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Martin Electric - Insurance Certificate' - MARTI01' - OP ID: 3E, '4C ®?®"" kk� CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 09/08/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions -of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER ?'� �: n,, InterWest Insurance Serv.; LLC - —' - - "" - ' ' °- ' #OB01094 330 Tres Pinos Road Suite A -1 Hollister, n 95023 - - Select Business Unit CONTACT Ericka Evans - - NAME• - PHONE 313-- FAX- 91- 737 .0 No. Ext • 530- 897 - A/c No • 530 - - - -` E -MAIL - - - - - - ADDRESS• eevans iwins.com, r_ _ _ _ _ _ INSURERS AFFORDING COVERAGE - NAIC # INSURER A: AmTrust International U1W Ltd. INSURED William Abner Martin INSURER B: EACH OCCURRENCE dba: Martin Electric 7531 Kentwood Court INSURER C: CLAIMS -MADE F1 OCCUR X X Gilroy, CA 95020 INSURER 0: 09/01/2018 DAMAGE TO RENTED PREMISES Ea occurrence) $ 100,00 INSURER E: MED EXP (Any one person) 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 City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. POLICY NUMBER MM /DD/YYYY MM DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE F1 OCCUR X X XN104278603 09101/2017 09/01/2018 DAMAGE TO RENTED PREMISES Ea occurrence) $ 100,00 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY a PRO- - LOC JECT ` - PRODUCTS- COMP /OP AGG $ 2,000,00 -- - -- - -- - - - - $, {- -- - ,- - - -- , OTHER Y - --- - -- AUTOMOBILE LIABILITY - °- E -- - - - - - COMBINED SINGLE LIMIT -- - Ea a.".nt $ - -- - -- - - -- - BODILY INJURY (Per person)- $- "— - - - ANY AUTO _ ALL OWNED '- - SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE - - Per accident $ - NON- OW__NED HIRED AUTOS AUTOS $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE ❑ OFFICER /MEMBER EXCLUDED? N / A PER OTH- STATUTE ER E L EACH ACCIDENT_ ; ,. _ $ _ (Mandatory in NH) E L DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ LL DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate holder is additional insured respects liability only; primary and waiver of subrogation apply as per the attached policy forms. CERTIFICATE HOLDER CANCELLATION CITY735 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and Icgo are registered marks of ACORD POLICY NUMBER XN104278603 COMMERCIAL GENERAL LIABILITY NX GL 189 05 11 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSUREDS - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Number. XN104278603 Endorsement Effective 9/82017 12 01 a m. Named Insured WILLIAM ABNER MARTIN Counter Signed By MARTIN ELECTRIC y r`. ....�?...� ...... SCHEDULE Name of Person or Organization CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES 7351 ROSANNA STREET, GILROY CA 95020 Location VARIOUS LOCATIONS THROUGHOUT GILROY, CA, SANTA CLARA COUNTY, CA (If no entry appears above, information required to complete this endorsement will be shown in the Declarations 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 B With respect to the insurance afforded to these additional insureds, 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 services, 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 NX GL 189 05 11 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc , with its permission D The following are added to SECTION V = DEFINITIONS "Your world" means work or operations performed by you or on your behalf,, and materials, parts_ o_ r equipment furnished in connection with such work or operations. E. The following additional provisions apply to any entity that is an insured by the terms of this endorsement P_nmary_Wording With respect to the Third Party shown above, this insurance_ is primary and non - contributing. Any and al[ other valid and collectable insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy, shall in no instance be considered as primary, co- insurance,'or contributing insurance. Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. 2. Waiver of Subrogation If required by written contractor agreement- We waive any right of recovery we may have against an entity thatz an additional msufed 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 NX GL 189 05 11 Page 2 0_ f 2 Includes copyrighted material, of Insurance Services Office, Inc., with its permission -1�...10101 MARTIN OP ID: 3E c OF LIABILITY INSURANCE DATE (MM /DDNYYY) 07/08/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must 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 InterWest Insurance Services License #OB01094 330 Tres Pinos Road Suite A -1 CONTACT NAME: Evans -NAME; PHONE FAX Arc No Ell: 530 - 897 -3137 (AC, No): 530 -891 -7737 E -MAIL ADDRESS: eevans@iwins.com Hollister, CA 95023 Select Business Unit INSURERS AFFORDING COVERAGE NAIC # INSURER A: AmTrust International U/W Ltd. INSURED Martin Electric Inc. INSURER B: EACH OCCURRENCE 7531 Kentwood Court Gilroy, CA 95020 INSURER C: CLAIMS -MADE OCCUR INSURER D X INSURER E: 09/01!2016 09/01/2017 INSURER F : PREMISES Eau occurrence) $ 100,00 nnvoeenGC CFRTIFICATF NIIMRFR- 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 ADDLISUBR I ACCORDANCE WITH THE POLICY PROVISIONS. POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /ODNYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS -MADE OCCUR X X XN104278602 09/01!2016 09/01/2017 PREMISES Eau occurrence) $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP /OP AGG $ 2,000,00 X POLICY ❑ PRO a LOC JECT $ OTHER: AUTOMOBILE LIABILITY A COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR /PARTNER /EXECUTIVE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ F—] OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A E.L. DISEASE - POLICY LIMIT 1 $ If yes, describe undor DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Certificate holder is additional insured respects liability only; primary and waiver of subrogation apply as per the attached policy forms. rcoTlclrnrc unl nco RANCFi I ATIAN CITY735 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: XN104278602 COMMERCIAL GENERAL LIABILITY NXGL1890511 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSUREDS - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Number: XN104278602 Endorsement Effective: 9/01/2016 12:01 a.m. Named Insured: MARTIN ELECTRIC INC Counter Signed By: SCHEDULE Name of Person or Organization: CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES 7351 ROSANNA STREET, GILROY CA 95020 Location: VARIOUS LOCATIONS THROUGHOUT GILROY AND SANTA CLARA COUNTY, CA (if no entry appears above, information required to complete this endorsement will be shown in the Declarations 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. B. With respect to the insurance afforded to these additional insureds, 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 services, 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. NX GL 189 05 11 Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission D. The following are added to SECTION V — DEFINITIONS: "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. E. The following additional provisions apply to any entity that is an insured by the terms of this endorsement: Primary Word inq With respect to the Third Party shown above, this insurance is primary and non - contributing. Any and all other valid and collectable insurance available to such Third Party in respect of work performed by you under written contractual agreements with said Third Party for loss covered by this policy, shall in no instance be considered as primary, co- insurance, or contributing insurance. Rather, any such other insurance shall be considered excess over and above the insurance provided by this policy. 2. 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 "you world' done under a contract with that person or organization. NX GL 189 05 11 Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission