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Honeywell - Insurance Certificate�1 ® A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/28/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder. is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the 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 CONTACT NAME. Aon Risk Services Northeast, Inc. New York NY Office (AICNNC. Et), (866) 283 -7122 (A, No.): 800- 363 -0105 E-MAIL ADDRESS: 199 water Street New York NY 10038 -3551 USA INSURER(S) AFFORDING COVERAGE NAIC # RGC INSURED - INSURER A: Greenwich. Insurance Company 22322 Honeywell International. Inc_ INSURER B: XL insurance America Inc 24554 115 Tabor Road Morris Plains NJ 07950 USA INSURER C: XL Specialty Insurance Co 37885 _ INSURER D: INSURER E: $5 +'000,000 INSURER F: $50,000 COVERAGES CERTIFICATE NUMBER: 570065903733 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. Limits shown are as requested -LTR' .. TYPE_ OF INSURANCE 7NSD WVD POLICY NUMBER _ -MMIDD ,, MMIDD... _ LIMITS__ _ A X COINMERCIAL GENERAL LIABILITY RGC EACH OCCURRENCE $5,000,000' 5, 000,000 CLAIMS -MADE ❑OCCUR _PREMISES -Ea occurrence $5 +'000,000 MED EXP (Any one person) $50,000 PERSONAL &ADVINJURY $5,000,000 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5,000,000 X POLICY ❑ PRO F] LOC JECT PRODUCTS- COMP /OP AGG InCI Uded OTHER: - - - - - - — - - A AUTOMOBILE LIABILITY RAC943764204 04/01/2017 04/01/2018 COMBINED SINGLE LIMIT Ea accident $5,000,000 ADS BODILY INJURY ( Per person). X ANY AUTO BODILY INJURY (Per accident) - - - - - - OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED P PROPERTY DAMAGE - ONLY AUTOS ONLY Per. accident UMBRELLA LUU3 OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED I _ IRETENTION _ B - WORKERS COMPENSATION AND RWD943540304 - 04 01 2017 04/01/2018 X STATUTE OTH- EMPLOYERS' LUU3ILITY YIN E.L. EACH ACCIDENT $5,000,000 C ANY PROPRIETOR / PARTNER / EXECUTIVE N/A RWC943540204 RWC 04/01/2017 04/01/2018 OFFICER/MEMBER EXCLUDE D? (Mandatory 16 NH) - AK, WI E.L. DISEASE -EA EMPLOYEE S5,000,000 If yes, descrtbe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE- POLICY LIMIT $5,000,000 C Excess WC RWE943540404 04/01/2017 04/01/20181 EL Each Accident $5,000,000 AZ, OH, WA EL Disease - Ea Emp $5,000,000 SIR applies per policy ter s & conditions EL Annual Aggregate $5,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached ff more spacRi is required) [Prof: RE: City of Gilroy; Gillroy CA; Honeywell Contract # 40098419] [AI: City Of Gilroy, its officers and employees] are included as additional insured for General Liability and Automobile Liability with respect to Honeywell operations in connection with Honeywell Contract # 40098419. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED - BEFORE THE EXPIRATION DATE THEREOF; NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Clay of Gilroy AUTHORIZED REPRESENTATIVE 7351 Rosanna St Gilroy CA 95020 USA ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD m` w c a) `m O 2 M r 0 co O O Z 0) W V t: 0) V AGENCY CUSTOMER ID: 570000054391 LOC #: ACO k--- ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk services Northeast, Inc. NAMED INSURED Honeywell international Inc. - POLICY NUMBER see certificate. Number: 5700659037.33 CARRIER See certificate Number: 570065903733 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS ITHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER TYPE OF INSURANCE INSURER SUBR WVD INSURER POLICY EFFECTIVE DATE MM/DD INSURER LIMITS ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy'limits. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE MM/DD POLICY EXPIRATION DATE MM/DD LIMITS OTHER c RWE943540504 Excess WC - NM SIR applies per policy terms 04/01/2017 & conditions 04/01/2018 Excess WC Limits are statutory in AZ, OH, WA, & NM ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL RGC943763004 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 City of Gilroy, its officers and employees RE: City of Gilroy; Gilroy CA; Honeywell Contract # 40098419 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) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment 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 intended use by 'any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 ©Insurance Services Office, Inc. ISO I Commercial General Liability Forms 107/01/04 POLICY NUMBER: COMMERCIAL RGC943763004 GENERAL LIABILITY CG 20 37 07 04. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed O erations City of Gilroy, its officers and employees RE: City of Gilroy; Gilroy CA; Honeywell Contract # 40098419 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 "bodilyinjury" or "property damage" caused, in whole or in part, .by "your work "' at the location designated and described 'in the schedule of this endorsement. performed .for that additional insured and included in the '`products- completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004 ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 03/25/2016 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 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 AOn Risk SerVlCeS Northeast, Inc. New York NY Office CONTACT NAME. (A/CNNo. Ext): 1866) 283 -7122 FAX No.): 800- 363 -0105 E•MAL ADDRESS: 199 Water Street New York NY 10038 -3551 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA; Greenwich Insurance Company 22322 Honeywell International Inc. INSURER B: XL Insurance America Inc 24554 115 Tabor Road Morris Plains NJ 07950 USA INSURER C: XL Specialty Insurance Co '37885 INSURER D: INSURER E: DAMAGE TO RENTED PREMISES Ea occurrence . $5,000,000 INSURER F: MEDEXP(Any one person). $50,000 COVERAGES CERTIFICATE NUMBER: 570061522250 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 SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSR LTR TYPEOFINSURANCE INSD WVD POLICY NUMBER (MMID (MMID D - Limits A X COMMERCIAL GENERAL LIABILITY RGC EACH OCCURRENCE $5,000,000 CLAIMS -MADE ❑X OCCUR DAMAGE TO RENTED PREMISES Ea occurrence . $5,000,000 MEDEXP(Any one person). $50,000 PERSONAL & ADV INJURY $5,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $5,000,000 X POLICY PRO- JECT 'LOC PRODUCTS - COMPIOPAGG Included A AUTOMOBILE LIABILITY RAC943764203 AOS 04/01/2016 04/01/2017 COMBINED SINGLE LIMB Ea accident $5,000,000 BODILY INJURY ( Per person) X ,ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS '- HIRED AUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE I Per accident UMBRELLA LIAB EACH OCCURRENCE AGGREGATE EXCESS LI BI HOCCUR CLAIMS -MADE DED RETENTION - B - C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR I PARTNER I EXECUTIVE YIN OFFICERIMEMBEREXCLUDED? (Mandatory in NH) If YYes, describe under DESCRIPTIONS- OF'.OPERATIONS.below.E.L. NIA RWD943540303 A05 RWC943540203 AK, WI 04/01/2016 04/01/2016 04/01/2017 04/01/2017 1 X STATUTE ORTH E.L. EACH ACCIDENT $5,,000,000 rE.L. DISEASE -EA EMPLOYEE $5,000,000 DISEASE- POLICY LIMIT $5,000,000 C Excess WC RWE943540403. 04/01/2016 04/01/2017 EL Each Accident $5,000,000 AZ, OH, WA EL Disease - Ea Emp $5,000,000 SIR applies per policy ter s & conditions EL Annual Aggregate $5,000,000 'DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) [Prof: RE: city of Gilroy; Gilroy CA; Honeywell Contract # 40098419] [AI: City of Gilroy, its officers and employees] are included as additional insured for General Liability and Automobile Liability with respect to Honeywell operations to connection with Honeywell Contract # 40098419. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Gilroy AUTHORIZED REPRESENTATIVE 7351 Rosanna St Gilroy CA 95020 t15A �f 9Q ,(/'az L ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD r w c d m .a 6 0 N N t0 O r Z W V Of ci iy AGENCY CUSTOMER ID: 570000054391 LOC #: ACO �--% ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY - Aon Risk Services Northeast, Inc. NAMED INSURED Honeywell International Inc. .POLICY NUMBER see Certificate Number: 570061522250 CARRIER See certificate Number: 570061522250 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS ITHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER TYPE OF INSURANCE ' INSURER SUBR WVD INSURER POLICY EFFECTIVE DATE MM/DD INSURER LIMITS ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ' ADDL INSD SUBR WVD - _ - POLICY NUMBER POLICY EFFECTIVE DATE MM/DD POLICY EXPIRATION DATE MM/DD LIMITS OTHER C RWE943540503 Excess WC - NM ISIR applies per policy to 04/01/2016 ms & conditions 04/01/2017 Excess WC Limits are statutory in AZ, OH, WA, & NM ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL RGC943763003 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 City of Gilroy, its officers and employees RE: City of Gilroy; Gilroy CA; Honeywell Contract # 40098419 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) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment 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 intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10,07 04 © ISO Properties, Inc., 2004 ©Insurance Services Office, Inc. ISO I Commercial General Liability Forms 107/01/04 POLICY NUMBER: COMMERCIAL RGC943763003 GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization (s): Location And Description Of Completed Operations City of Gilroy, its officers and employees RE: City of Gilroy; Gilroy CA; Honeywell Contract #40098419 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section li— 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004 �1 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) I 03130/2015 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 AOn Risk Services Northeast, Inc. New York NY Office CONTACT NAME. (A C, No, �); (866) 283 -7122 FAX No.: 800- 363 -0105 199 Water Street New York NY 10038 -3551 USA E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: XL insurance America Inc 24554 Honevwell International Inc. 101 Columbia Road Morristown Ni 07962 USA INSURER B: XL Specialty Insurance Co 37885 INSURER C: Greenwich Insurance Company 22322 INSURER D: INSURER E: .PREMISES Ea occurrence) INSURER R. MED EXP (Any one person) COVERAGES CERTIFICATE NUMBER: 570057169916 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. LlmBs shown are as_ requested LTR. TYPE OF INSURANCE INSD WVD POLICY NUMBER MMR = (MWDONYYYI LIMITS C X COMMERCIAL GENERAL LIABILITY RGC EACH OCCURRENCE $5,000,000 CLAIMS -MADE X❑OCCUR .PREMISES Ea occurrence) $5,000,000 MED EXP (Any one person) $50,000 PERSONAL B ADV INJURY $5.,000,000 GEN'L AGGREGATE .LIMIT APPLIES PER: GENERAL AGGREGATE $5,000,000 X �JEa �LOC y PRODUCTS - COMP /OPAGG Included OTHER: OTHER: • AUTOMOBILE LIABILITY RAC943764202 ADS 04/01/2015 04/01/2016 COMBINED SINGLE LIMIT Ea accident $5,000,000 BODILY INJURY ( Per Penton) _ • X ANY AUTO RAC943764302 04/01/2015 04/01/2016 ALL OWNED SCHEDULED NH (Primary $1M) BODILY INJURY (Per accident) AUTOS AUTOS HIRED AUTOS P NON -OWNED AUTOS PROPERTY DAMAGE Per accident UMBRELLA LIAB EACH OCCURRENCE AGGREGATE EXCESS LIAB HOCCUR CLAIMS -MADE DED F RETENTION A B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/ PARTNER /EXECUTIVE OFFICER/MEMBEREXCLUDED7 M (Mandatory in NH) Ues, describe under SCRIPTION.OF OPERATIONS below NIA RWD943540302 ADS RWC943540202 AK, WI 0470-172015 04/01/2015 -0-470-1-70-16 04/01/2016 X I PER OTH- STATUTE 1 1.11 E.L. EACH ACCIDENT - -- - S5,000,000 E.L. DISEASE -EA EMPLOYEE .$5,000,000 - - E.L. DISEASE- POLICY LIMIT $5,000,000 C Excess Auto Lia RA0943764502 04/01/2015 04 /O1 /2016',Combined Single Lim $4,000,000 NH DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) (P.roj: RE: City of Gilroy; Gilroy CA; Honeywell Contract # 40098419] [AI: City of Gilroy, its officers and employees] are included as additional insured for General Liability and Automobile Liability with respect to Honeywell operations in connection with Honeywell Contract # 40098419. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 'DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gilroy AUTHORIZED REPRESENTATIVE 7351 Rosanna St Gilroy CA 95020 USA VIM 'ey'Al/t JL 01988 -2014 ACORD CORPORATION. All rights reserved.. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD i `m c c • 3 0 S m m H 0 n n O Z di Y 0/ v AGENCY CUSTOMER ID: 570000054391 LOC #: AG'ORO® ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY -. . .. - - .. Aon.Risk Services Northeast, Inc. -NAMED INSURED - Honeywell International Inc. POLICY NUMBER See certificate Number: 570057169916 CARRIER See Certificate Number: 570057169916 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, . FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER YP TYPE OF INSURANCE INSURER SUBR WVD INSURER .POLICY EFFECTIVE DATE M/DDNYYY INSURER LIMITS - ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. R LT LT R YP TYPE OF INSURANCE INSD SUBR WVD - POLICY POLICY NUMBER .POLICY EFFECTIVE DATE M/DDNYYY POI:ICY- - EXPERATION DATE MM/DD/YYYY LIMITS - OTHER B Excess WC RWE943540402 AZ, OH, WA SIR applies per policy teims 04/01/2015 &.conditi 04/01/2016 ns EL Each ACCideht S510001000 EL Disease - Ea Empl $5,000,000 EL Annual Aggregate $5,000,000 B RWE943540502 Excess WC - NM SIR applies per policy to 04/01/2015 ms & conditi 04/01/2016 ns ACORD 101 (2008/01) O 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL. RGC943763002 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) OrOrganization(s): Locations Of Covered Operations City of Gilroy, its officers and employees RE: City of Gilroy; Gilroy CA; Honeywell Contract #40098419 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) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment 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 intended use by any person or organization other than another contractor or subcontractor engaged in performing operations fora principal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 ©Insurance Services Office. Inc. ISO I Commercial General Liability Forms 107/01/04 POLICY NUMBER: COMMERCIAL RGC943763002 GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed O erations City of Gilroy, its officers and employees RE: City of Gilroy; Gilroy CA; Honeywell Contract # 40098419 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004