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Chrisp Co. Insurance Certificate (Sub-contractor for Vanguard)q AC14ORL CERTIFICATE OF LIABILITY INSURANCE DATE 12/3/2014 DnYYY) 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([es) 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 Arthur J. Gallagher Co. Insurance Brokers of f CA, Inc. LIC #0726293 3697 Mt. Diablo Blvd., Suite 300 _NAME: Certificate Department PHONE 925- 299_1112 W 925 -953 -6270 E-MAIL . CertRequest;Jessica Easterling @ajg.com INSURE S AFFORDING COVERAGE NAIC # Lafayette CA 94549 INSURERA:Old Republic General Insurance Corp 24139 $1,000,000 INSURED INSURER 8: $50,000 Chrisp Company 43650 Osgood Road Fremont, CA 94539 INSURER C : $5,000 INSURER D : DED /OCC PERSONAL &ADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY EJ PECOT- 7 LOC OTHER: INSURER E $2,000,000 INSURER F: $2,000,000 CAVFRAnFS f_FRT1FI1_ATF MRIMRFR• 1708393343 DCVIClf%M MR11u01=0 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 POLICY Y EFF PKWY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR BI/PD: 10.000 Y Al CG99131464 2/1/2014 12/1 /2015 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $50,000 X MED EXP (Any one person ) $5,000 X DED /OCC PERSONAL &ADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY EJ PECOT- 7 LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 $ A AUTOM013ILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS AlCA99131404 2/1/2014 12/1/2015 UOMBINED SINGLE LIMIT Ea accident $1,000,000 X BODILY INJURY (Per person) $ INJURY BODILY INJY Per accident ( ) $ X DAMAGE Per. accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yyes, describe under DESCRIPTION'OFOPERATIONSbelow N/A Al CW99131404 2/1/2014 12/1/2015 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L .DISEASE - POLICY LIMIT '$1,000,000 [SEE ATTACHED SUPPL. PAGE] DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) ADDITIONAL INSURED: City of Gilroy, it's officers, officials, employees, agents and volunteers. Project: RE: Encroachment Permit Cert nvL-ur-Ic City of GilroyGilroy City Hall 7351 Rosanna Street Gilroy CA 95020 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 002749 POLICY NUMBER: AlCG99131404 COMMERCIAL GENERAL LIABILITY CG 2012 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Where required by written contract. Information required to complete this Schedule if not shown above, will be shown in the Declarations. A. Section 11 — Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. 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. 2. This insurance does not apply to:. a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products- completed operations hazard ". 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. All terms and conditions apply unless modified by this endorsement. CG 2012 0413 ® Insurance Services Office, Inc., 2012 Page 1 of 1 002749 OLD REPUBLIC GENERAL INSURANCE CORPORATION CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Location(s) of Covered Operations Or Organization(s): As required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. If so, we will share with that other insurance by the method described in paragraph 4.c. of Section IV — Commercial General Liability Conditions. All other terms and conditions remain unchanged. Named Insured Chrisp Company Policy Number CG9913.1.404 Endorsement No. Policy Period 12/1/14 to 12/1/15 Endorsement Effective Date: 12/1/2014 Producer's Name: Arthur J. Gallagher & Co. Insurance Brokers of CA, Inc. Producer Number: License #0726293 CG EN GN 0029 09 06 002749 AGENCY CUSTOMER ID: _ LOC 13: A ®® ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: AUDI I K71VAL KhMAKK5 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE: Additional Information GENERAL LIABILITY: " Additional Insured if required by written contract per attached Form CG20120413 " Coverage is Primary/Non- Contributory if required by written contract per attached CGENGN0029 0906 WORKERS' COMPENSATION: " Covered States: California, Nevada, Oregon ACORD 101 (2008101) OO 2008 ACORD CORPORATION. All riahts reserved The ACORD name and logo are registered marks of ACORD 002749