -2n15 A The ACORD name and logo are registered marks of ACORD All riahts reserved YOUTALL -01 KIM CERTIFICATE OF LIABILITY INSURANCE DATE(1611M11310 lYYY() 4124/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(ies) must 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 endorsoment(s). PRODUCER License # 0504035 Pacific Diversified Insurance, Inc. 15005 Concord Circle, Suite 110 NAME: 11(imberly D. White, CISR PHONE 408 842 -2131 2179 FAX f • ( ) Arc Ne • 408 842 -0867 ADDRESS kwhite @pdin §.com 408- 842 -2131 Morgan Hill, CA 95037 INSURER(S) AFFORDING COVERAGE NAIC INSURER 'Zurich American Insurance Co 16535 $ INSURED INSURER B $ INSURER C : MED EXP (Any one person) Hollister Youth Alliance INSURER D: Post Office Box 1291 Hollister, CA 950244291 INSURER E. GEJ'L AGGREGATE LIMIT APPLIES PEP, POLICY E] j� F1 LOC OTHER. INSURER F: $ PRODUCTS - COMPIOPAGG 1.1 r _r-w ro-rr =n i t nrr lmwr w• owrcinwi wrr rasQCO. 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 CONTRACTOR 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 O_ F SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMMD MM /DD/YYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR EACH OCCURRENCE $ UAMAUh PREMISES Ea�_ $ MED EXP (Any one person) $ PERSONAL $ ADV INJURY $ GEJ'L AGGREGATE LIMIT APPLIES PEP, POLICY E] j� F1 LOC OTHER. GENERAL AGGREGATE $ PRODUCTS - COMPIOPAGG $ $ AUTOMOBILELLLBILITY ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS NON-OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ee dent $ BODILY INJURY (Per person) $ INJURY ( Per ) BODILY INJURY Per dent $ (Per accident) $ UMBRELLA LIAB EXCESS LIAR HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPREETOR/PARTNER/EXECUTNE OFFICERIMEMBER EXCLUDED] (Mandatory In NH) If yes, describe under DESCRIPTIONOFOPERATIONSbelow NIA WC571027101 04101/2017 04/0112018 X STATUTE 6R - E.L. EACH ACCIDENT $ 1,000,00 E L DISEASE - EA EMPLOYEE $ 1,000,000 ELDISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attach ad if more space Is required) Re: Jobs or Events, As Per Written Contract The City of Gilroy, its officers, representatives, agents, and employees are named as additional insured as per carrier specific blankct endorsement attached 10 Days notice of cancellation for non payment and 30 days for all other notices. CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna Street 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 ©1988.2014 ACORD CC The ACORD name and logo are registered marks of ACORD RATION_ All riahts reserver! YOUTALL -01 KIM 14 ®c CERTIFICATE OF LIABILITY INSURANCE DATE 2//14/214/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(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 License # 0504035 Pacific Diversified Insurance, Inc. 15005 Concord Circle, Suite 110 NAM CONTACT Kimberly D. White, CISR PHONE (408) 842 -2131 2179 (408) 842 -0867 a/C No ADDRESS kwhite@pdins.com 408 -842 -2131 Morgan Hill, CA 95037 INSURER(S) AFFORDING COVERAGE NAIC INSURER -Nonprofits' Ins Alliance of CA 11845 $ 1,000,000 INSURED INSURER B .Zurich American Insurance Co 16535 Youth Alliance Diane Ortiz INSURER $ 20,00 Post Office Box 1291 INSURER D GEN'LAGGREGATE LIMIT APPLIES PER X POLICY ❑ ... LOC OTHER. INSURER E . S 2,000,00 Hollister, CA 95024 -1291 INSURER F. POCIAL SRVC PRO $ 1,000,00 ULJV tFiAGtS (:LR III- 11=ATI- NIrMRFR! RFV6 InI1J Ni IRARFa. 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 OMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER I (MMA7D/YYYY) MM/OD/YYYY LIMITS A X COMNERCIAL GENERAL LIABILITY CIANAS-0AADE M OCCUR L QUOR LIA1331 MILL X 2016 -06291NPO 11/162016 11/16/2017 EACHOCCURRENCE $ 1,000,000 PREMISES Eaocaarence $ 500,000 MEDEXP (Any cneperwn) $ 20,00 PERSONAL &ADVRMRY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER X POLICY ❑ ... LOC OTHER. GENERAL AGGREGATE S 2,000,00 PRODUCTS - COMP/OP AGG S 2,000,000 POCIAL SRVC PRO $ 1,000,00 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULm AUTOS AUTOS NON - OWNED HIREDAIIrOS AUTOS 2016 -06291 NPO 11 /162016 11/16/2017 C ED N EL MI Ea atxdent $ 100000 + + X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ eraccdent $ S UMBRELLA LIAe EXCESS LUIB HOCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION$ S B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y❑ (Mandatory In NH) IF s descnbe under DESCRIPTION OF OPERATIONS below N/A WC571027100 04)072 76 04)01/2017 I(+ PER _TU STATUTE ER L HACCIDENT $ 1,000,000 DISEASE- EA EMPLOYEE $ 1,000,000 EL DISEASE- POLICY LIMIT $ Q; e -fo It /K DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may ba attached if more space is required) Jobs As Per Written Contract or Agreement The City of Gilroy, Its officers, representatives, agents and employees are named as additional Insured, as per written contract or agreement and per carrier blanket endorsements attached. 10 Days notice of cancellation for non payment and 30 days for all other notifications. L,M t IrK.A I t nuLU1_-K CANCELLATION City of Gilroy 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 REPRESENTATIVE ^ ' ©1988 -2014 ACORD CORPORATION. All riahts ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER:2016 -0629 i NPO COMM ERCIALGENERAL LIABILITY CO 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS -- SCHEDULED PERSON OR ORGANIZATION This endgrsonlent modifies Insufarice- provided under the following: OOMMERCiAL GFNERAL LIABILITY COVERAGE PART 6CHEDULE Name Of Additional Insured Person(s) Or.or anization s : Locations Of Covered Operations Any person or organization that you are required to All Insured premises and operations edd as an additional Insured oh thla policy, finder a Written contract or agmement currdntiy in effect; or becoming�plfeptive durino.the term of this olicyy. he additional insured status will. not be afford d wlth respect to,Iiai�illty arising put of or related to your ar nn"des at a real dstate manager for that person or organization. information required to oom fete this Schedule, If not shown above will be shown in the Declarations. A. Section If — Who Is An insured is amended to Inclrldd as an additional Insured the pers66(s) or organkatibn(s) -shown 'in the _Sc iedute, .but only with respect to liabl9ty for "bodily injury,°, °prgperty damage• or "personal and advertising Injury° caused, in whole or in part, by. 1. Your acts or omissions; or 2. The acts or omissions of IhosO. acling bn your behalf; B. -With respect to the Insurance afforded to these additlatbl Insureds, the following additional exclu- sions apply. This insurance does not apply to 'bodily Injury" or 'property damage" occurring after. 1. All -work, including materials, parts or equip- ment furnished in conneetloti with such work, on the project (other than seMoe, maintenance or repairs) to be performed by or on behalf of " ' g covered operations has been completed: or the 0�d1tional insured(s) at tho locat arts) desi�- nated•above. 2. That portion of "your work" out of which the #lruy or damage arises has been put to its in- tended use by any person or organization other bait another contractor or subobnlractor en- gaged in performing operations for a prindpal as'a part of the safle project. CO 20 110 07 64 6 180 Properties, Inc., 2004 Page 1 of t ❑ POLICY NUMBER: 2016 -06291 NPO COMMERCIAL GENERAL LIABILITY CO 20 28 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL. INSURED -- DESIGNATED PERSON OR ORGANIZATION This erldoftemiant modifies Insurance provided Under-the foil6wing: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Arty arson or drganization.that you .are required to add as an additional Insured on this. poGdy. under a written contract or agreement ctlrrQntly In effect, or becoming effective during the term of this policy. The addifionai insured status Will not be afforded With respect to Ilabliityarlsing out of or related to your activities as a real estate manager for that person or organIzallom Section 0 — Who Is An Insured Is amendQd to In- clude as an addjilonal insured the persbri(s) or o"- zation(s) shown In the Sohedute, but onlywith respect to OabR for "bod1y injury, "property darnageP or "personal and advertising injury' caused, In whole- or In part, 4y yoyr acts or dmissrons bt the acts or dmis- sions of those acting on your behalf: A. In the performance of your dngoft.operadons; of S. In connection with your premises owned by or CO 20 26 OT 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑ POU NUMBER: 2016- 06291NPO COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANQES THE POLICY. PLEASE REAQ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement Inod(fies insurance provided under the following COMMERCIAL OENER AL LIABILITY COVERAQE PART SCHEDULE Name Of Additional Insured Person(s) or Organization(s): Lobation And Des@ri tton Of Completed Operations Any person or Argganikafloh that you are required All insured pretnises and operations to add as an ad tonal insured on thl polfgy, under atrlpritten contact or agraemenfeurreNty in effect, or becoming effectlye during the term of this policy. The. dddibonal insured status'will not be afforded with respect to GabUR' arising out of or related to your ache as a real estdte manager for that person or oWttizaEion. Information requIred to mm leis this Schedule, if not shown above, will be shown in the Declarations. Section 11 — Who. Is An Insured Is amended to include as an additional Insured the persons} gr organizatfoh(s) -shown In the Schedule, but only with respect to liabbiillity tor•°bodhy irP., • or �propgrty dam- age' caused, in whole nor by °your work" at the location designated and described In the schs- duie of this endoisement perfomled 40t that addi- tibnat Insured and included in the 'products- completed opetat(ohs hazard°_ CG 20 37 07 04 0 ISO Properties, Ina, 2004 Page 1 of 1 13 a i i NONPROFITS INSURANCE ALLIANCE of CAUr -oXNrA A (read jorjasurmte¢. A ReW fdrNodprdflts. THIS ENDOR$EME T CHANGES THE POLICY. PLEASE READ iT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON - CONTRIBUTORY E_ NDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION It — WHO IS AN INSURED Is amended to Include any public entity as an additional Insured for whom you are performing operations when you and such person or organization have agreed in a written contract -or written agreement that such public entity be added as an additional Insured(s) on your policy, but only with respect to flab ility for °bodily lnjury", "property damage" or 'personal and advertising injury' arising out of, in whole or In part, W. 1. Your negligent acts or omissions; or 2 The negligent acts or omissions of those acting on your behalf; In the performance of your ongoing operations. No such public en* 4 an additional Insured for fdabiifty arlstng out of the 'products- completed operations hazard' or for liability arising out of the tote negligence of that public entity. B. With respect to the insurance afforded to these addigonal insured(s), the following additional exclusions apply. This insurance does not apply to "bodily injury' or ° propelty damage° occurring after. 1. Ali work, including materials, parts or equipment fumished in connection with such work, on the project bother Than service, mairlienartce or tepdirs) to tie performed W.or on behalf of the additional Insured(s) atthe location of the covered operations has been completed; or 2 That portion of °your work out of which injury or damage arises has been put to its intended use by any person or organl4fion othdr than another contractor or subcontractor engaged In performing operations for a principal as a part of the same project The limits of insurance applicable to the additional insured(s) are those specified in the written contract between you and the- additional irmsured(s), pr the limits available under this policy, whichever are less. These limits are part of and not in additidh to the limits of insurance under this policy. D. With respect to,the insurance provided to the additional Insured(s). Condition 4. Other insurance of SECTION W— COMMERCIAL GENERAL LIABILITY CONDITIONS Is replaced bi the foltaving. 4. Other•in mrance a. primary Insurance This insurance is primary If you have agreed In a written contract or written agreement NIAC E61 0213 Page 102 (1) That this Insurance be primary. If.other insurance Is-also primary, we Wit share with all,that other lnsurance as described in c. below; or (2) The coverage afforded by this insurance Is primary and non - contributory with the additional tnsured(s)' own insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional insured(s) has beers added.a6 an additional insured or to other insurance described In p_ aragraph b, below, b. Excess insurance This insurance Is excess Aver. 1. Arty of the other insurance, whether primary, excess, contingent or on any other basis: (a) That is Fire, Extended Coveratge, Builder's Risk, Installation Risk or'simflar coverage for 'your work°; (b) That is fire, lightning, or exploblon insurance for premises rented to you or temporarily occupied by you with permission of the owner, (c) That is Insurance purchased by you to cover your liability as a tenant for 'property damage to premises temporarily occupied by you with permission of the owner, or (d) if the toss arises out of the maintenance or use of aitcraft, "autos - or watery raft to the exterit not.subject to Excluslon g. of SE=CTION I — COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE. , (e) That is anyother insurance, available to an additional Insured(s) under this Endorsement covering liability for damages arising out of the premises or operations, or products - completed operations, for which the additional Insured(s) has been added as an additional insured by that other insurance. (1) When this Insurance Is excess, we will have no duty under Coverages A or 3 to defend the additiongl Insured(s) against any "suir° if any Other Insurer has a duty to defend the additional insureds) against that "suit". If,rio other insurer defeuds, we will undeilake to do so, but we %ilia bg entitled to the additional lnsured(s)' rights against all those other Insurers. (2) When this Insurance Is exceeds over other insurance, we will pay only our share of the amount pf the loss, i(any, that exceeds the sup of: (a) The total amqurit that alf such other Insurance would pay for the loss in the abserre of this Insurance; and (b) The total of all deductible mid self- insured amounts under all that other insurance. 0) We will share the remalmng loss, If any, with any. other.insurance that is not described in this or insurance shown In the Oeglaraiion -5 of ttls Coverage- e. Methods-of $haring If all of the other insurance available to the additional insured(s) permits contributioh by equal shares, we will follow this method also. .V.nder this approach each Insurer contributes equal amounts until it-has paid its applicable limit of insurance or none of the loss remalns, whichever comes first If any other the other insurance available to the additional Insured(s) does not permit contribution by equal shares{ we will cd1*Ibute8 by limits. Under this method, each insurer's share is based on the ratio of its applicable limit of insurance to the total applicable Grru'ts of insurance of all Insurers. HMD E810213 Page 2 ort YOUTALL -01 KIM - CERTIFICATE- OF-LIABILITY INSURANCE DATEjMMlDD/WW) 11/23/2015 THIS 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 endomement(s). PRODUCER License # 0504035 X Pacific Diversified Insurance, Inc. 9015 Murray Ste 110 408 842 2131 Gilroy, CA 95020 -NAME. HO Ne Ext , (408) 842 -2131 F� No): (408) 842 -0867 EADMDARILESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Nonprofits' Ins Alliance of CA 11845 $ 1,000,000 INSURED INSURER B $ 500,000 INSURER C: MED EXP (Any one person) Youth Alliance Inc. Diane Ortiz Post Office Box 1291 INSURER D PERSONAL & ADV INJURY . $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JEC - LOC OTHER: Hollister, CA 95024 -1291 INSURER E: PRODUCTS - COMP /OP AGG INSURER F SOCIALS_ RVC PRO $ 1,000,000 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 INSD WVD POLICY NUMBER POLICY EFF MMIDD POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE T OCCUR HNOA/Liquor Liabilit X 2015- 06291NP0 11/1612015 11116/2016 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 500,000 X MED EXP (Any one person) $ 20,000 PERSONAL & ADV INJURY . $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY JEC - LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 SOCIALS_ RVC PRO $ 1,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea eocid nt $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPER DAMAGE $ $ UMBRELLA LIAB EXCESS LIAB OCCUR EACH OCCURRENCE . $ HCLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS'COMPENSATION AND EMPLOYERS- LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatary in NH) H es, describe under DESCRIPTION OF OPERATIONS below N/A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ A Directors & Officers 2015 -06291- DO -NPO 11/16/2015 11/1612016 D&O Coverage 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Scheduie, may be attached H more space is required) Certificate holder Is named as an additional insured on an annual basis forjobs, events, locations and/or trainings, as per written contract or agreement per carrier blanket additional insured form attached. 10 days notice of cancellation for non payment & 30 days for all other. CERTIFICATE HOLDER CANCELLATION City of Gilroy Recreation Department Attn: Sandra Sammut 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2014/01) 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 n IORR -2014 The ACORD name and logo are registered. marks of ACORD All rights reserved. J` POLICY NUMBER: QDj3— o(,c,Del I NPO COMMERCIAL GENERAL LIABILITY CG 201 D 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Persons) Or Organ ization s : Locations Of Covered Operations Any person or organization that you are required to All insured premises.and operations add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your . behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after. 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be, performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed, or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. GG 2010 07 04 © ISO Properties, Inc., 2004 Page 1, of 1 ❑ YOUTALL -01 KIM RT1FT�i�TE OF- LIABILITY- IIVSl�IZ41VCF- AM(MM/DDLYY- YY) - -. 11123/2015 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 holder in lieu of such endorsement(s). PRODUCER License # 0504035 CONTACT NAME: Pacific Diversified Insurance, Inc. 9015 Murray Ste 110 408 842 2131 Gilroy, CA 95020 PNON E o FAX (408) 842 -0867 t 408 842 -2131 Arc No E-MAIL RSS: INSURERS AFFORDING COVERAGE NAICp INSURER A- Nonprofits'. Ins Alliance of CA 11845 INSURED INSURER 8: $ 1,000,000 INSURER C : CLAIMS MADE FX1 OCCUR Youth Alliance Inc. Diane Ortiz Post.Ofce Box 1291 f INSURER D: 11116l2015 11/16/2016 Hollister, CA 95024 -1291 INSURER E: X INSURER F • $ 20,000 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 INSD WVD POLICY NUMBER POLICY EFF MM/DD POLICY -EXP MM/DD - .LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE FX1 OCCUR X 2015- 06291NP0 11116l2015 11/16/2016 IpREMISES Ea occurrence $ 500,000 X MED EXP (Any one person) $ 20,000 HNOA/Liquor Liabilit PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ` 2,000,000 X POLICY F-1 PRO JECT F—] LOC PRODUCTS - COMPIOP AGG $ 2,000,000 SOCIAL S_ RVC PRO $ 1,000,000 OTHER: AUTOMOBILE LIABILITY REM' SINGLE LIMIT Ea accident $ - BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON OWNED HIRED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ HCLAIMS4VIADE AGGREGATE $ EXCESS UAB DED_ __ - RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- S TATUTE ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE , POLICY LIMIT $ A Directors & Officers 2015 -06291- DO-NPO 11/16/2015 11/16/2016 D &O Coverage 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached:H mom. space is required) Re: Use of San Ysidro Recreation Facility each week for 201512016 policy term.State or government agency or subdivision or political subdivision & City of Gilroy, k's officials,employees & volunteers are included as additional insured as respects to general liability as required by written contract or agreement, per carrier specific forms attached and an annual basis. 10 Days notice of cancellation for non payment and 30 days for all other. GtK I It-IUA I C rIULUtK VArrIiCLLA r MA'd City of Gilroy 7351 Rosanna Street Gilroy, CA 95023 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 ©1988 -2014 ACORD The ACORD name and logo are registered marks of ACORD rights reserved. POLICY NUMBER: QD1S— o('0 a - I QPC) COMMERCIAL GENERAL LIABILITY CG 2010 07 04 . THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • A, ' • _' • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Locations Of Covered Operations Any person or organization that you are required to All insured premises and operations add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule, if not shown above will be shown in the Declarations.- A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage' or ",personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage occurring after: 1. All work, including material's, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of 'your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 Pagel of 1 ❑ YOUTALL -01 KIM 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 License # 0504035 'Pacific Diversified Insurance, Inc. 9015 Murray te 110 y 408 842 2131 Gilroy, CA 95020 NAME: y� PHONE FAX A/c No 408 FAX (MC, No (408) 842 -0867 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Nonprofits' Ins Alliance of CA 11845 INSURED Youth Alliance Inc. Diane Ortiz Post Office BOX 1291 Hollister, CA 950244291 INSURER 6: X INSURERC: X INSURER D: 2015 -06291NP0 INSURER E: 11/16/2016 INSURER F: $ 1.000,000 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 CONTRACTOR 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__ SHOW_ N MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDLSUBR INSD WVD POLICY NUMBER POLICY EFF MM/DD POUCY EXP MM/DD LIMITS A. X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR HNOA/LiquorLiabilit X 2015 -06291NP0 11/16/2015 11/16/2016 EACH OCCURRENCE $ 1.000,000 DAMAGE 'PREMISES Ea occurrence $ 500,000 X MED EXP (Anyone person) $ 20,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY 1:1 PRO JECT F7 LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 SOCIAL SRVC PRO $ 1,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT a accident $ BODILY INJURY (Per person) $' BODILY INJURY (Per accident) $ PROPE Z DAMAGE $ $. UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE F7 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA / A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT. $ A Directors 8r Officers 2015 - 06291- DO -NPO 11/1612015 11116/2016 DSO Coverage 11000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) 'City of Gilroy, Its officers, representatives, agents and employees are named as additional Insured per carriers blanket additional insured form attached, as per written contract. 10 days notice of cancellation for non payment and 30 days for all other. L;LK I II-IUA 1 t r7ULUCK V/i19VGLLri I IVI7 City of Gilroy 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 REPRESENTATIVE ACORD CORPORATION. All ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: qD1S- O(a l oPc) COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Locations Of Covered Operations Any person or organization that you are required to All insured premises and operations add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule if not shown above will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", ",property damage" or "personal and advertising injury" caused, in whole or in part, try: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. CG 2010 07 04 B. With respect to the insurance afforded to these additional 'insureds, the following additional exclu- sions apply:. This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same.project. © ISO Properties, Inc., 2004 Page 1 of 1 ❑ OP ID: KW LlNCL! I owre(mmiooirrrr) CERTIFICATE OF LIABILITY INSURANCE 10123/2014 tilt RTI CEFICATE 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 thelerms 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 endorsemen s . - PRODUCER CONTACT Phone: 408 - 842 -2131 NAME: Kimberly D. White, CISR G lr ycOffice ified insurance Fax: 408- 842 -0867 PHC "N E,d ; 831- 637 -7800` No): .831- 637 -4209 . 9075 Murray Avenue #110 ADDRESS: kwhite dins.com Gilro CA 5020- .._ ____ __ PRODUCER Paci9c, - Diversified Insurance CUSTOMER ID #: HOLLIBI INSURERISI AFFORDING COVERAGE NAIC# INSURED Youth Alliance Inc: Diane Ortiz Peterson Post Office Box 1291 Hollister, CA 95024 INSURER A :. INSURER C : INSURER E INSURER F. nce Alliance COVFRAGFS CFRTIFICATF NUMRFR, REVISION NIIMRFR- THIS IS TO CERTIFY THAT THE P.OLICIES.OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT, 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 ADDL POLICY- NUMBER MMMIDD MMIDD EXP - LIMITS A GENERAL LIABILITY X' COMMERCIAL GENERAL LIABILITY - - CLAIMS -MADE, OCCUR . .. X 2014 - 06291 -NP0 11/16/2014 111/1612015 -, EACH OCCURRENCE $ 1,000,000. PREMISES Ea occurrence $ 500,00 MED EXP {Any one person) $ 20,00 PERSONAL &ADV INJURY ` $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- Xt ' LOC PRODUCTS - COMP /OP AGG $' 2;000,00 $ - A A AUTOMOBILE LIABILITY - -- r ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON- OWNEDAUTOS _ ... 2014 -06291 NPO 11/16/2014 11/1612015 COMBINED SINGLE LIMB (Ea accident) $ 1,000,00 BODILY INJURY (Per person) ' $ BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) $ X ! X $ UMBRELLA LIAB EXCESS LIAS OCCUR CLAIMS -MADE EACH000URRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $' WORKERS COMPENSATION AND EMPLOYERS - LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED. (Mandatory In`'NH) If yes ,,describe under DESCRIPTION OF.OPERAT:IONS below N`/ A WCYTATT -- OTH -; - E.L. EACH ACCIDENT - - - $ E.L. DISEASE - EA EMPLOYEE '$ E.L DISEASE = POLICY LIMIT $ A A Directors /Officers Property - $16,500 12014-06291A-DO-NPO 2014- 06291. NPO 11/16/2014 11/16/2014 11111612015 11/16/2015 Prof.Liab 11000,00 EPLI Include DESCRIPTION OF OPERATIONS'/ LOCATIONS / VEHICLES (Attach ACORD 101, Additlonal Remarks Schedule, if more space Is required) City of Gilroy, its officers, representatives, agents and employees are named as additional. irislired. City of Gilroy 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. 61988 -2009 AEDRD CnRPORATION_ Ali riahts ACORD 25 (2009109) . The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Locations Of Covered Operations Any person or organization that you are required to All insured premises and operations add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional Insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insureds) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ OP ID: KW /4f OM®° CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) F710/2312014 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 Pho_ ne: 408 -842 -2131 Pacific Diversified Insurance Gilroy Office Fax: 408 - 842 -0867 9015 Muria Avenue #110 Gilroy, CA 5020 Pacific Diversified Insurance CONTACT —: NAME: Kimberly D. White, CISR PNArc ONE FAX , E11:831-637-7800 Arc No): 831- 637 -4209 ADDRESS: kwhite@dins.com PRODUCER CUSTOMER ID #: HOLLIBI INSURER(S) AFFORDING COVERAGE NAIC # EACH OCCURRENCE INSURED Youth Alliance Inc. INSURER A: Nonprofits' Insurance Alliance $ 500,00 Diane Ortiz Peterson Post Office Box 1291 INSURER B PERSONAL & ADV INJURY $ 1,000,00 Hollister, CA 95024 INSURER C : $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP /OP AGG $ 2,000,00 INSURER D : $ INSURER E: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS INSURERF: _ ----- _ -_- -- -- -- _ - _- 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 POLICY NUMBER F POLICY D POLICY / YY LIMITS • GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X 2014-06291 -NPO 11/1612014,1111612015 EACH OCCURRENCE $ 11000,000. DAMAGE TO RFNTEff-- _PREMISES Ea occurrence $ 500,00 MED EXP (Any one person) $ 20,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP /OP AGG $ 2,000,00 $ • A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 2014-06291 NPO 11116/2014 11/16/2015 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY (Per Parson) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ $ UMBRELLA LIAB EXCESS LLAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ _ AGGREGATE $ DEDUCTIBLE RETENTION. $ - $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) IF s; describe under__ - -_ DESCRIPTION OF OPERATIONS below N / A WGSTATU- OTH- E.L. EACH ACCIDENT $ E.L_ DISEASE _- ,EA.EMPLOYEE E. L. DISEASE - POLICY LIMB • • Directors /Officers jPrOP6ttV -$16,500 2014- 06291A- DO -NPO 2014 -06291 NPO 11/16/2014 11116/2014 11/16/2015 11/1612015 Prof.Liati 11000,00 EPLI Include DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space, Is required). City of Gilroy it's officers, officials, agents, employees 6 volunteers are named As addi i onal insured per attached carder specific endorsement and per written contract. City of Gilroy 7351 Rosanna Street Gilroy, CA 95023 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 ©1988 -2009 ACORD CORPORATION. All riahts reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Locations Of Covered Operations Any person or organization that you are required to All insured premises and operations add as an additional insured on this policy, under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II Who Is An Insured is amended to B include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional Insured(s) at the location(s) desig- nated above. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than .another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑