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Al's Septic Tank Service - 2015 Agreementr AGREEMENT FOR SERVICES (For contracts of $5,000 or less — NON - DESIGN OR NON - ENGINEERING TYPE CONTRACTOR) This AGREEMENT made this 27th day of March, 2015, between: CITY: City of Gilroy, having a principal place of business at 7351 Rosanna Street, Gilroy, California and CONTRACTOR: Al's Septic Tank Service, having a principal place of business at P.O.. Box 2225, Morgan Hill, CA 95038 -2225. ARTICLE 1. TERM OF AGREEMENT This Agreement will become effective on April 6, and will continue in effect through July 1, 2016 unless terminated in accordance with the provisions of Article 7 of this Agreement. ARTICLE 2. INDEPENDENT CONTRACTOR STATUS It is the express intention of the parties that CONTRACTOR is an independent contractor and not an employee, agent, joint venturer or partner of CITY. Nothing in this Agreement shall be interpreted or construed as creating or establishing the relationship of employer and employee between CITY and CONTRACTOR or any employee or agent of CONTRACTOR. Both parties acknowledge that CONTRACTOR is not an employee for state or federal tax purposes. CONTRACTOR shall not be entitled to any of the rights or benefits afforded to CITY'S employees, including, without limitation, disability or unemployment insurance, workers' compensation, medical insurance, sick leave, retirement benefits or any other employment benefits. CONTRACTOR shall retain the right to perform services for others during the term of this Agreement. ARTICLE 3. SERVICES TO BE PERFORMED BY CONTRACTOR Specific Services CONTRACTOR agrees to: Perform the services as outlined in Exhibit "A" within the time periods described therein. Method of Performing Services CONTRACTOR shall determine the method, details and means of performing the above - described services. CITY shall have no right to, and shall not, control the manner or determine the method of accomplishing CONTRACTOR'S services. -1- 4851- 9718 -06970 LAC104706083 Employment of Assistants CONTRACTOR may, at the CONTRACTOR'S own expense, employ such assistants as CONTRACTOR deems necessary to perform the services required of CONTRACTOR by this Agreement, subject to the prohibition against assignment and subcontracting contained in Article 5 below. CITY may not control, direct, or supervise CONTRACTOR'S assistants in the performance of those services. CONTRACTOR assumes full and sole responsibility for the payment of all compensation and expenses of these assistants and for all state and federal income tax, unemployment insurance, Social Security, disability insurance and other applicable withholding. Place of Work CONTRACTOR shall perform the services required by this Agreement at any place or location and at such times as CONTRACTOR shall determine is necessary to properly and timely perform CONTRACTOR'S services. ARTICLE 4. COMPENSATION In consideration for the services to be performed by CONTRACTOR, CITY agrees to pay CONTRACTOR as provided for in Exhibit `B ", "Payment Schedule ". Invoices CONTRACTOR shall submit invoices for all services rendered. Payment Payment shall be due within thirty (30) days after receipt of invoice describing the work performed during the preceding period. If CITY objects to all or any portion of any invoice, CITY shall notify CONTRACTOR of the objection within thirty (30) days from receipt of the invoice, give reasons for the objection, and pay that portion of the invoice not in dispute. It shall not constitute a default or breach of this Agreement for CITY not to pay any invoiced amounts to which it has objected until the objection has been resolved by mutual agreement of the parties. Expenses CONTRACTOR shall be responsible for all costs and expenses incident to the performance of services for CITY, including but not limited to, all costs of equipment used or provided by CONTRACTOR, all fees, fines, licenses, bonds or taxes required of or imposed against CONTRACTOR and all other of CONTRACTOR'S costs of doing business. CITY shall not be responsible for any expenses incurred by CONTRACTOR in performing services for CITY. -2- 4851- 9718 -06970 LAD04706083 ARTICLE 5. OBLIGATIONS OF CONTRACTOR Tools and Instrumentalities CONTRACTOR shall supply all tools and instrumentalities required to perform the services under this Agreement at its sole cost and expense. CONTRACTOR is not required to purchase or rent any tools, equipment or services from CITY. Licenses CONTRACTOR shall possess a State of California Contractor's license in the appropriate category for performing services under this Agreement. CONTRACTOR shall obtain a City of Gilroy Business License. Workers' Compensation CONTRACTOR agrees to provides workers' compensation insurance for CONTRACTOR'S employees and agents and agrees to hold harmless, defend with counsel acceptable to CITY and indemnify CITY, its officers, representatives, agents and employees from and against any and all claims, suits, damages, costs, fees, demands, causes of action, losses, liabilities and expenses, including without limitation attorneys' fees, arising out of any injury, disability, or death of any of CONTRACTOR'S employees. Indemnification of Liability, Duty to Defend A. As to all liability, to the fullest extent permitted by law, CONTRACTOR shall defend, through counsel approved by CITY (which approval shall not be unreasonably withheld), indemnify and hold harmless CITY, its officers, representatives, agents and employees against any and all suits, damages, costs, fees, claims, demands, causes of action, losses, liabilities and expenses, including without limitation attorneys' fees, arising or resulting directly or indirectly from any act or omission of CONTRACTOR or CONTRACTOR'S assistants, employees or agents, including all claims relating to the injury or death of any person or damage to any property. Insurance In addition to any other obligations under this Agreement, CONTRACTOR shall, at no cost to CITY, obtain and maintain throughout the term of this Agreement: (a) Commercial Liability Insurance on a per occurrence basis, including coverage for owned and non -owned automobiles, with a minimum combined single limit coverage of $1,000,000 per occurrence for all damages due to bodily injury, sickness or disease, or death to any person, and damage to property, including the loss of use thereof. As a condition precedent to CITY'S obligations under this Agreement, CONTRACTOR shall furnish written evidence of such coverage (naming CITY, its officers and employees as additional insureds on the Comprehensive Liability insurance policy referred to in (a) immediately above via a specific endorsement)' and requiring -3- 4851- 9718 -06970 LAC104706083 thirty (30) days written notice of policy lapse or cancellation, or of a material change in policy terms. Assignment Notwithstanding any other provision of this Agreement, neither this Agreement nor any duties or obligations of CONTRACTOR under this Agreement may be assigned or subcontracted by CONTRACTOR without the prior written consent of CITY, which CITY may withhold in its sole and absolute discretion. State and Federal Taxes As CONTRACTOR is not CITY'S employee, CONTRACTOR shall be responsible for paying all required state and federal taxes. Without limiting the foregoing, CONTRACTOR acknowledges and agrees that: *CITY will not withhold FICA (Social Security) from CONTRACTOR'S payments; *CITY will not make state or federal unemployment insurance contributions on CONTRACTOR'S behalf; *CITY will not withhold state or federal income tax from payment to CONTRACTOR; *CITY will not make disability insurance contributions on behalf of CONTRACTOR; *CITY will not obtain workers' compensation insurance on behalf of CONTRACTOR. ARTICLE 6. OBLIGATIONS OF CITY Cooperation of City CITY agrees to respond to all reasonable requests of CONTRACTOR and provide access, at reasonable times following receipt by CITY of reasonable notice, to all documents reasonably necessary to the performance of CONTRACTOR'S duties under this Agreement. Assignment CITY may assign this Agreement or any duties or obligations thereunder to a successor governmental entity without the consent of CONTRACTOR. Such assignment shall not release CONTRACTOR from any of CONTRACTOR'S duties or obligations under this Agreement. events: ARTICLE 7. TERMINATION OF AGREEMENT Termination on Occurrence of Stated Events This Agreement shall terminate automatically on the occurrence of any of the following 1. Bankruptcy or insolvency of either party; -4- 4851- 9718 -06970 LAC \04706083 2. Sale of the business of either party; 3. Death of either party. Termination by City for Default of CONTRACTOR Should CONTRACTOR default in the performance of this Agreement or materially breach any of its provisions, CITY, at CITY'S option, may terminate this Agreement by giving written notification to CONTRACTOR. For the purposes of this section, material breach of this Agreement shall include, but not be limited to the following: 1. Not performing any of its services professionally and /or timely. 2. CONTRACTOR'S breach of any of its representations, warranties or covenants contained in this Agreement. CONTRACTOR shall be entitled to payment only for work satisfactorily completed through the date of the termination notice, as reasonably determined by CITY, provided that such payment shall not exceed the amounts set forth in this Agreement for the tasks described on Exhibit `B" which have been fully, competently and timely rendered by CONTRACTOR. Notwithstanding the foregoing, if CITY terminates this Agreement due to CONTRACTOR'S default in the performance of this Agreement or material breach by CONTRACTOR of any of its provisions, then in addition to any other rights and remedies CITY may have, CONTRACTOR shall reimburse CITY, within ten (10) days after demand, for any and all costs and expenses incurred by CITY in order to complete the tasks constituting the scope of work as described in this Agreement, to the extent such costs and expenses exceed the amounts CITY would have been obligated to pay CONTRACTOR for the performance of that task pursuant to this Agreement. Termination for Failure to Make Agreed -Upon Payments Should CITY fail to pay CONTRACTOR all or any part of the compensation set forth in Article 4 of this Agreement on the date due, then if and only if such nonpayment constitutes a default under this Agreement, CONTRACTOR, at the CONTRACTOR'S option, may terminate this Agreement if such default is not remedied by CITY within thirty (30) days after demand for such payment is given by CONTRACTOR to CITY,. Transition After Termination Upon termination, CONTRACTOR shall immediately stop work, unless cessation could potentially cause any damage or harm to person or property, in which case CONTRACTOR shall cease such work as soon as it is safe to do so. CONTRACTOR shall incur no further expenses in connection with this Agreement. CONTRACTOR shall promptly deliver to CITY all work done toward completion of its services, and shall act in such a manner as to facilitate any new CONTRACTOR'S assumption of duties. -5- 4851- 9718- 0697v1 LAQ04706083 ARTICLE 8. GENERAL PROVISIONS Notices Any notice to be given hereunder by either party to the other may be effected either by personal delivery in writing or by mail, registered or certified, postage prepaid with return receipt requested. Mailed notices shall be addressed to a party at the address appearing below such party's signature below, but each party may change the address by written notice in accordance with this paragraph. Notices delivered personally will be deemed delivered as of actual receipt; mailed notices will be deemed delivered as of three (3) days after mailing. Entire Agreement of the Parties This Agreement supersedes any and all prior agreements, either oral or written, between the parties hereto with respect to the rendering of services by CONTRACTOR for CITY and contains all the covenants and agreements between the parties with respect to the rendering of such services in any manner whatsoever. Each party to this Agreement acknowledges that no representations, inducements, promises or agreements, orally or otherwise, have been made by any party, or anyone acting on behalf of any party, which are not embodied herein, and that no other agreement, statement or promise not contained in this Agreement shall be valid or binding. Any modification of this Agreement will be effective only if it is in writing signed by both parties. Partial Invalidity If any provision in this Agreement is held by a court of competent jurisdiction to be invalid, void or unenforceable, the remaining provisions will nevertheless continue in full force without being impaired or invalidated in any way. Americans With Disabilities Act of 1990 Throughout the term of this Agreement, the CONTRACTOR shall comply fully with all applicable provisions of the Americans With Disabilities Act of 1990 ( "the Act") in its current form and as it may be amended from time to time. The Contractor shall also require such compliance of all subcontractors performing work under this Agreement, subject to the prohibition against assignment and subcontracting contained in Article 5 above. The CONTRACTOR shall defend with counsel acceptable to CITY, indemnify and hold harmless the CITY OF GILROY, its officers, employees, agents and representatives from and against all suits, claims, demands, damages, costs, causes of action, losses, liabilities, expenses and fees, including without limitation attorneys' fees, that may arise out of any violations of the Act by the CONTRACTOR, its subcontractors, or the officers, employees, agents or representatives of either. -6- 4851- 9718 -06970 LAC104706083 Compliance With Laws The CONTRACTOR shall keep itself informed of all State and National laws and all municipal ordinances and regulations of the CITY which in any manner affect those engaged or employed in the work, or the materials used in the work, or which in any way affect the conduct of the work, and of all such orders and decrees of bodies or tribunals having any jurisdiction or authority over the same. Without limiting the foregoing, CONTRACTOR agrees to observe the provisions of the Municipal Code of the CITY OF GILROY, obligating every contractor or subcontractor under a contract or subcontract to the CITY OF GILROY for public works or for goods or services to refrain from discriminatory employment or subcontracting practices on the basis of the race, color, sex, religious creed, national origin or ancestry of any employee, applicant for employment, or any potential subcontractor. Attorneys' Fees If any action at law or in equity, including an action for declaratory relief, is brought to enforce or interpret the provisions of this Agreement, the prevailing party will be entitled to reasonable attorneys' fees, which may be set by the court in the same action or in a separate action brought for that purpose, in addition to any other relief to which that party may be entitled. Governing Law and Venue This Agreement shall be governed by and construed in accordance with the laws of the State of California without regard to the conflict of laws or provisions of any jurisdiction. The exclusive jurisdiction and venue with respect to any and all disputes arising hereunder shall be in state and federal courts located in Santa Clara County, California. a -7- 4851- 9718 -06970 CAC104706083 Executed at Gilroy, California, on the date and year first above written. CONTRACTOR: Al's Septic Tank Service By: ;AA� > 19 Lv'9 t4 u- o Sp (Print Name) CITY: lrilill Iv WILU) Address for Notices: Address for Notices: P.O. BOX 2225 Morgan Hill, CA 95037 -2225 Social' Security or Taxpayer Identification Number: 46- 3857760 By: Title: 4851 - 9718- 0697v1 LAC104706083 7351 Rosanna Street Gilroy, CA 95020 Attn: City Administrator Approved as to Form: ity Attorney .8- EXHIBIT "A" I. SCOPE OF SERVICES Pump septic tanks at Christmas Hill Park, 7049 and 7050 Miller Avenue. Pumping schedule to be as requested by the city. II. NOTICE TO PROCEED /COMPLETION OF SERVICE A. NOTICE TO PROCEED CONTRACTOR shall commence services upon delivery to CONTRACTOR of written Notice to Proceed. B. COMPLETION OF SERVICES When CITY determines that CONTRACTOR has satisfactorily completed all of the services defined under this Agreement, CITY shall give CONTRACTOR written Notice of Final Acceptance, and CONTRACTOR shall not incur any further costs hereunder. CONTRACTOR may request this determination of completion when, in its opinion, it has satisfactorily completed .all of the services under this Agreement, and if so requested, CITY shall make this determination within two (2) weeks of such request, or if CITY determines that CONTRACTOR has not satisfactorily completed all of such services, CITY shall so inform CONTRACTOR within this two (2) week period. III. SCHEDULE Septic tank pumping to be completed as requested by the City of Gilroy. IV. DIRECT EXPENSES Direct expenses are charges and fees not included in the Scope of Services described above. CITY shall be obligated to pay only for those direct expenses which have been previously approved in writing by CITY. CONTRACTOR shall obtain written approval from CITY prior to incurring or billing of direct expenses. Copies of pertinent financial records, including invoices, will be included with the submission of billing(s) for all direct expenses. III. GENERAL PROVISIONS A. STANDARD OF WORKMANSHIP CONTRACTOR represents and warrants that it has the qualifications, skills and licenses necessary to perform the services, and its duties and obligations, expressed and implied, -9- 4851- 9718 -06970 LAC104706083 contained herein, and CITY expressly relies upon CONTRACTOR'S representations and warranties regarding its skills, qualifications and licenses. CONTRACTOR shall perform such services and duties in conformance to and consistent with the standards generally recognized as being employed by professionals in the same discipline in the State of California. B. RESPONSIBILITY OF CONTRACTOR CONTRACTOR shall be responsible for the professional quality, technical accuracy, and the coordination of the services furnished by it under this Agreement. The CITY'S review, acceptance or payment for any of the services required under this Agreement shall not be construed to operate as a waiver of any rights under this Agreement or of any cause of action arising out of the performance of this Agreement, and CONTRACTOR shall be and remain liable to CITY in accordance with applicable law for all damages to CITY caused by CONTRACTOR'S negligent performance of any of the services furnished under this Agreement. C. RIGHT OF CITY TO INSPECT RECORDS OF CONTRACTOR CITY, through its authorized employees, representatives or agents, shall have the right, at any and all reasonable times, to audit the books and records (including, but not limited to, invoices, vouchers, canceled checks, time cards, etc.) of CONTRACTOR for the purpose of verifying any and all charges made by CONTRACTOR in connection with this Agreement. CONTRACTOR shall maintain for a minimum period of three (3) years (from the date of final payment to CONTRACTOR), or for any longer period required by law, sufficient books and records in accordance with standard accounting practices to establish the correctness of all charges submitted to CITY by CONTRACTOR, all of which shall be made available to CITY at the CITY's offices within five (5) business days after CITY'S request. D. NO PLEDGING OF CITY'S CRED Under no circumstances shall CONTRACTOR have the authority or power to pledge the credit of CITY or incur any obligation in the name of CITY. E. OWNERSHIP OF MATERIAL. All material (including information developed on computer(s)) prepared (or caused to be prepared) under this Agreement shall be the property of CITY. F. NO THIRD PARTY BENEFICIARY. This Agreement shall not be construed or deemed to be an agreement for the benefit of any third party or parties, and no third party or parties shall have any claim or right of action hereunder for any cause whatsoever. G. WAIVER. -10- 4851- 9718 -06970 LAM04706083 CONTRACTOR agrees that waiver by CITY of any one or more of the conditions of performance under this Agreement shall not be construed as waiver(s) of any other condition of performance under this Agreement. H. AMENDMENTS. No alterations or changes to the terms of this Agreement shall be valid unless made in writing and signed by both parties. hereto. I. CONFLICT OF INTEREST. CONTRACTOR certifies that to the best of its knowledge, no CITY employee or office of any public agency interested in this Agreement has any pecuniary interest in the business of CONTRACTOR and that no person associated with CONTRACTOR has any interest that would constitute a conflict of interest in any manner or degree as to the execution or performance of this Agreement. J. CAPTIONS. The captions of the various sections, paragraphs and subparagraphs of this Agreement are for convenience only and shall not be considered nor referred to for resolving questions or interpretation. -11- 4851- 9718 -06970 LAC104706083 EXHIBIT "B" PAYMENT SCHEDULE Payment will be made upon completion based on $425.00 for a 1500 gallon tank or $660.00 for a 2500 gallon tank -12- 4851- 9718 -0697v1 LAC104706083 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/ODMIM 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((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 h_ older In lieu of such endonsement(s). PRODUCER Phone: 58"74-3800 Fax 800-921,5608 CONSTRUCTION SPECIALTIES INSURANCE SERVICES 100 HOWE AVENUE SUITE 200 NORTH SACRAMENTO CA 95825 mAmeA`CT Construction Specialties Insurance Services P "D"nro 8813 -874 -3800 F"'I 800 -921 -5508 E CRESS: info @csisins.com INSURERS) AFFORDING COVERAGE NAIC III Agency Lid#: OB35752 INBURERA : Security National Insurance Company _ 19879 INSURED AL'S SEPTIC TANK SERVICE, INC. - INSURER INSURER C P.O. BOX 2225 MORGAN HILL CA 95038 -2225 INSURER D: INSURER E DAMAGE TO RENTED PREMISES. Ea occurence $ 100,000 INSURER F $ 51000 COVERAGES CERTIFICATE NUMBER: 63724 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. [NOR TYPE OF INSURANCE � 'O- SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A GENERAL LIABILITY NA103817202 10120/14. '', 10120115 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES. Ea occurence $ 100,000 MED. EXP (Any one person) $ 51000 PERSONAL 8 ADV INJURY $ 1,0001000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 1,000,000 X POLICY JECT LOG $ .AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea socWenp $ ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY [d @nQ MACE $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAe CLAIMS -MADE DED I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? f� �I (Mandatory in NH) NIA WC ATU. TORYrLIMITS ER" $ E. L. EACH ACCIDENT $ E.L. DISEASE -EA EMPLOYEE $ ttESC DESCRIPTION DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) '10 DAYS NOTICE FOR NON - PAYMENT, 30 DAYS FOR ALL OTHER CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES ARE NAMED ADDITIONAL: INSURED ONLY AS THEIR INTERESTS MAY APPEAR PER FORM 49-0108 0711 ATTACHED, INCLUDES WAIVER OF SUBROGATION AND PRIMARY INSURANCE WORDING. COMPLETED OPS PER FORM CG 2 37 07 04 ATTACHED. RE: CHRISTMAS HILL PARK - 7050 MILLER AVENUE, GILROY, CA 95020. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF GILROY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN PUBLIC WORKS DEPT. ACCORDANCE WITH THE POLICY PROVISIONS. 7351 ROSANNA STREET AUTHORIZED REPRESENTATIVE GILROY, CA 95020 Attention: c _ Brett Webster ORD 25 (2010105) a 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD -BLANKET ADDITIONAL INSUREDS - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Policy Number: NA103817202 Endorsement Effective: 3/27201512:01 a.m. Named Insured Countersigned By: AL ELLIOT AL'S SEPTIC TANK SERVICE SCHEDULE Name oT Person or Organization: CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES 7351 ROSANNA STREET GILROY CA 95020 7050 MILLER AVENUE, GILROY CA 95020 (If no entry appears above, information req as applicable to this endorsement.) A. Section II — Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only to the extent that the person or organization shown in the Schedule is held liable for your acts or omissions arising out of your ongoing operations performed for that insured. S. With respect to the insurance afforded to these additional insured, the following exclusion is added: 2. Exclusions 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 site 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. C. The words "you" and "your" refer to the Named Insured shown in the Declarations. D. "Your work" means work or operations performed by you or on your behalf; and materials, parts or equipment furnished in connection with such work or operations. Primary Wording If required by written contract or agreement: Such insurance as is afforded by this policy shall be primary insurance, and any insurance or self - insurance maintained by the above additional insured(s) shall be excess of the insurance afforded to the named insured and shall not contribute to it. Waiver of Subrogation If required by written contract or agreement: We waive any right of recovery we may have against an entity that is an additional insured per the terms of this endorsement because of payments we make for injury or damage arising out of "your work" done under a contract with that person or organization. 49 -0108 0711 May Include Copyrighted Material of Insurance Services Offices, Inc. Page 1 of 1 ❑ Used with permission 6. COMMERICAL GENERAL LIABILITY CG 20 37 07 04 Policy #: NA103817202 Insured Name: AL'S SEPTIC TANK SERVICE 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, OFFICIALS SERVICE SEWAGE AND SEPTIC TANK FOR AND EMPLOYEES CITY PARK 7050 MILLER AVENUE G I LROY CA 95020 7351 ROSANNA STREET G I LROY CA 95020 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 Copyright Iso Properties, Inc., 2004 Page 1 of 1 Insured ACORR VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE WDATE 2015 °"""' Fosro7r26f s 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. This form Is used to report coverages provided to a single spoeifk vehicle or equipment Do not use this form to report liability coverage provided to muMple vehicles under a single policy. Use ACORD 25 forthat purpose. PRODUCER SrateF rm Ken Fels, Agent 605 Tennant Ave., Ste A MDIgen Hill, CA 95037 CONTACT 40 779 4186 FAX (408) 782 8080 . n L CUSTOM R WSUR AFFORDING COVERAGE NAIC f INSURED AI's Septic Tank Service PO BOX 2225 Morgan Hill. CA 95037 INSURER A X I VEHICLE L MUW INSURERS: AU THO ENTATIVE INSURER C: COMBINED SINGLE LIMIT INSURER 0: BODILY INJURY (Per person) INSURER E: DESCRIPTION OF VEHICLE OR EQUIPMENT YEAR 1997 MAKEIMANIUFACTURBR MODEL Kerlwanh T800 BODY TYPE Tank VEHICLE IDENTIFICATION NUMBER . 1XKAD29X8VR729228 DESCRIPTION ADD•L. MWD SERIAL NUMBER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICY(IES) OF INSURANCE LISTED BELOW HAS /HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD(S) 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 POUCY(IES) DESCRIBED HEREIN IS/ARE SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCY(IES). ... DLSR '.LTR. ADD•L. MWD TYPE OF INSURANCE POLICY NUMBER. P0L1CYEFFECTIVE DATE (MMIDOWW) POLICYEXPRATION DATE (MMIDOIYYYY) LIMITS LOAN J LEASE NUMBER 7351 ROSANNA ST. X I VEHICLE L MUW AU THO ENTATIVE COMBINED SINGLE LIMIT .S 1'0W'000 BODILY INJURY (Per person) S X 280 6213 F18 05B 12/1812014 06/18/2015 BODILY INJURY (Per ecddeM S PROPERTY DAMAGE S GENERILLLIA8IUTY EACHOCCURFNCE S OCCURRENCE GENERAL AGGREGATE S CLAIMS MADE 1 S INSR LTR... LOW PATME - TYPE OF INSURANCE POLICY NUMBER POLICYEFFECTNE DATE (WNDDNM) POUCYEXPSRATION. OATS (MMMWYYYY) LIIAITS I DEDUCTIBLE X VEHCOLJSION LOSS ' 280 8213 FIB 05B 12/1812014 06/18/2015 ❑ ACV ❑ AGREED AMT ❑ r3 STATED AMT S UNIT $500 DED X VEHCOMP I I VEHOTC ❑ ACV ❑ AGREED AMT S LIMIT ❑ ❑ STATED AMT $5()0 DED PROPERTY BASIC BROAD SPECIAL - ❑ ACV [:1 AGREED AMT ❑ RC E] STATED AMT ❑ S LIMIT S OED REMARKS (INCLUDING SPECIAL CONDITIONS I OTHER COVERAGES)1Attach ACORD 101, Addlllortal Remarb Sehed^ N more spas* Is required) CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES, PUBLIC WORKS 7351 ROSANNA ST GILROY CA 95020 EAMCFI 1 ATION Select one of the following: SHOULD ANY OF THE ABOVE DESCRIBED ;POLICIES BE CANCELLED The addill" Oderest desolmed below has been added to the pOICY(les) dated herein DY pddey nu7nber(4 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE a raaunt has been wbnitted to and the addhtmn trdeiest dsaalbed below to Ors ponCy(losl etdad ocifty raftler(s). DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. VEHICLE 1. EQUIPMENT INTEREST: I ILEASED I I FINANCED DESCRW71ON OF THE ADDITIONAL INTEREST - X ADOMONAL INSURED R Lose PAYEE NAME AN DA I CORESS OF ADDITIONAL INTEREST CITY OF GILROY, PUBLIC WORKS DEPT. LENDERS Loss PAYEE LOAN J LEASE NUMBER 7351 ROSANNA ST. GILROY. CA. 95020 AU THO ENTATIVE V 111IhCV 1 V AbVRY bVIVVnM r IVw. nu nynw raav •vu. ACORD 23 (2010105) The ACORD name and logo are registered marks of ACORD 1004361 142987.2 01 -28 -2013 .4CC7K VEHICLE OR EQUIPMENT CERTIFICATE OF INSURANCE r DATE"MMIDDIYYYY) osro7nots 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. This form Is used to report coverages provided to a single specific vehicle or equipment. Do not use this form to report liability coverage provided to multiple vehicles under a single policy. Use ACORD 25 for that purpose. PRODUCER StafeArm Ken Fels, Agent 605 Tennant Ave., Ste A Morgan IfIlI, CA 95037 CONTACT w {408) 7794186 Fax NP I: (408) 782 8080 _ E4MIL CUSTOM .INSURE AFFORDING COVERAGE NAICA INSURED Al's Septic Tank Service PO BOX 2225 Morgan Hill CA 95037 MSURER A: - INSURER S 'i INSURER C: COMBINED SINGLE LIMIT INSURER D: BODILY INJURY (Per. person) INSURER 'E : DESCRIPTION OF VEHICLE OR EQUIPMENT YEAR I MARE I MANUFACTURER MODEL BODY TYPE VEHICLE IDENTIFICATION NUMBER 1995 International Tank IHTGLADTOSH676617 DESCRIPTION SERIAL NUMBER COVERAGES CERTIFICATE NUMBER! REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICY(IES) OF INSURANCE LISTED BELOW HASIHAVE BEEN ISSUED TO THE INSURED NAMED.ABOVEiFOR THE POLICY PERIOD(S ) 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 POLICY(IES) DESCRIBED HEREIN ISIARE SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCY(IES), INSR LTR ADM iasRe . _— _ TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE . DATE (MMIDDIYYYY) . POLICY EXPIRATION DATE IMWDDIYYM L INIT S X I VEHICLE LIABILITY 'i COMBINED SINGLE LIMIT is 1'0W'000 BODILY INJURY (Per. person) S X 052 6917 B22 05G 08122/2014 08/2212015 BODILY INJURY (Per accit" f PROPERTY DAMAGE 'f GENERAL. LIABILITY EACH OCCURENCE $ OCCURRENCE GENERAL AGGREGATE S CLAIMS MADE S INSR LOSS POLICY EFFECTIVE POLICY EXPIRATION - LTR PAYE TYPE OF INSURANCE POLICY NUMBER DATE M MfODIYYYYI DATE (MWOOMYYY) LIMITS I DEDUCTIBLE X VEH COLLISION LOSS 052 8917 B22 05G 0812212014 0&2212015 ❑ ACV ❑ AGREED AMT ❑ ❑STATED ANT S LIMIT $500 DED X 'VEHCOMP VEHOTC ❑ ACV ❑ AGREED AMT S LIMIT ❑ ❑ STATED AMT S W. DEC, PROPERTY BASIC BROAD SPECIAL ❑ ACV ❑ AGREED AMT ❑ RC ❑. STATED AMT ❑ f LIMIT f DED LRmAms (INCLDDMo SPECIAL. DUNDITIONS / OTHER COVERAGES) (Attach ACORD 401, Additional RamaiMS BeneAUte, N more epee Is n ROO CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES, PUBLIC WORKS DEPT. 7351 ROSANNA ST GILROY,CA. 95020 rot one of the following: The addldonal Ittteteal described below has been added to the polig(ies) listed by pollry.ntimber(s). A revved hes then wbmitted to odd the aadida ml imerest described below to the porgpes) liet heiNn lWy rwm a CLE I EQUIPMENT INTEREST: I ILEASED I I FINANCED NAME CITY OF GILROY, PUBLIC WORKS DEPT. 7351 ROSANNA ST. 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 PROVMONS, DESCRIPTION OF THE ADDITIONAL INTEREST ADDITIONAL INSURED R LOSS PAYEE, LENDER'S LOSS PAYEE LOAN I LEASE NUMBER CORPORATION. All ACORD 23 (2010/05) The ACORD name and logo are registered marks of ACORD 1004381 142887.7 01-28 -2013 CALPRID OP ID: KW CERTIFICATE OF LIABILITY INSURANCE 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 DATE 042412015 04/24/2015 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 Phone: 408 -842 -2131 CONTACT NAME: Kimberly White, CISR Pacific Diversified Insurance Fax: 408 -842 -0867 Attn: Accounting Department Murray Avenue #110 Gilroy, CA 95020 Pacific Diversified Insurance PHONE 408$42 -2131 ac No : 408 - 842 -0867 ac No Et ):406-842-2131 ADDRESS: kwhite@pdins.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: CBIC Contractors Bonding & Ins 6851 INSURED Cal Pride Inc. Leo & Diane Haro 6140 Pacheco Pass Hwy. INSURER B: PREMISES Ea occurrence INSURER c A X COMMERCIAL GENERAL LIABILITY X Hollister, CA 95023 INSURER D: 12/12/2014 INSURER E: CLAIMS -MADE FX] OCCUR INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADD UB POLICY NUMBER MMDD/YYYY MM DD //YYYY ' LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 300,00 A X COMMERCIAL GENERAL LIABILITY X E11B69572. 12/12/2014 12/12/2015 CLAIMS -MADE FX] OCCUR MED EXP (Any one person) $ 5.00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000.09 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,00 X POLICY PRO L $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident - $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED AUTOS NON -OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAR DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER /EXECUTIVE WC STATU- 0TH - T IT 'R E.L. EACH, ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS' below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Re: Jobs As Per Written Contract; The City of Gilroy, its officers, officials and employees ARE NAMED AS AN ADDITIONAL INSURED per attached endorsement. City of Gilroy 7351 Rosanna St. 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 « C� (c�199R.2nln ACORn CORPORATION- All rights reserved ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is reports, surveys, field orders, amended to include as an additional in- change orders or drawings and sured any person or organization for specifications; or whom you are performing operations b. Supervisory, inspection, when you and such person or organiza- tion have agreed in a written contract or tectural or engineering activities. ri hies. agreement that such person or organi- 2. "Bodily injury" or "property damage" zation is to be added as an additional occurring after: insured on your policy. Such person or organization is an additional insured on- a. All work, including materials, ly with respect to "bodily injury or "prop- parts or equipment furnished in erty damage" caused by your negli- connection with such work, on gence in the Performance of your ongo- the project than service, ing operations performed for that addi- eother maintenance tional insured. performed by or on behalf of the additional insured(s) at the loca- A person's or organization's status as tion of the covered operations an additional insured under this en- has been completed; or dorsement ends when your operations for that additional insured are com- b. That portion of "your work" out of pleted. which the injury or damage aris- es has been put to its intended To the extent required under said written use by any person or organiza- contract or agreement, this policy will tion other than another contrac- apply as primary insurance to additional for or subcontractor engaged in insureds and other insurance which may performing operations for a prin- be available to such additionali insureds cipal as a part of the same will be non- contributory.We waive our project. right of recovery against such additional insureds. 3. "Bodily injury", "property damage" or occurring or commencing before B. With respect to the insurance afforded to execution of the written contract or these additional insureds, the following agreement that requires such per - additional exclusions apply: son or organization be added as an This insurance does not apply to: additional insured on your policy. 1. "Bodily injury", "property damage" or C. Definitions arising out of the rendering of, or the "Ongoing operations" means operations failure to render, any professional not included in the "products- completed architectural, engineering or survey- operations hazard." ing services, including but not limited to: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, a CBGL 00 71 0512 Includes copyrighted material of Page 1 of 1 Insurance Services Office, Inc., with its permission. ,sec ®REP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 5/6/2015 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 NTA Sondra Carter NAME. T PHONE (831)724 -1085 No: (831)724 -1089 P[BR Insurance Agency 1006 Freedom Boulevard. EMAIL sondra@kbkinsurance.com ADDRESS: _-... INSURERS AFFORDING COVERAGE NAIC 9 INSURERA:State Compensation Ins. Fund 35076 Watsonville CA 95076 INSURED INSURER B : PREMISES Ea occurren e Alvin James Elliott, Sr. INSURERC: CLAIMS -MADE 7 OCCUR DBA: Al r s Septic Tank Service INSURER D: P.O. BOX 2225 INSURER E: Morgan Bill CA 95038 INSURER F: COVERAGES CERTIFICATE NUMBER:CL154104909 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 ADDLSUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ PREMISES Ea occurren e $ CLAIMS -MADE 7 OCCUR MED EXP (Any one person) $ PERSONAL& ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY 7 JECT F LOC GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SIN LE LIMI Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS INJURY BODILY INJU Per accident ( ) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED. 11 RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? [7 (Mandatory In NH) If yes, RIPTIOe under DESCRIPTION OF OPERATIONS below NIA 9100009 -2015 5/20/2015 5/20/2016 PER OTH- . x STATUTE I ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 EL DISEASE - POLICY LIMIT $ 11 00,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) chris.weske @cityofgilroy.o SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Its Officers, Officials and Employees ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Department 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 Sondra Carter /SONDRA ACORD 25 (2014101) INSn25 r2mami ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AcORU® CERTIFICATE OF LIABILITY INSURANCE 164� DATE(MM/DD/YYYY) 5/6/2015 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 CONTACT Sondra Carter ICBK InsllraIICe Agency PHONE (831)724 -1085 N2): (831)724 -1089 EMAIL sondra@kbkinsurance.com ADDRESS: 1006 Freedom Boulevard INSURER(S) AFFORDING COVERAGE NAIC A INSURERA:State Compensation Ins. Fund 35076 Watsonville CA 95076 INSURED INSURER B: $ Alvin .James Elliott, Sr. INSURERC: ' $ DBA: Al's Septic Tank Service INSURER D : $ P.O. BOX 2225 INSURER E: Morgan Sill CA 95038 INSURER F : COVERAGES CERTIFICATE NUMBER:CL154104909 RFVISION NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL R POLICY NUMBER POLICY EFF POLICY EXP 20= .LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F-1 OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY E JECT PRO- F-1 LOC GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ $ OTHER: AUTOMOBILE LIABILITY MBINE I L LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAR EACH OCCURRENCE $ HOCCUR AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN P R H- 8 STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 A ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) fF yes, describe undo[ N/A 9100009 -2014 5/20/2014 5/20/2015 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 11000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) chris.weske @cityofgilroy.o SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Its Officers, Officials and Employees ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Department 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 Sondra Carter /SONDRA J--` ©1988 -2014 ACORD CORPORATION_ All riahts reserved_ ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)