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JJR Construction - Insurance Certificates
Client#:307587 JJRCONST ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 12/30/2011 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 John Arents PHONE FAX HUB Intl Insurance Serv.Inc. (A/C, -MCAIL Ext>:925-609-6500 (ac,No): 925-609-6550 P.O.Box 4047 ADDRESS: INSURERS)AFFORDING COVERAGE NAIC# Concord,CA 94524-4047 INSURER A Wausau Underwriters Ins Co 26042 INSURED INSURER B:Liberty Insurance Corporation 42404 JJR Construction,Inc. INSURER C:Cypress Insurance Company(CA) 10855 1120 9th Avenue INSURER D: San Mateo,CA 94402 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: AIGLAWU 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 TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY YT POLICY EXP LIMITS (MM/DD/YYYY) (MM/DD/Yl'YY) A GENERAL UABIUTY TBJZ91458282022 01/01/2012 01/01/20131E EACH�OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea NTT rr0ence) $300,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $10,000 X PD Ded:1,000 PERSONAL&ADVINJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPUES PER: PRODUCTS-COMP/OP AGG $2,000,000 7 POLICY X Ytel- LOC Project Agg $15,000,000 A AUTOMOBILE LIABILITY ASJZ91458282012 01/01/2012 01/01/2013 COMBINED SINGLE LIMIT(Ea accidnt) $1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL AUTOS OWNED SCHEDULED BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) _ $ B x UMBRELLA LIAB X OCCUR TH7Z91458282032 01/01/2012 01/01/2013 EACH OCCURRENCE $5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $5,000,000 DED X RETENTION$10000 $ C WORKERS COMPENSATION 3300060435121 01/01/2012 01/01/2013 X 'r - OTH- AND EMPLOYERS'LIABILITY Y1 N TORY LIMITS ER ANY OFFICER/MEMBER EXCLUDED?PROPRIETOR/PARTNER/EXECUTIVE N/A E.L EACH ACCIDENT $1,000,000 (Mandatory In NH) E.L DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) Re:Project#09-CDD-171, Federal Project#ESPL-5034(20)-Citywide Sidewalk Rehabilitation Project. The City of Gilroy,its elected and appointed officers,officials,employees and volunteers as Additional Insured as respects General Liability and coverage is Primary&Non-Contributory per attached form LG 3180/0907(section 10).Auto Liability Additional Insured per CA2048/0299,primary wording per CA 00 01/0310.Workers Compensation Waiver of Subrogation per WC990410A.All as required by written contract. CERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Community Development Department ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy,CA 95020 AUTHORIZED REPRESENTATIVE 4rogeeeedraPar■ ACORD CORPORATION.All rights reserved. ACORD 25(2010/05) 1 of 1 The ACORD name and logo are registered marks of ACORD #S1485725/M1471231 KM47 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIBERTY DirectSolutions for Contractors This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART This endorsement modifies insurance by broadening the insurance provided by CG 00 01. Index of modified items: Item 1–REASONABLE FORCE Item 2.-NON-OWNED WATERCRAFT EXTENSION Item 3.-ALIENATED PREMISES Item 4.-PROPERTY IN YOUR CARE,CUSTODY OR CONTROL Item 5.-DAMAGE TO PREMISES RENTED TO YOU-EXPANDED COVERAGE Item 6.-BODILY INJURY TO CO-EMPLOYEES Item 7.-HEALTH CARE PROFESSIONALS AS INSUREDS Item 8.-NEWLY FORMED OR ACQUIRED ENTITIES Item 9.-BLANKET ADDITIONAL INSURED AND WAIVER OF SUBROGATION—MANAGERS OR LESSORS OF PREMISES Item 10.-EXPANDED BLANKET ADDITIONAL INSURED AND WAIVER OF SUBROGATION(FOR INSTALLATION EXPOSURES) Item 11.-BLANKET ADDITIONAL INSURED AND WAIVER OF SUBROGATION–PERSON OR ORGANIZATION Item 12.-ADDITIONAL INSURED–ARCHITECTS,ENGINEERS OR SURVEYORS Item 13.-ADDITIONAL INSURED–STATE,MUNICIPALITY OR POLITICAL SUBDIVISION-PERMITS Item 14.-ADDITIONAL INSURED AND WAIVER OF SUBROGATION–LESSOR OF LEASED EQUIPMENT Item 15.-KNOWLEDGE OF OCCURRENCE Item 16.-UNINTENTIONAL ERRORS AND OMISSIONS Item 17.-BODILY INJURY REDEFINITION Item 18.-MOBILE EQUIPMENT REDEFINITION Item 19.-SUPPLEMENTARY PAYMENTS Item 20.-LIBERALIZATION These changes broaden the policy sections described unless differing language is separately endorsed to the coverage part. Item 1.-REASONABLE FORCE Exclusion a.of Coverage A is replaced by the following: a. Expected or Intended Injury "Bodily injury"or"property damage"expected or intended from the standpoint of the insured. This exclusion does not apply to "bodily injury" or "property damage" resulting from the use of reasonable force to protect persons or property. Item 2.-NON-OWNED WATERCRAFT EXTENSION Subparagraph g.(2)of Exclusion g.of Coverage A(Section I-Coverages)is replaced by the following: (2) A watercraft you do not own that is: (a) Less than 55 feet long;and (b) Not being used for public transportation or as a common carrier. Item 3.-ALIENATED PREMISES 1. Subparagraph j.(2) of Exclusions of Section I – Coverages – Bodily Injury And Property Damage Liability is replaced by the following: LG 3180 09 07 Page 1 of 8 (2) Premises you sell,give away,or abandon,if the"property damage"arises out of any part of those premises, and occurs from hazards that were known by you,or should have reasonably been known by you,at the time the property was transferred or abandoned. Item 4.-PROPERTY IN YOUR CARE,CUSTODY OR CONTROL 1. Subparagraphs(3)and(4)of exclusion j.of coverage A.do not apply except to (a) borrowed equipment,or C (b) "property damage"to property in your care,custody and control while in transit. This insurance does not apply to any portion of a loss for which the insured has available any other valid and collectible insurance,whether primary,excess,contingent,or on any other basis,unless such other insurance was specifically purchased by the insured to apply in excess of this policy. 2. Limits of Insurance Subject to Paragraphs 2., 3., and 5. of Section III — Limits Of Insurance, the most we will pay for insurance provided by paragraph 1.,above is: $10,000 Each Occurrence Limit $25,000 Aggregate Limit The Each Occurrence Limit for this coverage applies to all damages as a result of any one"occurrence"regardless of the number of persons or organizations who sustain damage because of that"occurrence." The Aggregate Limit is the most we will pay for the sum of all occurrences covered by this provision. Item S.-DAMAGE TO PREMISES RENTED TO YOU-EXPANDED COVERAGE A.Fire,Lightning Or Explosion Damage The last paragraph of 2.Exclusions under Section I—Coverage A is replaced by the following: Exclusions c. through n. do not apply to damage to premises rented to you or temporarily occupied by you with permission of the owner when the damage is caused by fire, lightning, or explosion or subsequent damages resulting from such fire,lightning or explosion,including water damage. A separate limit of insurance applies to this coverage as described in Section III—Limits of Insurance. B.Limits for Damage to Premises Rented to You Paragraph 6.of Section III—Limits of Insurance is replaced by the following: Subject to 5. above,the Damage to Premises Rented to You Limit is the most we will pay under Coverage A for any combination of: (a) damage caused by fire,lightning,or explosion or subsequent damages resulting from such fire, lightning or explosion,including water damage to premises rented to you,or temporarily occupied by you with permission of the owner;and (b) "property damage"(other than damage by fire)to premises,including the contents of such premises,rented to you for a period of 7 or fewer consecutive days. Item 6.-BODILY INJURY TO CO-EMPLOYEES 1. Subject to the Each Occurrence Limit and the General Aggregate Timit,Paragraphs 2.a.(1)(a),(b)and(c)of SECTION II—Who Is an Insured do not apply to your supervisory or management"employees"for"bodily injury"only. 2. Subject to the Each Occurrence Limit and the General Aggregate Limit,Paragraphs 2.a.(1)(a),(b)and(c)of SECTION II—Who Is an Insured do not apply to your"employees"or"volunteer workers"for"bodily injury" arising out of a Good Samaritan act to a co-"employee"or co-"volunteer worker." A Good Samaritan act means an attempt to rescue or aid a person in imminent or serious peril,provided the attempt is not recklessly made. Damages owed to an injured co-"employee"or"volunteer worker"will be reduced by any amount paid or available to the injured co-"employee"or"volunteer worker"under any other valid and collectible insurance. LG 31 80 09 07 Page 2 of 8 Item 7.-HEALTH CARE PROFESSIONALS AS INSUREDS Paragraph 2.a.(1)(d)of Section II–Who Is An Insured is deleted unless: (i) You are engaged in the occupation or business of providing or offering medical, surgical, dental, x-ray or nursing services,treatment,advice or instruction;or (ii) The"employee"has any other insurance that would also cover claims arising under this provision,whether the other insurance is primary,excess,contingent or on any other basis. Item 8.-NEWLY FORMED OR ACQUIRED ENTITIES Paragraph 3.of Section II–Who Is An Insured is replaced by the following: 3. Any organization,other than a joint venture,you newly acquire or form and over which you maintain majority ownership or majority interest,will qualify as a Named Insured if there is no other similar insurance available to that organization. a. Coverage under this provision is afforded only until i. the 180th day after you acquire or form the organization;or ii. separate coverage is purchased for the organization;or iii. the end of the policy period, whichever is earlier. b. Coverage A does not apply to"bodily injury"or"property damage"that occurred before you acquired or formed the organization;and c. Coverage B does not apply to"personal and advertising injury"arising out of an offense committed before you acquired or formed the organization. No person or organization is an insured with respect to the conduct of any past partnership, current or past joint venture or past limited liability company that is not shown as a Named Insured in the Declarations. Item 9. -BLANKET ADDITIONAL INSURED AND WAIVER OF SUBROGATION—MANAGERS OR LESSORS OF PREMISES A. Section II–Who Is An Insured is amended to include as an insured any manager or lessor of premises leased by you in which the written lease agreement obligates you to procure additional insured coverage,provided that 1. the "bodily injury", "property damage" or "personal and advertising injury" giving rise to liability occurs subsequent to the execution of the agreement;and 2. the written agreement is in effect at the time of the "bodily injury", "property damage", "personal and advertising injury"for which coverage is sought. That person or organization shall be referred to as the additional insured. The coverage afforded to the additional insured is limited to liability in connection with the ownership,maintenance or use of the premises leased to you and caused,in whole or in part, by some negligent acts or omissions of you, your employees,your agents, or your subcontractors. There is no coverage for the additional insured for"bodily injury", "property damage"or"personal and advertising injury"arising out of the sole negligence of the additional insured or by those acting on behalf of the additional insured,except as provided below. If the written agreement to indemnify an additional insured requires that you indemnify the additional insured for its sole negligence,then the coverage for the additional insured shall conform to that agreement;provided,however,that the contractual indemnification language of the agreement is valid under the law of the state where the agreement was formed. If the written agreement provides that a particular state's law will apply,then such provision will be honored. B. Waiver Of Subrogation For any additional insured that obtains insured status on this policy through paragraph A.,above,we waive any right of recovery we may have against the additional insured because of payments we make for "bodily injury", "property damage"or"personal and advertising injury"to which this insurance applies. C. Exclusions This insurance does not apply to: 1. Any"occurrence"that takes place after you cease to be a tenant in that premises. LG 31 80 09 07 Page 3 of 8 2. Any construction,renovation,demolition or installation operations performed by or on behalf of the Additional Insured. 3. Any premises for which coverage is excluded by endorsement. D. Other Insurance _ The insurance provided by this endorsement applies only to coverages and limits of insurance required by written agreement,but in no event exceeds either the scope of coverage or the limits of insurance available within this policy. This insurance shall be excess over any other insurance available to the additional insured,whether such insurance is on an excess,contingent or primary basis,unless you are obligated under a written agreement to provide liability insurance for that additional insured on any other basis. In that event,this policy will apply solely on the basis required by such written agreement. To the extent that the additional insured has the right to pursue any other insurance carrier for coverage, including a defense,we shall share that right with the additional insured. Item 10.- EXPANDED BLANKET ADDITIONAL INSURED AND WAIVER OF SUBROGATION(FOR INSTALLATION EXPOSURES) A. Section II—Who Is An Insured is amended to include as an insured any person or organization to whom you are obligated by a written agreement to procure additional insured coverage,provided that: 1. the "bodily injury," "property damage," or "personal and advertising injury" giving rise to liability occurs subsequent to the execution of the written agreement;and 2. the written agreement is in effect at the time of the "bodily injury," "property damage," or "personal and advertising injury"for which coverage is sought. That person or organization shall be referred to as the additional insured. The coverage afforded to the additional insured is limited to liability caused,in whole or in part,by the negligent acts or omissions of you,your employees,your agents,or your subcontractors,in the performance of your ongoing operations. This insurance does not apply to"bodily injury,"or"property damage,""personal and advertising injury"arising out of "your work"included in the"products-completed operations hazard"unless you are required to provide such coverage for the additional insured by the written agreement, and then only for the period of time required by the written agreement and only for liability caused,in whole or in part,by the negligent acts or omissions of you,your employees, your agents,or your subcontractors. There is no coverage for the additional insured for "bodily injury", "property damage" or "personal and advertising injury"arising out of the sole negligence of the additional insured or by those acting on behalf of the additional insured, except as provided below. If the written agreement to indemnify an additional insured requires that you indemnify the additional insured for its sole negligence, then the coverage for the additional insured shall conform to that agreement;provided,however,that the contractual indemnification language of the agreement is valid under the law of the state where the agreement was formed. If the written agreement provides that a particular state's law will apply,then such provision will be honored. B. Waiver Of Subrogation For any additional insured that obtains insured status on this policy through paragraph A.,above,we waive any right of recovery we may have against the additional insured because of payments we make for "bodily injury", "property damage"or"personal and advertising injury"to which this insurance applies. C. Exclusions With respect to the insurance afforded to these additional insureds,the following additional exclusions apply: LG 31 80 09 07 Page 4 of 8 This insurance does not apply: 1.to"bodily injury","property damage"or"personal and advertising injury" arising out of the rendering of or the failure to render,any professional architectural,engineering or surveying services,including: a. The preparing,approving,or failing to prepare or approve,maps,shop drawings,opinions,reports,surveys, field orders,change orders or drawings and specifications;or b. Supervisory,inspection,architectural or engineering activities. 2. to "bodily injury" or"property damage" that occurs during the ongoing operations of a project where you have purchased an Owners&Contractors Protective Liability or Railroad Protective Liability Policy for the additional insured. 3. when coverage is available under a consolidated(wrap up)insurance program in which you are involved. D.Other Insurance The insurance provided by this endorsement applies only to coverages and limits of insurance required by written agreement,but in no event exceeds either the scope of coverage or the limits of insurance available within this policy. This insurance shall be excess over any other insurance available to the additional insured,whether such insurance is on an excess,contingent or primary basis,unless you are obligated under a written agreement to provide liability insurance for that additional insured on any other basis. In that event,this policy will apply solely on the basis required by such written agreement. To the extent that the additional insured has the right to pursue any other insurance carrier for coverage,including a defense,we shall share that right with the additional insured. Item 11.-BLANKET ADDITIONAL INSURED AND WAIVER OF SUBROGATION—PERSON OR ORGANIZATION A. Section II—Who Is An Insured is amended to include as an additional insured any person or organization to whom you are obligated by a written agreement to procure additional insured coverage,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 premises owned by you provided that: (a) the "bodily injury", "property damage" or "personal and advertising injury" giving rise to liability occurs subsequent to the execution of the agreement;and (b) the written agreement is in effect at the time of the"bodily injury","property damage", "personal injury"or "advertising injury"for which coverage is sought. That person or organization shall be referred to as the additional insured. There is no coverage for the additional insured for "bodily injury", "property damage" or "personal and advertising injury"arising out of the sole negligence of the additional insured or by those acting on behalf of the additional insured, except as provided below. If the written agreement to indemnify an additional insured requires that you indemnify the additional insured for its sole negligence, then the coverage for the additional insured shall conform to that agreement; provided,however,that the contractual indemnification language of the agreement is valid under the law of the state where the agreement was formed. If the written agreement provides that a particular state's law will apply,then such provision will be honored. B. Waiver Of Subrogation For any additional insured that obtains insured status on this policy through paragraph A.,above,we waive any right of recovery we may have against the additional insured because of payments we make for "bodily injury", "property damage"or"personal and advertising injury"to which this insurance applies. LG 31 80 09 07 Page 5 of 8 C. Exclusions This insurance does not apply to: 1. Any premises or equipment leased to you. 2. Any construction,renovation,demolition or installation operations performed by or on behalf of you,or those _ operating on your behalf. D.Other Insurance O The insurance provided by this endorsement applies only to coverages and limits of insurance required by written agreement,but in no event exceeds either the scope of coverage or the limits of insurance available within this policy. This insurance shall be excess over any other insurance available to the additional insured,whether such insurance is on an excess,contingent or primary basis,unless you are obligated under a written agreement to provide liability insurance for that additional insured on any other basis. In that event,this policy will apply solely on the basis required by such written agreement. To the extent that the additional insured has the right to pursue any other insurance carrier for coverage,including a defense,we shall share that right with the additional insured. Item 12.-ADDITIONAL INSURED—ARCHITECTS,ENGINEERS OR SURVEYORS A. Section II—Who Is An Insured is amended to include as an additional insured any architect,engineer,or surveyor engaged by you 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 connection with your premises;or 2. In the performance of your ongoing operations. B. With respect to the insurance afforded to these additional insureds,the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage"or"personal and advertising injury"arising out of the rendering of or the failure to render any professional services by or for you,including. 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders,change orders or drawings and specifications;or 2.Supervisory,inspection,architectural or engineering activities. Item 13.-ADDITIONAL INSURED—STATE,MUNICIPALITY OR POLITICAL SUBDIVISION-PERMITS Section II—Who Is An Insured is amended to include as an additional insured any state, municipality or political subdivision with respect to any operations performed by you, or on your behalf, for which the state, municipality or political subdivision has issued a permit However,this insurance does not apply to: 1. "Bodily injury," "property damage" or "personal and advertising injury" arising out of operations performed for the state,municipality or political subdivision;or 2. Any "bodily injury" or "property damage" included within the "products-completed operations hazard", except when required by written contract or agreement initiated prior to loss;or 3. `Bodily injury," "property damage" or "personal and advertising injury," unless negligently caused, in whole or in part,by you or those acting on your behalf. Item 14.-ADDITIONAL INSURED AND WAIVER OF SUBROGATION—LESSOR OF LEASED EQUIPMENT A. Section II -Who Is An Insured is amended to include as an additional insured any person or organization from whom you lease equipment when you and such person or organization have agreed in a written agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused,in whole or in part,by your maintenance,operation or use of equipment leased to you by such person or organization. There is no coverage for the additional insured for"bodily injury", "property damage"or"personal and advertising injury" arising out of the sole negligence of the additional insured or by those acting on behalf of the additional insured. LG 31 80 09 07 Page 6 of 8 A person's or organization's status as an additional insured under this endorsement ends when the agreement with you for such leased equipment ends. B.Waiver of Subrogation For any additional insured that obtains insured status on this policy through paragraph A.,above,we waive any right of recovery we may have against the additional insured because of payments we make for "bodily injury", "property damage" or "personal and advertising injury" caused,in whole or in part,by your maintenance, operation or use of equipment leased to you by such person or organization. C. Other Insurance This insurance shall be excess over any other insurance available to the additional insured,whether such insurance is on an excess, contingent or primary basis, unless you are obligated under a written agreement to provide liability insurance for that additional insured on any other basis. In that event, this policy will apply solely on the basis required by such written agreement. To the extent that the additional insured has the right to pursue any other insurance carrier for coverage,including a defense,we shall share that right with the additional insured. Item 15.-KNOWLEDGE OF OCCURRENCE Subparagraph 2.a.,b. and c. of Condition 2. Section IV—Commercial General Liability Conditions are amended to add the following: As used in this paragraph,the word"you"refers to an"executive officer",partner,member or legal representative,and any other"employee"with insurance or risk management responsibilities. Item 16.-UNINTENTIONAL ERRORS AND OMISSIONS Paragraph 6.of Section IV—Commercial General Liability Conditions is amended to add the following. Any unintentional error or omission in the description of, or failure to completely describe, any premises or operations intended to be covered by this policy will not invalidate or affect coverage for those premises or operations. However,you must report such error or omission to us as soon as practicable after its discovery. This provision does not affect our right to collect additional premium or exercise our right of cancellation or non- renewal. Item 17.-BODILY INJURY REDEFINITION The definition of"bodily injury"in Section V-DEFINITIONS section is replaced by the following: "Bodily injury"means bodily injury,sickness or disease sustained by a person. It includes death or mental anguish, which results at any time from such physical harm,physical sickness or physical disease. Mental anguish means any type of mental or emotional illness or distress. Item 18.-MOBILE EQUIPMENT REDEFINITION Paragraph 12.f.(1) (a),(b) and(c)of Section V—Definitions does not apply to self-propelled vehicles of less than 1000 pounds gross vehicle weight. Item 19.-SUPPLEMENTARY PAYMENTS Section I - Coverages, Supplementary Payments - Coverages A and B,item 1. b. and 1. d., respectively, are replaced with: b. Up to$2,500 for cost of bail bonds required because of accidents or traffic law violations arising out of the use of any vehicle to which the Bodily Injury Liability Coverage applies. We do not have to furnish these bonds. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or"suit"including substantiated loss of earnings up to$500 a day because of time off from work. LG 31 80 09 07 Page 7 of 8 Item 20.-LIBERALIZATION Section IV-Commercial General Liability Conditions is amended to add the following: 10. Liberalization If we adopt a change in our forms or rule which would broaden your coverage without an extra charge, the broader coverage will apply to this policy. This extension is effective upon the approval of such p broader coverage in your state. This endorsement is executed by the Premium $ Effective Date 01/01/2012 Expiration Date 01/01/2013 For attachment to Policy No. TBJZ91458282022 Audit Basis Issued To JJR Construction,Inc. bicf- SECRETARY PRESIDENT Countersigned by Authorized Representative Issued Sales Office and No. End.Serial No. LG 31 80 09 07 Page 8 of 8 POLICY NUMBER: ASJZ91458282012 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: 01/01/2012 Named Insured: JJR Construction, Inc. (Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): Any person or organization where the named insured has agreed by written contract to include such person or organization as a designated insured. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 COMMERCIAL AUTO • b. Return the stolen property, at our ex- pense. We will pay for any damage that results to the "auto"from the theft; or a. For any covered "auto" you own, this coverage form provides primary insur- c. Take all or any part of the damaged or ance. For any covered "auto" you don't stolen property at an agreed or appraised own, the insurance provided by this cov- value. erage form is excess over any other col- — If we pay for the "loss", our payment will in- lectible insurance. However, while a coy- dude the applicable sales tax for the dam- ered "auto" which is a "trailer" is con- aged or stolen property. nected to another vehicle, the Liability Coverage this coverage form provides for 5. Transfer Of Rights Of Recovery Against the"trailer"is: Others To Us If any person or organization to or for whom (1) Excess while it is connected to a mo- tor vehicle you do not own. we make payment under this coverage form has rights to recover damages from another, (2) Primary while it is connected to a those rights are transferred to us. That person covered "auto"you own. or organization must do everything necessary b. For Hired Auto Physical Damage Cover- to secure our rights and must do nothing after age, any covered "auto" you lease, hire, "accident"or"loss"to impair them. rent or borrow is deemed to be a covered B. General Conditions "auto" you own. However, any "auto"that is leased, hired, rented or borrowed with 1. Bankruptcy a driver is not a covered "auto". Bankruptcy or insolvency of the "insured" or c. Regardless of the provisions of Para- the"insured's"estate will not relieve us of any graph a. above, this coverage form's Li- obligations under this coverage form. ability Coverage is primary for any liability 2. Concealment, Misrepresentation Or Fraud assumed under an "insured contract". • This coverage form is void in any case of d. When this coverage form and any other fraud by you at any time as it relates to this coverage form or policy covers on the — coverage form. It is also void if you or any same basis, either excess or primary, we other"insured", at any time, intentionally con- will pay only our share. Our share is the ceal or misrepresent a material fact concern- proportion that the Limit of Insurance of ing: our coverage form bears to the total of .° a. This coverage form; the limits of all the coverage forms and policies covering on the same basis. b. The covered "auto"; 6. Premium Audit c. Your interest in the covered "auto"; or a. The estimated premium for this coverage d. A claim under this coverage form. form is based on the exposures you told 3. Liberalization us you would have when this policy be- If we revise this coverage form to provide San. We will compute the final premium more coverage without additional premium due when we determine your actual ex- °- charge, your policy will automatically provide posures. The estimated total premium will be credited against the final premium due the additional coverage as of the day the re- and the first Named Insured will be billed vision is effective in your state. for the balance, if any. The due date for 4. No Benefit To Bailee – Physical Damage the final premium or retrospective pre- 0= Coverages mium is the date shown as the due date °— We will not recognize any assignment or on the bill. If the estimated total premium grant any coverage for the benefit of any per- exceeds the final premium due, the first son or organization holding, storing or trans- Named Insured will get a refund. porting property for a fee regardless of any b. If this policy is issued for more than one ■ other provision of this coverage form. year, the premium for this coverage form • will be computed annually based on our rates or premiums in effect at the begin- ning of each year of the policy. CA 00 01 03 10 © Insurance Services Office, Inc., 2009 Page 9 of 12 0113e7 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 04 10A(Ed 07-07) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA BLANKET BASIS We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you _ perform work under a written contract that requires you to obtain this agreement from us.) The additional premium for this endorsement shall be 2.00 %of the total policy premium otherwise due on such remuneration. The minimum premium for this endorsement is$ 35n nn Schedule Person or Organization Job Description ALL ORGANIZATIONS FOR WHOM THE WAIVER OF SUBROGATION IS ALL CALIFORNIA OPERATIONS ISSUED This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 01/01/2012 Policy No. 3300060435-121 Endorsement No. 1 Insured JJR CONSTRUCTION, INC. Premium$ Insurance Company Countersigned by Cypress Insurance Company WC 99 04 10A (Ed 07-07) John Arents HUB Int 1 Insurance Serv. Inc. P.O. Box 4047 Concord, CA 94524-4047 City of Gilroy Community Development Department 7351 ROSANNA ST GILROY CA 95020-6141 Client#:307587 JJRCONST ACORD,... CERTIFICATE OF LIABILITY INSURANCE DATE( 011 Y) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION C.D. Behrens 925-609-6500 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HUB Int'I Insurance Serv. Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 4047 Concord,CA 94524-4047 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Indemnity Co of 25682 - JJR Construction,Inc. INSURER B: Travelers Property Casualty Co 25674 1120-9th Avenue INSURER C: San Mateo,CA 94402 INSURER D: INSURER E: AIGLAWU COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'LJ I POLICY EFFECTIVE POLICY EXPIRATION LTR INSRE TYPE OF INSURANCE POLICY NUMBER DATE(MM!DD,YYYY) DATE(MM!DDIYYYY) LIMITS A GENERAL LIABILITY 4T22C03629P063TCT1 01/01/2011 01/01/2012 EACH OCCURRENCE $1,000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED X PREMISES(Ea occurrence) $300,000 CLAIMS MADE X OCCUR MED EXP(Any one person) $10,000 X PD Ded:1.000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 7 POLICY X J�CT LOC A AUTOMOBILE LIABILITY BA3629P06311 CNS 01/01/2011 01/01/2012 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person) S ii HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABILITY 4TSMCUP3629P063TIL 01/01/2011 01/01/2012 EACH OCCURRENCE $5,000,000 , © OCCUR CLAIMS MADE AGGREGATE $5,000,000 $ ■ DEDUCTIBLE $ X RETENTION S 10000 $ B WORKERS COMPENSATION AND 4TJUB3629P06311 01/01/2011 01/01/2012 X TORYLIMITS OER EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE n E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re:Sidewalk Improvement Project No.09-CDD-166 and Curb Ramp Improvement Project No.09-CCD-165. The City of Gilroy,its elected and appointed officers,officials,employees and volunteers as Additional Insured as respects General Liability,and coverage is Primary&Non-Contributory,per attached form CGD246 0805.Auto Liability Additional Insured per CAT420 0706, primary wording per CA0001 0306. Workers Compensation Waiver of Subrogation per WC990376/00.All as required by written contract. CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Gilroy DATE THEREOF,THE ISSUING INSURER WILL MAIL 3n DAYS WRITTEN Community Development Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,gmacomorg000metx 7351 Rosanna Street Me 1001101XMATIRDC aRXEAfatt)002F XXXM ►cxel6cION99F )03KINctxx Gilroy,CA 95020 RRIMUXDOCKPZZU A •p_E•R P- NTATIVE i.,, .e_. ACORD 25(2009/01)1 of 2 #S1018712/M1017024 0 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SK42 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2009/01) 2 of 2 #S1018712/M1017024 POLICY NUMBER: 4T22C03629P063TCT11 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY — BLANKET ADDITIONAL INSURED (CONTRACTORS) - This endorsement modifies insurance provided under the following: — COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED p (Section II) is amended sured does not apply to "bodily injury" or to include any person or organization that you "property damage" caused by "your work" agree in a "written contract requiring insurance" and included in the "products-completed op- to include as an additional insured on this Cover- erations hazard" unless the "written contract age Part,but: requiring insurance" specifically requires you to provide such coverage for that additional a) Only with respect to liability for "bodily injury", insured, and then the insurance provided to "property damage"or"personal injury";and the additional insured applies only to such b) If, and only to the extent that, the injury or "bodily injury" or "property damage" that oc damage is caused by acts or omissions of curs before the end of the period of time for you or your subcontractor in the performance which the "written contract requiring insur of "your work" to which the "written contract ance" requires you to provide such coverage requiring insurance" applies. The person or or the end of the policy period, whichever is organization does not qualify as an additional earlier. insured with respect to the independent acts or omissions of such person or organization. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and 2. The insurance provided to the additional insured collectible "other insurance", whether primary, by this endorsement is limited as follows: excess, contingent or on any other basis, that is a) In the event that the Limits of Insurance of available to the additional insured for a loss we cover under this endorsement. However, if the"written this Coverage Part shown in the Declarations contract requiring insurance" specifically requires exceed the limits of liability required by the that this insurance apply on a primary basis or a "written contract requiring insurance", the in- primary and non-contributory basis, this surance provided to the additional insured insurance is primary to "other insurance" shall be limited to the limits of liability re- quired by that "written contract requiring in- available to the additional insured which covers surance". This endorsement shall not in- that person or organization as a named insured crease the limits of insurance described in for such loss, and we will not share with that Section III p Limits Of Insurance. "other insurance". But the insurance provided to the additional insured by this endorsement still is b) The insurance provided to the additional in- excess over any valid and collectible "other in- sured does not apply to "bodily injury", "prop- surance", whether primary, excess, contingent or erty damage" or "personal injury" arising out on any other basis, that is available to the addi- of the rendering of, or failure to render, any tional insured when that person or organization is professional architectural, engineering or sur an additional insured under such "other insur- veying services,including: ance". I. The preparing, approving, or failing to 4. As a condition of coverage provided to the prepare or approve, maps, shop draw- additional insured by this endorsement: ings, opinions, reports, surveys, field or- a) The additional insured must give us written ders or change orders, or the preparing, notice as soon as practicable of an "occur- approving, or failing to prepare or ap- rence" or an offense which may result in a prove,drawings and specifications;and claim. To the extent possible, such notice ii. Supervisory, inspection, architectural or should include: engineering activities. c) The insurance provided to the additional in- CG D2 46 08 05 ' 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" any provider of "other insurance" which would or offense took place; cover the additional insured for a loss we ii. The names and addresses of any injured cover under this endorsement. However, this — persons and witnesses;and condition does not affect whether the insur- ance provided to the additional insured by iii. The nature and location of any injury or this endorsement is primary to "other insur- — damage arising out of the "occurrence" or ance" available to the additional insured _ offense. which covers that person or organization as a named insured as described in paragraph 3. b) If a claim is made or "suit" is brought against above. — the additional insured, the additional insured must: 5. The following definition is added to SECTION V. i. Immediately record the specifics of the ['DEFINITIONS: claim or"suit"and the date received;and "Written contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement under which you are required to include a The additional insured must see to it that we person or organization as an additional in- receive written notice of the claim or "suit" as sured on this Coverage Part, provided that soon as practicable. the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or "suit", cooperate with us in the investigation or settlement of a. After the signing and execution of the the claim or defense against the "suit", and contract or agreement by you; otherwise comply with all policy conditions. b. While that part of the contract or agreement is in effect;and d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to c. Before the end of the policy period. Page 2 of 2 ' 2005 The St.Paul Travelers Companies, Inc. CG D2 46 08 05 Excerpt from: CAT420 0706 BUSINESS AUTO COVERAGE EXTENSION FORM BUSINESS AUTO COVERAGE FORM Policy Number: BA3629P06311CNS Insurer: JJR Construction, Inc. F. BLANKET WAIVER OF SUBROGATION SECTION IV BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us is deleted and replaced by the following: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. G. BLANKET ADDITIONAL INSURED SECTION II LIABILITY COVERAGE, part A. 1. Who Is An Insured, paragraph c. is amended by adding the following: Any person or organization that you are required to include as an additional insured on this Coverage Form in a written contract or agreement that is signed and executed by you before the ]Jodily injury] or [jroperty damagelloccurs and that is in effect during the policy period is an ©nsured0for Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an DnsuredUunder the Who Is An Insured provision contained in Section II. Page 1 of 1 £ - Excerpts from: Form CA0001 0306 BUSINESS AUTO COVERAGE FORM Policy Number: BA3629P06311CNS Insurer: JJR Construction,Inc. 5. Other Insurance a. For any covered ElautoOyou own,this Coverage Form provides primary insurance. For any covered ljautopyou don©own,the insurance provided by this Coverage Form is excess over any other collectible insurance. However, while a covered[ utopwhich is a[rrailerpis connected to another vehicle,the Liability Coverage this Coverage Form provides for the prailerpis: (1) Excess while it is connected to a motor vehicle you do not own. (2) Primary while it is connected to a covered[lutopyou own. b. For Hired Auto Physical Damage Coverage, any covered[ utopyou lease, hire, rent or borrow is deemed to be a covered atutopyou own. However,any[autopthat is leased, hired, rented or borrowed with a driver is not a covered[Autop c. Regardless of the provision of Paragraph a above,this Coverage Form[ Liability Coverage is primary for any liability assumed under an[insured contractp d. When this Coverage Form and any other Coverage Form or policy covers on the same basis, either excess or primary,we will pay only our share.Our share is the proportion that the Limit of Insurance of our Coverage Form bears to the total of the limits of all the Coverage Forms and policies covering on the same basis. Page 1 of 1 AEL AMP - END ORS ENE! POLiCY NUMBER: 4TJUB362f WAIVER F OUR RIGHT TO RECOVER FROM 0Th ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payme is from anyone liable for en Injury covered by ti enforce our right against the person or organ nation named in the Sc had: e. You must maintain payroll records accurately segregating the remuneration of your emplo the work described in the Schedule. The additional premium for this endorsement shall be s the California work rntur otherwise due on such remuneration. Schedule Person or Organization Job De criptioi J 'r PERSON OR D'RGANIZATUON FOR WHICH THE NAMED INSURED HAS Ac.TRE.F.E BY WRITTEN CONTRACT EXECUTED. FRIOR TO LOSS TO FURNISH THI S WAX SfEk. • - Client#:307587 JJRCONST ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE( 011 Y) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION C.D.Behrens 925-609-6500 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HUB Intl Insurance Serv.Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 4047 Concord,CA 945244047 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Indemnity Co of 25682 JJR Construction,Inc. INSURER B: Travelers Property Casualty Co 25674 — 1120-9th Avenue INSURER C: San Mateo,CA 94402 INSURER D: INSURER E: AIGLAWU COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSAE TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YYYY) DATE(MM/DD/YYYY) LIMITS A GENERAL LIABILITY 4T22C03629P063TCT1 01/01/2011 01/01/2012 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $300,000 _ PREMISES(Ea occurrence) CLAIMS MADE IN OCCUR MED EXP(Any one person) $10,000 X PD Ded:1,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 —1 POLICY n STET)- n LOC A AUTOMOBILELIABILITY BA3629P06311CNS 01/01/2011 01/01/2012 COMBINEDSINGLEUMIT X ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per ecddent) PROPERTY DAMAGE $ (Per acddent) GARAGE UABIUTY AUTO ONLY-EA ACCIDENT $ _ H ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABILITY 4TSMCUP3629P063TIL 01/01/2011 01/01/2012 EACH OCCURRENCE $5,000,000 jJOCCUR CLAIMS MADE AGGREGATE $5,000,000 $ DEDUCTIBLE $ X RETENTION $10000 $ B WORKERS COMPENSATION AND 4TJUB3629P06311 01/01/2011 01/01/2012 X I WC STATUS I I O R EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE-Y-111E.L.EACH ACCIDENT $1,000,000 FCEtry NE EXCLUDED? — E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: Project#09-CDD-171,Federal Project#ESPL-5034(20)-Citywide Sidewalk Rehabilitation Project. The City of Gilroy,its elected and appointed officers,officials,employees and volunteers as Additional Insured as respects General Liability and coverage is Primary&Non-Contributory per attached form CGD246 0805.Auto Liability Additional Insured per CAT420 0706,primary wording per CA0001 0306. Workers Compensation Waiver of Subrogation per WC990376/00.All as required by written contract. CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Gilroy DATE THEREOF,THE ISSUING INSURER WILL EMAIL an DAYS WRITTEN Community Development Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 7351 Rosanna Street , .'7.1-. •►4'4'1.1$'I'I•4••J••l^•94.1 11•�id1.1 .'u4 4'0 11'4 .4 Y1(..-i,l re yre l.'s'.•:♦. Gilroy,CA 95020 mettramottax ACORD 25(2009/01)1 of 2 #S1018713/M1017024 8 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SK42 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). — 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). DISCLAIMER The Certificate of Insurance does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2009/01) 2 of 2 #S1018713/M1017024 POLICY NUMBER: 4T22C03629P063TCT11 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) - This endorsement modifies insurance provided under the following: — COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED p (Section II) is amended sured does not apply to "bodily injury" or to include any person or organization that you "property damage" caused by "your work" agree in a "written contract requiring insurance" and included in the "products-completed op- to include as an additional insured on this Cover- erations hazard" unless the "written contract age Part,but: requiring insurance" specifically requires you to provide such coverage for that additional a) Only with respect to liability for "bodily injury", insured, and then the insurance provided to "property damage"or"personal injury';and the additional insured applies only to such b) If, and only to the extent that, the injury or "bodily injury" or "property damage" that oc damage is caused by acts or omissions of curs before the end of the period of time for you or your subcontractor in the performance which the "written contract requiring insur of "your work" to which the "written contract ante" requires you to provide such coverage requiring insurance" applies. The person or or the end of the policy period, whichever is organization does not qualify as an additional earlier. insured with respect to the independent acts or omissions of such person or organization. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and 2. The insurance provided to the additional insured collectible "other insurance", whether primary, by this endorsement is limited as follows: excess, contingent or on any other basis, that is a) In the event that the Limits of Insurance of available to the additional insured for a loss we this Coverage Part shown in the Declarations cover under this endorsement. However, if the"written exceed the limits of liability required by the contract requiring insurance" specifically requires "written contract requiring insurance", the in- that this insurance apply on a primary basis or a surance provided to the additional insured primary and non-contributory basis, this insurance is primary to "other insurance" shall be limited to the limits of liability re- quired by that "written contract requiring in- available to the additional insured which covers surance". This endorsement shall not in that person or organization as a named insured crease the limits of insurance described in for such loss, and we will not share with that Section III p Limits Of Insurance. "other insurance". But the insurance provided to the additional insured by this endorsement still is b) The insurance provided to the additional in- excess over any valid and collectible "other in- sured does not apply to "bodily injury", "prop- surance", whether primary, excess, contingent or erty damage" or "personal injury" arising out on any other basis, that is available to the addi of the rendering of, or failure to render, any tional insured when that person or organization is professional architectural, engineering or sur an additional insured under such "other insur- veying services,including: ante". i. The preparing, approving, or failing to 4. As a condition of coverage provided to the prepare or approve, maps, shop draw- additional insured by this endorsement: ings, opinions, reports, surveys, field or- a) The additional insured must give us written ders or change orders, or the preparing, notice as soon as practicable of an "occur- approving, or failing to prepare or ap- rence" or an offense which may result in a prove,drawings and specifications;and claim. To the extent possible, such notice ii. Supervisory, inspection, architectural or should include: engineering activities. c) The insurance provided to the additional in- CG D2 46 08 05 ' 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 • COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" any provider of "other insurance" which would or offense took place; cover the additional insured for a loss we ii. The names and addresses of any injured cover under this endorsement. However, this persons and witnesses;and condition does not affect whether the insur- ance provided to the additional insured by — iii. The nature and location of any injury or this endorsement is primary to "other insur- damage arising out of the "occurrence" or ance" available to the additional insured offense. which covers that person or organization as a b) If a claim is made or "suit" is brought against named insured as described in paragraph 3. above. the additional insured, the additional insured must: 5. The following definition is added to SECTION V. i. Immediately record the specifics of the 0 DEFINITIONS: claim or"suit"and the date received;and "Written contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement The additional insured must see to it that we under which you are required to include a person or organization as an additional in- receive written notice of the claim or "suit" as soon as practicable. cured on this Coverage Part, provided that the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or "suit", cooperate with us in the investigation or settlement of a. After the signing and execution of the the claim or defense against the "suit", and contract or agreement by you; otherwise comply with all policy conditions. b. While that part of the contract or d) The additional insured must tender the de- agreement is in effect;and fense and indemnity of any claim or "suit" to c. Before the end of the policy period. Page 2 of 2 ' 2005 The St.Paul Travelers Companies,Inc. CG D2 46 08 05 Excerpt from: CAT420 0706 BUSINESS AUTO COVERAGE EXTENSION FORM BUSINESS AUTO COVERAGE FORM Policy Number: BA3629P06311CNS Insurer: J3R Construction, Inc. F. BLANKET WAIVER OF SUBROGATION SECTION IV BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us is deleted and replaced by the following: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. G. BLANKET ADDITIONAL INSURED SECTION II LIABILITY COVERAGE, part A. 1. Who Is An Insured, paragraph c. is amended by adding the following: Any person or organization that you are required to include as an additional insured on this Coverage Form in a written contract or agreement that is signed and executed by you before the ]odily injury0 or [property damages occurs and that is in effect during the policy period is an jinsuredOfor Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an©nsuredUunder the Who Is An Insured provision contained in Section II. Page 1 of 1 Excerpts from: Form CA0001 0306 BUSINESS AUTO COVERAGE FORM Policy Number: BA3629P06311CNS Insurer: JJR Construction,Inc. 5. Other Insurance a. For any covered[tutopyou own,this Coverage Form provides primary insurance. For any covered[autopyou don own,the insurance provided by this Coverage Form is excess over any other collectible insurance. However, while a covered[ utopwhich is a prailerpis connected to another vehicle,the Liability Coverage this Coverage Form provides for the prailerpis: (1) Excess while it is connected to a motor vehicle you do not own. (2) Primary while it is connected to a covered[lutopyou own. b. For Hired Auto Physical Damage Coverage, any covered[autopyou lease, hire, rent or borrow is deemed to be a covered[iutopyou own. However,any Eautopthat is leased, hired, rented or borrowed with a driver is not a covered[autop c. Regardless of the provision of Paragraph a.above,this Coverage Form[ Liability Coverage is primary for any liability assumed under an ensured contractp d. When this Coverage Form and any other Coverage Form or policy covers on the same basis, either excess or primary,we will pay only our share. Our share is the proportion that the Limit of Insurance of our Coverage Form bears to the total of the limits of all the Coverage Forms and policies covering on the same basis. Page 1 of 1 TRAVELERS J EMP Ef4DORSENal F NUMBER: 4T,U6362 WAIVER OF OUR RIGHT TO RECOVER FROM 0TH ENDORSEMENT - CALIFORNiA (BLANKET WAR) We have the right to recover our payments from anyone liabie for sn injury covered by ti enforce our right against the person or organization named in the Bone uie. You must maintain payroll records accurately eauregating the remuneration of your empio tne work described in the $cheduta. The additional premium for this endorsement shall be S ve the California worki mium otherwise due on such remuneration.. Schedule Person to Organization Job Descriptioi NV PERSON OR ORGAN'ZATI ON FOR WHICH THE NAMED INSURED HAS AGREED 511 WRITTEN C. ACT E 'r CU a+. pm-0R TO LOSS TO FU€R4ZSSE THIS WAIVE . Client#: 131836 50JJRCONS 1ACORD,S CERTIFICATE OF LIABILITY INSURANCE 1/13/2010 DATE PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION (925)609-6500 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HUB Intl Insurance Serv.Inc. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O.Box 4047 Concord,CA 94524-4047 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Indemnity Co of CT 25682 - JJR Construction,Inc. INSURER B: Travelers Prop Cas Co of Amer 25674 1120-9th Avenue INSURER C: Insurance Company of the West 27847 San Mateo,CA 94402 INSURER D: - INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR NSRC DATE(MM/DYYY) DATE{MM/DD/YYYY1 A GENERAL LIABILITY 4T22C03629P063TCT1 01/01/2010 01/01/2011 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE SO RENTED $300 000 PREMISES(Ea occurrence) CLAIMS MADE X OCCUR MED EXP(Any one person) $10,000 X PD Ded:1,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 nPOLICY n JE 4 n LOC A AUTOMOBILE LIABILITY BA3629P06310CNS 01/01/2010 01/01/2011 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY _ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTY DAMAGE (Per acddent) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ B EXCESS/UMBRELLA LIABIUTY 4TSMCUP3629P063TIL 01/01/2010 01/01/2011 EACH OCCURRENCE $5,000,000 I OCCUR u CLAIMS MADE AGGREGATE $5,000,000 $ DEDUCTIBLE $ X RETENTION $10,000 $ C WORKERS COMPENSATION AND WSD500009502 01/01/2010 01/01/2011 X ORYuMU- 17,1- EMPLOYERS'LIABILITY TORY LIMITS FR ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory n ) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: Project#09-CDD-171,Federal Project#ESPL-5034(20)-Citywide Sidewalk Rehabilitation Project. The City of Gilroy,its elected and appointed officers,officials,employees and volunteers as Additional Insured as respects General Liability and coverage is Primary&Non-Contributory per attached form CGD246 0805.Auto Liability Additional Insured per CAT420 0706,primary wording per CA0001 0306. Workers Compensation Waiver of Subrogation per WC990634.All as required by written contract. CERTIFICATE HOLDER CANCELLATION 10 Days for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION City of Gilroy DATE THEREOF,THE ISSUING INSURER WILL gatemtrit MAIL '%n DAYS WRITTEN Community Development Department NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, 7351 Rosanna Street Gilroy,CA 95020 ACORD 25(2009/01)1 of 2 #S267781/M264935 0 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD VBH IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). — 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). DISCLAIMER The Certificate of Insurance does not constitute a contract between the issuing insurer(s),authorized representative or producer,and the certificate holder,nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25(2009/01) 2 of 2 #S267781/M264935 Policy Number: 4T22C03629P063TCT10 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY — BLANKET ADDITIONAL INSURED _ (CONTRACTORS) This endorsement modifies insurance provided under the following: — COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED p (Section II) is amended c) The insurance provided to the additional in- to include any person or organization that you sured does not apply to "bodily injury" or agree in a "written contract requiring insurance" "property damage" caused by your work' to include as an additional insured on this Cover- and included in the "products-completed op- age Part,but: erations hazard" unless the "written contract requiring insurance" specifically requires you a) Only with respect to liability for "bodily injury", to provide such coverage for that additional "property damage"or'personal injury';and insured, and then the insurance provided to b) If, and only to the extent that, the injury or the additional insured applies only to such damage is caused by acts or omissions of "bodily injury" or "property damage" that oc- you or your subcontractor in the performance curs before the end of the period of time for of "your work" to which the "written contract which the "written contract requiring insur- requiring insurance" applies. The person or ance" requires you to provide such coverage organization does not qualify as an additional or the end of the policy period, whichever is insured with respect to the independent acts earlier. or omissions of such person or organization. 3. The insurance provided to the additional insured 2. The insurance provided to the additional insured by this endorsement is excess over any valid and by this endorsement is limited as follows: collectible "other insurance", whether primary, a) In the event that the Limits of Insurance of excess, contingent or on any other basis, that is this Coverage Part shown in the Declarations available to the additional insured for a loss we exceed the limits of liability required by the cover under this endorsement. However, if the"written "written contract requiring insurance", the in- contract requiring insurance" specifically requires surance provided to the additional insured that this insurance apply on a primary basis or a shall be limited to the limits of liability re- primary and non-contributory basis, this quired by that "written contract requiring in insurance is primary to "other insurance" . This endorsement shall not in- available to the additional insured which covers surance". the limits of insurance described in that person or organization as a named insured Section III Limits Of Insurance. for such loss, and we will not share with that "other insurance". But the insurance provided to b) The insurance provided to the additional in- the additional insured by this endorsement still is sured does not apply to "bodily injury", "prop- excess over any valid and collectible "other in- erty damage" or "personal injury" arising out surance", whether primary, excess, contingent or of the rendering of, or failure to render, any on any other basis, that is available to the addi- professional architectural, engineering or sur- tional insured when that person or organization is veying services,including: an additional insured under such "other insur- ance". i. The preparing, approving, or failing to prepare or approve, maps, shop draw- 4. As a condition of coverage provided to the ings, opinions, reports, surveys, field or- additional insured by this endorsement: ders or change orders, or the preparing, a) The additional insured must give us written approving, or failing to prepare or ap- notice as soon as practicable of an "occur- prove,drawings and specifications;and rence" or an offense which may result in a ii. Supervisory, inspection, architectural or claim. To the extent possible, such notice engineering activities. should include: CG D2 46 08 05 ' 2005 The St. Paul Travelers Companies, Inc. Page 1 of 2 COMMERCIAL GENERAL LIABILITY i. How, when and where the "occurrence" any provider of "other insurance" which would or offense took place; cover the additional insured for a loss we i cover under this endorsement. However, this i. The names and addresses of any injured — persons and witnesses;and condition does not affect whether the insur- ance provided to the additional insured by — iii. The nature and location of any injury or this endorsement is primary to 'other insur- damage arising out of the "occurrence" or ance" available to the additional insured — offense. which covers that person or organization as a named insured as described in paragraph 3. b) If a claim is made or "suit" is brought against above. — the additional insured, the additional insured must: 5. The following definition is added to SECTION V. i. Immediately record the specifics of the UDEFINITIONS: claim or"suit"and the date received;and "Written contract requiring insurance" means ii. Notify us as soon as practicable. that part of any written contract or agreement under which you are required to include a The additional insured must see to it that we person or organization as an additional in- receive written notice of the claim or "suit" as sured on this Coverage Part, provided that soon as practicable. the "bodily injury" and "property damage" oc- c) The additional insured must immediately curs and the "personal injury" is caused by an send us copies of all legal papers received in offense committed: connection with the claim or "suit", cooperate with us in the investigation or settlement of a. After the signing and execution of the the claim or defense against the "suit", and contract or agreement by you; otherwise comply with all policy conditions. b. While that part of the contract or agreement is in effect;and d) The additional insured must tender the de- fense and indemnity of any claim or "suit" to c. Before the end of the policy period. Page 2 of 2 ' 2005 The St.Paul Travelers Companies, Inc. CG D2 46 08 05 • Excerpt from: CAT420 0706 BUSINESS AUTO COVERAGE EXTENSION FORM BUSINESS AUTO COVERAGE FORM Policy Number: BA3629P063120CNS Insurer: Travelers Indemnity Company of CT Policy Period: January 1,2010 to January 1,2011 F. BLANKET WAIVER OF SUBROGATION SECTION IV a BUSINESS AUTO CONDITIONS, A. Loss Conditions, 5. Transfer Of Rights Of Recovery Against Others To Us is deleted and replaced by the following: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the extent required of you by a written contract executed prior to any "accident" or "loss", provided that the "accident" or "loss" arises out of operations contemplated by such contract. The waiver applies only to the person or organization designated in such contract. G. BLANKET ADDITIONAL INSURED SECTION II a LIABILITY COVERAGE, part A. 1. Who Is An Insured, paragraph c. is amended by adding the following: Any person or organization that you are required to include as an additional insured on this Coverage Form in a written contract or agreement that is signed and executed by you before the[Oodily injurY° or[property damage°occurs and that is in effect during the policy period is an ©nsured°for Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an ensured°under the Who Is An Insured provision contained in Section II. Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- BLANKET We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). The additional premium for this endorsement shall be 3% of the total California Workers' Compensation premium otherwise due. — Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION ALL CALIFORNIA OPERATIONS FOR WHOM THE NAME INSURED IS REQUIRED UNDER WRITTEN CONTRACT TO FURNISH THIS WAIVER Policy Number:WSD 5000095-02 Insured: JJR CONSTRUCTION INC. Endorsement Effective: 1/1/2010 Coverage Provided by: ICW Issue Date: 12/31/2009 Countersigned by: WC 99 06 34 (Ed. 8-00)