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LSA Associates - Insurance CertificateCliont!!- R59 LSAASSOCI1 ACORD,. CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 9/23/2016 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 Dealey, Renton & Associates NUONTAcT Julie L. Nelson PHONE 510 465 -3090 510 452 -2193 AIC No Ext : _ AIC No P. O. Box 12675 E-MAIL t nelson @deale renon.com ADDRESS: J y - Oakland, CA 94604-2675 510 465 -3090 INSURERS) AFFORDING COVERAGE NAIC # INSURER A Hartford Fire Ins. Co. 19682' INSURED INSURER Bt Trumbull Insurance Co. 27120 LSA Associates, Inc. INSURER C: Berkley Insurance Company 32603 20 Executive Park, Suite 200 Irvine, CA 92614 INSURER D INSURER E INSURER F: $300,000 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTRR TYPE OF INSURANCE IANDgRL Sy yp POLICY NUMBER MMO/uDDY MMNDY LIMITS A X COMMERCIAL GENERAL LIABILITY 57CESOF4492. 9/3012016 09/30/2017 EACH OCCURRENCE $110001000 CLAIMS -MADE 7 OCCUR PREMISES E occE once $300,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO. LOC PRODUCTS - COMP /OP AGG ? $ 2,000,00-0 $ OTHER: B AUTOMOBILE LIABILITY 57UUNIF1488 9/3012016 09130/201 E °'de °sINGLE.cIMIr 1,006,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED. SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peracc dent $ - UMBRELLA LIAB 1 OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N OFFICERIMEMBER EXCLUDED? FN (Mandatory In NH) N/A 57WEGG5794 9/30/2016 09/30/201 PER OTH- X E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE.- POLICY LIMIT $1,000,000 C Professional AEC901319600 9/3012016 091301201 $2,000,000 per Claim Liability $4,000,000 Annl Aggr. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD tilt, Additional Remarks Schedule, may be attached H more,space is required) General Liability Policy excludes claims arising out of the performance of professional services. Project Name /Number: Election Code 9212/CGL1601 City of Gilroy, its officers and employees are named as Additional Insured as respects General Liability and Auto Liability coverages. Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will mail 30 days written notice to the Certificate Holder. Professional Liability Retroactive Date: 06/04/1976 City of Gilroy Attn: Kristi Abrams 7351 Rosanna Street Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CoZGkF:�i�Ti C!s[d•7:7�7.7•I 7Zd7_� II [•7: �_11ri[� iT�7�-'a. fT � ACORD 25 (2014/01) 1 of 1 The ACORD name and logo are registered marks of ACORD OS1829566IM1828942 AZM POLICY NUMBER: 57CESOF4492 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE. POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name Of Additional Insured Person(s) Or Organization(s): City of Gilroy Attn: Kristi Abrams 7351 Rosanna Street Gilroy, CA 95020 SCHEDULE Location(s) Of Covered Operations NAME OF PERSON(S) OR ORGANIZATION(S) CONT.: City of Gilroy, its officers and employees Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply. This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 POLICY NUMBER: 57CESOF4492 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided. under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Location And Description Of Completed Or Organization(s): Operations City of Gilroy NAME OF PERSON(S) OR ORGANIZATION(S) CONT.: City of Gilroy, its officers and employees Attn: Kristi Abrams 7351 Rosanna Street Gilroy, CA 95020 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 EXCERPTS FROM CA 00001 (1001) HARTFORD BUSINESS AUTO COVERAGE Insured: LSA Associates, Inc. Policy Number :57UUNIF1488 Policy Effective Dates: 09/30/2016 Additional Insured: NAME OF PERSON(S) OR ORGANIZATION(S) CONT.: City of Gilroy, its officers and employees Additional Insured: SECTION II — LIABILITY COVERAGE 1. WHO IS AN INSURED: The following are "insureds" c. Anyone liable for the conduct of an "insured"... but only to the extent of that liability. Primary Insurance: SECTION IV — BUSINESS AUTO CONDITIONS B. General Conditions - 5. Other Insurance a. For any covered "auto" you own, this Coverage Form provides primary insurance. For any covered "auto" you don't own, the insurance provide by this Coverage Form is excess over any other collectible insurance. c. Regardless of the provisions of paragraph a. above, this Coverage Form's Liability Coverage is primary for any liability assumed under an "insured contract ". Cross Liability Clause: SECTION V — DEFINITIONS G. "Insured" means any person or organization qualifying as an insured in the Who is An Insured provision of the applicable coverage. Except with respect to the Limit of Insurance, the coverage afforded applies separately to each insured who is seeking coverage or against whom a claim or "suit" is brought. EXCERPTS FROM HA9916 (0302) HARTFORD COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT 15. WAIVER OF SUBROGATION — We waive any right of recovery we may have against any person or organization with whom you have a written contract that requires such waiver because of payments we make for damages under this Coverage Form.