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Michael Baker International - Insurance CertificateAC® ® CERTIFICATE OF LIABILITY INSURANCE DAT ( ) 09/05/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT. If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk services Central, Inc Pittsburgh PA Office CONTACT NAME PHONE Ezt) <866) 283 -7122 FAX No) (800) 363 -0105 E -MAIL ADDRESS Dominion Tower, 10th Floor 625 Liberty Avenue INSURER(S) AFFORDING COVERAGE NAIC # Pittsburgh PA 15222 -3110 USA INSURED INSURER XL Insurance America_ Inc_ _24554 Michael Baker International, Inc INSURER B Liberty Mutual Fire Ins Co 23035 5 Hutton Centre Drive Suite 500 INSURER Liberty Insurance Corporation 42404 INSURER Lloyds Syndicate No. 2623 AA1128623 Santa Ana CA 92707 USA INSURER E PREMISES Ea occurrence $300,000 INSURER F MED EXP (Any one person) $10,000 COVERAGES CERTIFICATE NUMBER: 570068250007 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS Limits shown are as requested INSR LTR TYPE OF INSURANCE IN Vivo PO NUMBER POLICY EF MM/DDNYYY MM/DD/YYYY LIMITS _ B X COMMERCIAL GENERAL LIABILITY TB EACH OCCURRENCE $2 , OOO , OOO CLAIMS -MADE X❑ OCCUR General Liability PREMISES Ea occurrence $300,000 MED EXP (Any one person) $10,000 PERSONAL& ADV INJURY $2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE_ _ _ $4,000,000 POLICY E P'2_ FX] LOC JECT PRODUCTS - COMP /OPAGG $4,000,000 OTHER B AUTOMOBILE LIABILITY A52- 681 - 004145 -727 Commercial Auto - AOS 08/30/201708/30 /2018 COMBINED SINGLE LIMIT Ea accident $2,000,000 BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per accident) - - OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident A X UMBRELLA LIAB X OCCUR US00079952LI17A 08/30/2017 08/30/2018 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS -MADE Umbrella AGGREGATE $10,000,000 DED I X RETENTION 810,000 C WORKERS COMPENSATION AND LIABILITY Y/N ANY PROPRIETOR / PARTNER! EXECUTIVE WA768DO04145777 workers Comp - AOS 08/30/2017 08/30/2018 X STATUTE ORH EMPLOYERS' E L EACH ACCIDENT $1,000,000 OFFICER /MEMBER EXCLUDED? N (Mandatory In NH) ❑ N / A E L DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below I E L DISEASE - POLICY LIMIT $1,000,000 D E&O -PL- Primary PSDEF1700460 08/31/2017 08/31/2018 Per Claim $5,000 ,000 Professional Liab. and CP Aggregate $5,000,000 SIR applies per policy terms & condi ions DESCRIPTION OF OPERATIONS /LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached d more space Is required) RE: Project Name: All Operations. City of Gilroy, its officers and employees are included as Additional Insured in accordance with the policy provisions of the General Liability policy. CERTIFICATE HOLDER CANCELLATION 1 - tie SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS City of Gilroy AUTHORIZED REPRESENTATIVE 7351 Rosanna Street a Gilroy CA 95020 USA JQ'an � %��c c/s�.tr�rrO �GamLta =G e/�aa ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 08/29/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not c_ onfer rights to the certificate holder in lieu o_ f su_c_h_endorsement(s). PRODUCER Aon Risk Services Central, Inc. Pittsburgh PA Office CONTACT NAME (A/CNN Ext) (866) 283 -7122 FAX No) (800) 363 -0105 Dominion Tower, 10th Floor 625 Liberty Avenue E -MAIL ADDRESS INSURER(S) AFFORDING COVERAGE NAIC # Pittsburgh PA 15222 -3110 USA INSURED INSURER XL insurance America Inc 24554 Michael Baker International. Inc INSURER B Liberty Mutual Fire Ins Co 23035 5 Hutton Centre Drive Suite 500 INSURER Liberty Insurance Corporation 42404 Santa Ana CA 92707 USA INSURER D Lloyd's Syndicate No. 2623 AA1128623 INSURER E $300,000 INSURER F MED EXP (Any one person) $10,000 COVERAGES CERTIFICATE NUMBER: 570068151042 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS Limits shown are as requested INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUM_ BER mmnm MM/DD _ LIMITS B X COMMERCIAL GENERAL LIABILITY TB EACH OCCURRENCE $2,000,000 CLAIMS -MADE X❑ OCCUR General Liability PREMISES Ea occurrence _ $300,000 MED EXP (Any one person) $10,000 PERSONAL& ADV INJURY $2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER GENERAL AGGREGATE $4,000,000 POLICY IEJEC X❑ LOC JECT PRODUCTS - COMP /OP AGG $4,000,000 _ OTHER B AUTOMOBILE LIABILITY As2- 681 - 004145 -727 Commercial Auto - ADS 08/30/2017 08/30/2018 COMBINED SINGLE LIMIT Ea accident $2,000,000 BODILY INJURY ( Per person) X ANYAUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident A X UMBRELLA LIAR X OCCUR U500079952LI17A 08/30/2017 08/30/2018 EACH OCCURRENCE $10,000,000 EXCESS LIAR CLAIMS -MADE Umbrella AGGREGATE $10,000,000 DED X RETENTION $10,000 C WORKERS_ COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR / PARTNER / EXECUTIVE N WA768DO04145777 Workers Comp - ADS 08/30/2017 08/30/2018 X PER - OTH- STATUTE ER E L EACH ACCIDENT n,_000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) ❑ NIA A E L DISEASE -EA EMPLOYEE $1,0()0,000 - - If yes describe under DESCRIPTION OF OPERATIONS below E L DISEASE- POLICY LIMIT $1,000,000 D E&O- PL- Primary PSDEF1700460 08/31/2017 08/31/2018 Per Claim $5,000,000 Professional Liab. and CP Aggregate $5,000,000 SIR applies per policy ter s & conditions DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Project Name: All Operations. City of Gilroy, its officers and employees are included as Additional insured in accordance with the policy provisions of the General Liability policy. CERTIFICATE HOLDER CANCELLATION c9 w w 0 U [O Q ! w c 0) m O 4!_ c=am SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS City of Gilroy AUTHORIZED REPRESENTATIVE ®`9-- 7351 Rosanna Street_ Gilroy CA 95020 USA ��4'on i���,uSfc �s,rr�eD E�amlta:G e./ na. ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ® '4� ° CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) r 08/29/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights_ to the certificate holder _ i_n_ lieu_ of such endorsement(s). PRODUCER AOn Risk Services Central, Inc. Pittsburgh PA Office CONTACT NAME PHONE (g66) 283 -7122 FAX (800) 363 -0105 (AIC No Ext) A/C No.) E -MAIL ADDRESS. Dominion Tower, 10th Floor 625 Liberty Avenue INSURER(S) AFFORDING COVERAGE NAIC # Pittsburgh PA 15222 -3110 USA INSURED INSURERA XL Insurance America Inc 24554 Michael Baker International, Inc. Formerly Pacific municipal Consultants (PMC) INSURER B Liberty Mutual Fire Ins CO 23035 INSURER Liberty Insurance Corporation 42404 INSURER D Lloyd's syndicate No. 2623 AA1128623 2729 Prospect Park Drive, Suite 220 Rancho Cordova CA 95670 USA INSURER E. PREMISES Ea occurrence INSURER F MED EXP (Any one person) COVERAGES CERTIFICATE NUMBER: 570068149892 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MM/DD LIMITS B X COMMERCIAL GENERAL LIABILITY TB EACH OCCURRENCE $2,000,000 CLAIMS -MADE ❑X OCCUR PREMISES Ea occurrence $300'000 MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $2_,_000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4,000,000 POLICY PRO- JECT � LOC PRODUCTS - COMP /OP AGG $4,000,000 OTHER B AUTOMOBILE LIABILITY As2- 681 - 004145 -727 08/30/201708/30 /2018 COMBINED SINGLE LIMIT Ea accident $2,000,000 BODILY INJURY ( Per person) X ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Peracadent A X UMBRELLA LIAB X OCCUR US00079952LI17A 08/30/2017 08/30/2018 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $10,000,000 DED I X RETENTION $10.000 C C EMPLOYER COMAPBENSAATIONAND YIN ANY PROPRIETOR I PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED'? � N/A WAA0768DO04145777 WC7681004145787 08/30/2017 08/30/2017 08/30/2018 08/30/2018 X SEA UTE ERH E L EACH ACCIDENT $1,000,000 E L DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) WI If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE- POLICY LIMIT $1,000,000 D E&O -PL- Primary PSDEF1700460 08/31/2017 08/31/2018 Per Claim $5,000,000 Professional & Pollution Aggregate $5,000,000 SIR applies per policy terms & condi ions DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Addniorial Remarks Schedule, may be attached if moro space is required) For Named insured Only: Attn- Pam warfield. RE Pro3eCt Name: AS Needed Planning and Environmental Services. The City of Gilroy, its officers, officials and employees are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. General Liability and Automobile Liability policies evidenced herein are Primary and Non - Contributory to other insurance available to Additional Insured, but only in accordance with the policy's provisions. should General Liability, Automobile Liability, Professional Liability and workers' Compensation policies be cancelled before the expiration date thereof, the policy provisions will govern how notice of cancellation may be dell ered to certificate holders in accordance with the policy provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS City of Gilroy AUTHORIZED REPRESENTATIVE 7351 Rosanna street Gilroy CA 95020 USA ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD m c d V m O 2 N rn a CD 0 0 L0 O Z d A V lv U yg9 �a �s a Lar '% °® CERTIFICATE OF LIABILITY INSURANCE DATE(MMDDVVYY) 09/022016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: AOn Risk services Central, Inc. Pittsburgh PA Office (866) 263 -7122 FAX CBDD) 363 -0105 A No. AK:. No.: Dominion Tower, 10th Floor 625 Liberty Avenue E-MNL ADDRESS: INSURER(S) AFFORDING COVERAGE "CO Pittsburgh PA 15222 -3110 USA INSURED INSURER A: Liberty Mutual Fire Ins Cc 123035 EACHOCCURRENCE Michael Baker International. Inc. Formerly Pacific Municipal Consultants (PMC) INSURER B: Liberty Insurance Corporation 142404 - DLAIM$ -NtADE .00CUR INSURER C: National union Fire Ins CO of Pittsburgh�19445 INSURER O: Lloyd's syndicate No. 2623 AA1128623 2729 Prospect Park Drive, Suite 220 Rancho Cordova CA 95670 USA INSURER E: PREMISES Ea ocwirenm $100,000 INSURER F: MED EXP(Any one person) $5,000 COVERAGES - - CERTIFICATE NUMBER:: 570063540743 " - -" 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 1 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO.ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested INSIR -41 TYPE OF INSURANCE p WVT) POLICY NUMBER Mgvp LIMITS X 'COMMERCIAL GENERAL LIASKJTY TB EACHOCCURRENCE $2,000,000 DLAIM$ -NtADE .00CUR PREMISES Ea ocwirenm $100,000 MED EXP(Any one person) $5,000 PERSONAL B AOV INJURY $2,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4,000,000 POLICY EJECT ❑ LOD PRODUCTS - COMWOP AGO $4,000,000 OTHER: A Aurombiou LIABILITY A52- 681 - 004145 -726 08/30/2016 08/30/2017 COMBINED SINGLE LIMIT e ocX. a $2,000,000 BODILY INJURY (Per person) I% ANYAUTO BODILY INJURY (Per aceden0 OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per X.dent C X UMBRELLA LIAR X OCCUR BE060476715 08 /30/2016 08/30/2017 EACH OCCURRENCE $10700,003 EXCES9 LIAR CLAIMS -MADE AGGREGATE '$10,000,000 DEO X ".RETENTION$10. 000 _ B e - WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR) PARTNER I EXECUTIVE OFFILERPAEMSER EXCLUDED? N❑ (Myyaeendabry In NH) OF.SCRIPTPON OF OPERATIONS eelnw NIA IQC1602675 WA768D 04 45776 A05 WC7681004145786 wI 1 08/30/2016 017 08/30/2017 X' I PER - STATUTE 0TH- T E, L, EACH ACCIDENT $1,000,000 E. L. DISEASE -EA EMPLOYEE' $1,000.,000 E.L. DISEASE - POLICY LIMIT $1:000.000 D E&O -PL- Primary 08/31/2016 08/31/2017 Per claim 5,000,000 Professional. & Pollution Aggregate $5,000,000 5IR applies per policy terns & condi ions .DESCRIPTION OF OPERATIONS I LOCATIONS) VEHICLES (ACORD 101 A4dIK l Remerke Schedule, my W elhcMd N more apace Is required) For .Named Insured only: Attn: Pam Warfield. RE: Project Name: As Needed Planning and Environmental Services. The City of Gilroy, its officers, officials and employees are included as Additional insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. General Liability and Automobile Liability policies evidenced herein are Primary and Non - contributory to other insurance available to Additional Insured, but only in accordance with the y .polio s provisions. Should General Liability, Automobile Liability, Professional Liability and Workers' Compensation policies be cancelled before the expiration date thereof, the policy provisions will govern how notice of cancellation may be delivered to certificate 'holders in accordance with the policy provisions. d c F c m C a x e r N 2 q� V _C t: u� CERTIFICATE HOLDER CANCELLATION W SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED .BEFORE THE EXPIRATION DATE THEREOF. NOTICE WIU. BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Gilroy AUTHORIZED REPRESENTATIVE 7351 Rosanna Street Gilroy CA 95020 USA sJI.tXG �eFa.t - N.byall6G ✓fM 01988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATO(w 2'2ote THIS CERTIFICATE: IS ISSUED AS A- MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE. DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: M the certificate holder Is an ADDITIONAL INSURED, the policy(k,$) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an Endorsement. A statement on this Certificate does not Confer rights to the Certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Services Central, Inc. Pittsburgh PA Office CONTACT NAME: PHON (M. NO, EH% (866) 283 -7122 (800) 363 -0105 Dominion Tower, 10th Floor 625 Liberty Avenue Ea MOMS, INSURERS) AFFORDING COVERAGE NAIC P Pittsburgh PA 15222 -3110 USA INSURED INSURERA: Liberty Mutual Fire Ins Cc 23035 Michael. Baker International, Inc. PD Box 57057 Irvine CA 92619-7057 USA INSURER B: Liberty Insurance Corporation 42404 INSURER C: National Union Fire Ins Co of Pittsburgh 19445 INSURER D: Lloyd's syndicate No. 2623 AA1128623 INSURER E: PREMISES Ea o=mnm INSURER F'. X MED UP (Any one penwn) g4Litlyte_vt=11a 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 IHEREIN: IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Umlte shown areas requested INSR TYPE OF INSURANCE POLICY NUMBER IyypD LVO DMRS X .COMMERCIAL GENERAL LIABILITY TB EACH OCCURRENCE $2,000,000 CLAIMS -MADE X❑OCDOR PREMISES Ea o=mnm $100x000 X MED UP (Any one penwn) $5,000 Cunaamual Lieblllty PERSONAL S ADV INJURY '.$2,000,000 GENT AGGREGATE LIMIT APPLIES PER GENERALAGGREGATE $4,000,000 POLICY ❑X PRO- ECT 7 LOC PRODUCTS_ COMPIOP AGO - $4,000,000 OTHER: A AUTOMOBILE LIABILITY AS2- 681 - 004145 -726 08/30/201608/30 /2017 COMBINED SINGLE LIMB (Ea =idntl $2,,000,000 BODILY INJURY (Par peman) X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY BODILY INJURY (Per acddem) PROPERTY DAMAGE' Peracmdent C % UMBRELLA LIAS % OCCUR BE060476715 08/30/201 08/30/2017 EACH OCCURRENCE $10,000;000 EXCESS UAS CLAIMSd DE AGGREGATE $10,000,000 DED [% RETENTION 330, 000 • • WORXERS COMPENSATION AND EMPLOYERS'LNBILrTY - YIN ANY PROPRIETOR/ PARTNER' EXECUTIVE OF E%OLUOEOr E] ,(Mandatory In NH) NIA WA7 80 4 ADS WC7681004145786 wI 2016 08/30/2016 08/30/2017 08/30/2017 X PER OTH- STATUTE E.L. EACH ACCIDENT $1,000,000 E.L DISEASE -EA EMPLOYEE_ - $1;000,000 '- Ir yyeeee deecdbe unWr DESCRIPTIONOF OPERATIONS W1. E,L'DISEASE- POLICY LIMIT $1,000.,000 D E&O -PL- Primary QC1602675 I 08/31/2016 08/31/2017 Per Claim 510001000 I Professional & Pollution Aggregate $5,000,000 SIR applies per policy ter s & condi ions DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Addllbnel Remulu Schedule, may M wt,cllad If more s m is required) RE: Project Name; All operations. City of Gilroy its officers and .employees are included as Additional Insured in accordance with the policy provisions of the Genera Liability policy. i - i City of Gilroy 7351 Rosanna Street Gilroy CA 95020 USA ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED' POLICIES BE CANCEI I Fn BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED ' IN ACCORDANCE WITH THE 'POLICY PROVISIONS. eil!/ 019884015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD x LD 0 U m a 0 c C c 9 O O AqP c5 n N 0 Z m 1�r U 7122014000Wr=091 Policy Number M- 681 - 004145 -716 Issued by Liberty VAdual. Fire Insurance Co.. THIS ENDORSENENTCHANGES THE POLICY. PLEASE READ IT CAREFULLY. S LANKET ADDITIONAL gtSURED This endoesoment modits bssuranee provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION 11- WHO 15 AN INSURED Is amended to Include as an Insured any person or organization for whom you have agreed In wring to provide WWRy insurance. But The insurance provided by this amendment 1. Applies only to ;bo* Injury' or'propeny damage' arising out of (a) aywk wow or (b)prem ises or outer property owned by or rented to you; 7- Applies only to coverage and minimum pmBs_of insurance required by the written agreement but in no event exceeds edherthe scope of coverage orthe limits of kwance provided by this policy: and 3. Does not apply to any person or organization for whom you have procured separade Uabiltty insurance wide such insurance Is IneBen, regardless ofwhetherthe scope of coverage or Itplts'of insurance of this policy exceed those of such other inaurance or whether such atim Iravance b valid and collectible. The following provisions also apply: 1. Where the applicable wrften agreement requires the insured to provide IWAl' y imurame.on a_ primary, excess,, cantingent orany, other basls, this poky will apply soletyy on the basis required by such written agraemam and . barn &Other Insurance of SECTION IV of this policywAl not apply. 2 Where the applicable wraten agreement does not'specdy on what basis the liabilay kmuw= will apply, the provisions of Item 4. Other insurance of SECTION IV of ft polcy vdtgoverm 3 This endorsement shall not apply.to any person or organization for atgr' bodily IrJW or *Prop" damage if any other add(ftmtal insured endorsement on this policy applies to that persorf of orgarzltatlon with regard to the •body lMiif or'property.darnap*. 4. Yf any otheraddhional kestrel endorsement applies to any person or organization andyou ale obligated under a vwdten agre smart to provide 6aWity Insurance one prtrnary, excess cenbngent or any other baste forew additional insured: this policy will spplySolely on the basis required by suds .wrltmn agreement and gem 4. Outer Insurance of SECTION IV of this Polley will not apply, regardless of whetlterthe person or or anlzafion has available other valid and collectible Insurance. If the applicable mrbtcn agreement does hot _spa* on what basis the BabDlty Insurance relit apply, the provisions of Item 4. Other Insurance of SECTION IV of this policy will govern. LN 20 0106 0S POLICY NUMBER TB2_681- 004145 -716 2100148000Y700054 COMMERCIAL GENERAL LIABILITY CG 24 64 0509 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsemeed modBfles insurance provided under the folovft COMMER AL GENERAL LIABILITY COVERAGE PART PRODUOrWCOMPLETED OPERATIONS LIABILITYC OVERAGEPART The fo0oxi6rg is added to Paragraph S. Transtar of Rigirts Of: IAcovaW Against Others To Us of Section IY— Condibtdns:. We valve any Fight of recovery we may have against the person or onlarizatfan shown in the Schedule a via make for Input' or ngoarts operaft or is+aaiver applies shoom In the SCHEDULE Name Of hereon OrOrpnlzatlom As required by a written contract or agreement entered into prior to loss 00 240405 09 0Insurance Services Office, Inc. 2008 Page 1 of 1 tsxtotou Policy Number TM2 =681- 004145 -716 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEI ENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO THIRD PARTIES This endursemeed 0110CIfts insurance Proytded under the foAoarlrhW BUSINESS. AUTO. COVERAGE PART MOTOR eARRIER COVERAGE PART COVERAGE FORM Schedule Name of Other Pereon(s) I 0 on a: Address or mailing address: Number Days Notice: Per schedule on file c e u e'on' i e- the com an fer A. If we cancel this policy for any reason War Oran nonpayment of Premium, we al notify the Persons or orgaribstiuns shown In the Schedule attars. We will send nodes to the small or rnaNng address rated above at feast 10 days. or the number of days above. if any. before the cancellation becomes effactim In no event does the notice to the third party exceed the notice to the float named Insured. B. This advance nolttica6on of a pending cancellation of coverage is imarhded as a_courtesy only. Our fallure to provide such advance notification VA not sift the policy illation date nor negate: eanowtation of the Policy. AA other tears and conditions of this policy remain unchanged. LI M Oa 010511 0 2D11 Liberty Mutual Getup of ComPArdes. All rights reserved. Pagel of 1 Includes copyrighted matetia l W Insursnoe Services Office. Inc., with its permission. sestotsoeoasoosvz Policy Number.. SS2- 681- 004145 -726 Issued by: Liberty Mutual Fire insurance Co. THIS ENDORSEMENT CHANGES THE POLICY. PI EA READ IT CAREFULLY. DESIGNATED INSURED - .NONCONTRIBUTING This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIERS COVERAGE FORM TRUCKERS COVERAGE FORM Wdh respect to coverage provided by this endorsement the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organizalion(s) who are 'oxsurew under the Who Is An Insured Provision of the Coverage: Form. This endorsement does not alter coverage provided in the Coverage form_ Schedule Name of Person(s) or Organizations(s): Aay person or agani.aation whom you have agreed is writing to add as as additional insured, but only to coverage 6, minimum limits of insurance required by the written ag eement, and in no event to etc ed either the scope of coverage or the limits of insurance provided in this policy. Regarding Designated Contractor Project: Each person or organization shown in the Schedule of the *insured' Is an for Liability Coverage, but only to the extent that person or orgarrtzation qualifies as an Inured` under the Who Is An Insured Provisfae contained in Section U of the Coverage Form. The following is added to the. Other Insurance Condition: If you have agreed in a written agreement that this poky will be primary and without .rgif¢ of contribution from any Insurance in force for an Adddonal Insured for Iiab* ansetg out of your operations, and the agreement was executed prior to the "b'odily Irguy' or 'property damage'. then this ersurance WM be pmnary and we will not seek contribution from such insurance. AC 84 23 0811 ® 2010, liberty Mutual Group of Companies. Ail rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office. Inc„ . with As permission. IIU01400004500395 POLICYNUMMR: AS2- 681 -004145 -726 COMHERCIAI.AUFO CA04441013 TFUS ENDORSEMENT CHANGESTHE POLICY. PLEASE READ rr CAREFULLY. WAIVER OF'TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUB RQGATIDN) This endorsement modes insurance provided uruWthe fogowbW. AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect . to coverage provided by this endorsem ent, -the provisions of the, Coverage Fmm -apply unlessmodged by the endorsement Ut f 111 Tl NameW Dt Person(sy Or Organlzatlon(s): Any any M of recovveV pdorto with vhWint a lam Uer+ have weed in writing to'rowaiwe Premium: $ INCL lbftrvnad;nrewliedtocomplete.this Schedule. ifrrot shown above. vA be shown in the Declarations. The Transfix Of Rights Of Recovery Against Others To Us condNon does not apply to the person(s) or organizations) show In the Schedule, bud only to the extern that sutnogatioir s waked prior to the 'acddern' or the 'loss° under a contract with that person ororganbmUon CA 04 44 10 13 0 Insurance Services office. hrc_ 2D11 page 1 of 1 21=4=0,MloB Policy Number.. AS2- 681- 004145 -726 Issued Dr. Liberty mutual Fire musur =e co. THIS ENDORSEM1ENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY_ NOTICE OF UNCELLATiON TO THIRD PARTIES This endorsement modo6es Insuuance provided omder the following: BUSINESS AUTO COVERAG E PART MOTOR CARRIER COVERAGE PART GARAGE COVERAGE PART . TRUCKERS COVERAGE PART EXCESS AUTOMOBILE LIABLFTY INDEMNITY COVERAGE PART SELF - INSURED TRUCKER EXCESS LMLI7Y COVERAGE PART COMMERCIAL GENERAL LIABILTYCOVERAGE PART EXCESS - COMMERCIAL GENERAL LIABILITY COVERAGE PART' PRODUCTSICGMPLETED OPERATIONS LIABAM COVERAGE PART LIQUOR LIABPLIT1f COVERAGE PART Schedule Name.qf Other Persanfs)L Onpntmdan(s).. Emall Addre s - -- - - Per 8c1a4hh!le an _file- with. the, Per schedule, on file with the O=vaaY A. 9 we, cancel this policy for any reason other than nonpayment of premium, we will no* ft persons or orgart&ations shaven in the Schedule above by emaa.as soon as practical alter nak)rbg the fast Named Insured. B. This adwmce emaa roofig *ion of a pending cancellation of coverage is intended as coudesy only. Our failure to provide such advance natfficallmh w81 not erteotd the paft cancellation date nor negate cance8aton of the policy. AN othertemisand conddions of thus policy remah unchanged. LIM99 02 0811 ® 2011. Liberty Mutual Group of Companies. AN ffghts reserved. Pagel of 1 Includes copyrighted materfdf of Insurance Services Office. Inc with Its permission. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this poGey. 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.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Not applicable in Alaska, Kentucky, New Hampshire and New Jersey Schedule Where required by contract or written agreement prior to loss and allowed' by law. In the states of Alabama, Arizona, Arkansas, Colorado, Dist Of Col, Georgia; Idaho; Illinois.indiana,Micilgan,- Mississippi, Missburi,— - -- - -- -- -- - -- Montana; Nevada; New Mexico, NorthCarolina, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South: Dakota, Vermont, West Virginia the premium charge Is 2% of the total manual premium, subject to a minimum premium of $100 per policy. In the states of. Connecticut. Florida, Iowa, Maryland, Nebraska; Oregon the premium charge is 1 % of the total manual premium subject to a minimum premium of $250 per policy. In the state of Louisiana the premium charge is 2% of the total standard premium subject to a minimum premium of $250 per pollcy.In the state of Massachusetts the premium charge is 1 %,of the total manual premium. In the state of New York the premium charge Is 2% of the total manual premium, subject to a minimum premium of $250 per policy. In the state of Tennessee there is no premium charge. In the state of Virginia the premium charge is 5% of the total manual premium, subject to a minimum premium of $250 per policy. Issued by Liberty Insurance Corporation 21814 For attachment to Policy No. WA7- 68D- 004145 -776 Effective Darta 081302018' Premium $ Issued to Wichael Bakerdntemational, Inc. WC 00 0313 ®1983 National Council on Compensation Insurance. Page 1 of 1 Ed. 04101/1984 NOTME of CAUCELL MAI m TMIMPAR A it we cancel 96 pd far any reasnn o0w 0tmr rmpoymmt of prem%M are vM ooft @a persona or of atmamfn lhaS drde tidouv: Wa vrlll send tttrticetot{te area arma0np lldw bobar at. least 10 days, or'9ta number of days Qsted bebw, 0 mv. be&na cartcA tica boomma effina . In no swwA dcas t11e rtoUoa t01he 0drd parQr.Cataeed the nalloa m the taffi ne>aed bmdted. B. TNS advmm nom an of a perWbv carasoation of covW4e Is blended as a cmvtesp a*. Our.6ua to Movide such adtm = naflicallon *0 rMt eMand the policy armRsk f dais nor nets caivalWan of the poky. Naraofgme ftaHo� P�son(s) FeF�dwdule 011t11a7yaft0la Schedule Snail Address or malftAddrsm Al cOterton sad otuNUUMs Ord* policy nmwin uncharsed. buedby LPomylmura=Cbrpaaasn21814 Number Sage Notice;. 0 FcraasdmwdtoF*ftT4o. WA7 -68D- 004145 -776 PMffiUM9 teavapb NBtYmet BelterCaryorffisn IAIAQ 18 tI8 it 02011, Ubarty Mubsf Group. All M#& Reserved. Ed: 0 5 011201 1 Rape 1 of 1 This page intentionally left blank. AC RO O® CERTIFICATE OF LIABILITY INSURANCE DAT (MNVDo /e YY) 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_60ES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, Certain policies may require an endorsement A statement on this certificate does not Confer rights to the Certificate holder in lieu of such endomement(s). 'PRODUCER CONTACT NAME: Aon Risk Services Central, Inc. Pittsburgh PA Office Dominion Tower, 10th Floor 625 Liberty Avenue (866) 283 -7122 FAX (800) 363 -0105 (Me. No. Em): NC. NO.: EMAIL ADDRESS: INSURERS) AFFORDING COVERAGE NAIC0 Pittsburgh PA 15222 -3110 USA INSURED INSURERA: Liberty Mutual Fire Ins CO 23035 Michael Baker International. Inc. Formerly Pacific Municipal consultants.(PMC) INSURER e: Liberty Insurance Corporation. 42404 INSURER C: National union Fire Ins Co of Pittsburgh 19445 INSURER D: Lloyd's Syndicate NO.. 2623 AA1128623 2729 Prospect Park Drive, suite 220 Rancho Cordova CA 95670 USA INSURER E: PREMISES Ea oavnema INSURER F: MEO EXP (Any arse parson) COVERAGES CERTIFICATE NUMBER: 570063540743 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 IBE 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. 11mhs shown ere aeregoeated LTR TYPE OF INSURANCE INS MAID .POLICY NUMBER mo p LINITS- A X COMMERCIAL GENERAL LIABILITY TB EACH OCCURRENCE S2, 000,, 000 CLAIMS -MADE ❑X OCCUR PREMISES Ea oavnema $100,000 MEO EXP (Any arse parson) _ $5,000 PERSONAL &ACV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY ❑X JEST rx-1 LOC PRODUCTS - COMPIOP AGG. S4,000,000 OTHER: A.. AIITOM05111 UkBILITM AS2- 681- 004145 -726 08/30/201608/30 /2017 COMBINED SINGLE LIMIT -- a end 12,000,000 BODILY INJURY( Per person) % ANY AUTO BODILY INJURY (Per ottderd) OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per acdtleni C UMBRELLA LIAR OCCUR OE060476715 08/30/2016 0 17 EACH CCCURRENCE $10,000,000 EXCESS UAS H CLAIMS -MADE AGGREGATE $10,000,000 RED' I X IRETENT ION 130; 000 I B. B WORKERS COMPENSATION AND EMPLOYERS' UABIUTY ANY PROPRIETOR I PARTNER I EXECUTIVE YIN OFFICERIMEMBER EXCLUDED' (rMndawq In NH). 'NIA WA7 8D 0414 77 A05 WC7681004145786 WI 1 08/30/2016 8 08/30/2017 X PER STATUTE QTH• ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE.EA EMPLOYEE_ $1,000.,000 If yyea. dosedee under DESCRIPTION OF OPERATIONSbabw E.L. DISEASE - POLICY LIMIT $1,000,000 D IESO-PL- Primary QC1602675 -- 08/31/2016 08131/2017 Per claim $5,000,000 Professional & Pollution Aggregate $5,000,000 SIR applies per policy ter s & condi ions DESCRNTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 1e1� Ademonel Ramada Schedpk, run, M eeeoMd M moro spate N reyuNM)' - For Named Insured only: Attn: Pam Warfield. RE: Project Name: AS Needed Planning and Environmental services. The City Of Gilroy, its officers, officials and employees are included as Additional Insured in accordance with the policy provisions of the General Liability and Automobile Liability policies. General Liability and Automobile Liability policies evidenced herein are Primary and Non- Contributory to other insurance available to Additional Insured, but only in accordance with the policy's provisions. Should General Liability, Automobile Liability, Professional Liability and workers' Compensation .policies be cancelled before the expiration date thereof, the policy provisions will govern how notice of cancellation may be delivered to certificate holders in accordance with the policy provisions. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED M. ACCORDANCE WITH. THE POLICY PROVISIONS. City of Gilroy AUTHORIZED REPRESENTATIVE 7351 Rosanna Street Gilroy CA 95020 USA (�� �� Q p cDC/ars ✓G _ �iH�itrt9 4 Oise 01988 -2015 ACORD CORPORATION.. All rights reserved: ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD m` A c m O 6 O a n A r n O 2. yNy: C M U