Chrisp Company - Insurance CertificateCERTIFICATE OF LIABILITY INSURANCE
1 DATE( D"YYY)
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
Arthur J. Gallagher & Co. Insurance Brokers
of California, Inc. I LIC #0726293
3697 Mt. Diablo Blvd., Suite 300
NAME, Certificate Department
PH ONE 925 299 -1112 FAX 925-953-6270
E -MAIL . CertRe uests @a com
4 jg
INSURER(S) AFFORDING COVERAGE
NAIC If
Lafayette CA 94549
INSURER A: Zurich American Insurance Company
16535
$1,000,000
INSURED
INSURER B:
$50,000
INSURER C:
MED EXP (Any one person)
ChrISP Company
INSURER D:
DED /OCC
43650 Osgood Road
Fremont, CA 94539
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PECOT- LOC
OTHER:
GENERAL AGGREGATE
INSURER E:
PRODUCTS - COMP /OP AGG
INSURER F:
$
COVERAGES CERTIFICATE NUMBER- 2017765375 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
INSD
WVD
POLICY NUMBER
POLICY EFF
MMIDD/YYYY
POLICY EXP
MIDD/YY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑X OCCUR
BI /PD: $10,000
Y
GLO 0217730 -02
12/1/2017
121112018
EACH OCCURRENCE
$1,000,000
DAMAGE TO RENTEU_
PREMISES Ea occurrence
$50,000
X
MED EXP (Any one person)
$5,000
X
DED /OCC
PERSONAL & ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY X PECOT- LOC
OTHER:
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP /OP AGG
$2,000,000
$
A
AUTOMOBILE
LIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY X AUTOS ONLY
BAP 0217729 -02
12/1/2017
12/1/2018
Ea accidern
E 1,000,000
X
BODILY INJURY (Per person)
$
BODILYINJURY (Per accident)
E
X
PROPER AMAGE
per accident
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION $
! $
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
WC 0217731 -02
12/1/2017
12/1/2018
PER O
X STATUTE E ER RT
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYEE
$1,000,000
E.L. DISEASE - POLICY LIMIT
$1,000,000
[SEE ATTACHED SUPPL. PAGE]
DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
ADDITIONAL INSURED: City of Gilroy, it's officers, officials, employees, agents and volunteers.
Project: RE: Encroachment Permit Cert
l:tK I II-IUA I t HULUtK UANUtLLA I IUN
City of GilroyGilroy City Hall
7351 Rosanna Street
Gilroy CA 95020
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
® 1988 -2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Contractors Liability Supplemental Coverages And
Conditions
19
ZURICH
Policy No.
Eff. Date of Pol.
I Exp. Date of Pol. Eff. Date of End.
I Producer No.
AddT Prem
Return Prem.
GLO 0217730 -02
:12/1/2017
:1211/2018 12/1/2017
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
NON -OWNED WATERCRAFT SCHEDULE
Watercraft Length: feet
(If no amount is shown above, 51 feet applies.)
A. Non -owned Watercraft Liability Extended Coverage
Paragraph (2) of Exclusion 2.g. Aircraft, Auto Or Watercraft under Section I - Coverage A - Bodily Injury And
Property Damage Liability is replaced by the following:
(2) A watercraft you do not own that is:
(a) Less than the length shown in the Non -Owned Watercraft Schedule of this endorsement; and
(b) Not being used to carry persons or property for a charge;
B. Damage To Premises Rented Or Occupied By You
1. The last paragraph under Paragraph 2. Exclusions of Section I - Coverage A - Bodily Injury And Property
Damage Liability is replaced by the following:
Exclusions c. through n. do not apply to damage by "specific perils" to premises while rented to you or temporarily
occupied by you with permission of the owner. A separate Damage to Premises Rented To You Limit of
Insurance applies to this coverage as described in Section III - Limits Of Insurance.
2. The paragraph directly following Paragraph (6) in Exclusion j. of Section I - Coverage A - Bodily Injury And
Property Damage Liability is replaced by the following:
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" to premises (other than damage
by "specific perils "), including "property damage" to the contents of such premises, rented to you under a rental
agreement for a period of 14 or fewer consecutive days. A separate Limit of Insurance applies to Damage to
Premises Rented to You as described in Section III - Limits Of Insurance.
3. Paragraph 6. of Section III - Limits Of Insurance is replaced by the following:
6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under
Coverage A for damages because of "property damage" to any one premises while rented to you, or in the
case of damage by one or more "speck perils" to any one premises, while rented to you or temporarily
occupied by you with permission of the owner.
4. Paragraph a. of the "insured contract" definition under the Definitions Section is replaced by the following:
U- GL- 1060 -E CW (04113)
Page 1 of 6
Includes copyrighted material of Insurance Services Office. Inc., with its permission.
a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that
indemnifies any person or organization for damage by "specific perils" to premises while rented to you or
temporarily occupied by you with permission of the owner is not an "insured contract ";
5. Paragraph (ii) under Paragraph 4.b.(1) of the Other Insurance Condition under Section IV — Commercial
General Liability Conditions is replaced by the following:
(ii) That is property insurance providing coverage for "specific perils" for premises rented to you or temporarily
occupied by you with permission of the owner;
6. The following definitions are added to the Definitions Section:
"Specific perils" means fire, lightning, explosion, windstorm or hail, smoke, aircraft or vehicles, riot or civil
commotion, vandalism, leakage from fire extinguishing equipment, weight of snow, ice or sleet or "water damage ".
"Water damage" means accidental discharge or leakage of water or steam as the direct result of the breaking or
cracking of any part of a system or appliance containing water or steam.
C. Additional Insured —Lessor Of Leased Equipment— Automatic Status When Required In Lease Agreement
With You
1. Section II — Who Is An Insured is amended to include as an additional insured any person(s) or organization(s)
from whom you lease equipment when you and such person(s) or organization(s) have agreed in a written
contract or written agreement that such person(s) or organization(s) be added as an additional insured on your
policy. Such person(s) or organization(s) is an additional 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(s) or organization(s).
However, the insurance afforded to such additional insured:
a. Only applies to the extent permitted by law; and
b. Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured.
A person's or organization's status as an additional insured under this endorsement ends when their contract or
agreement with you for such leased equipment ends.
2. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any
"occurrence" which takes place after the equipment lease expires.
3. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits
of Insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
a. Required by the written contract or written agreement you have entered into with the additional insured; or
b. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
The insurance provided by this Paragraph C. shall not increase the applicable Limits of Insurance shown in the
Declarations.
D. Additional Insured — Managers Or Lessors Of Premises
1. Section II — Who Is An Insured is amended to include as an additional insured any person(s) or organization(s)
that you have agreed in a written contract or written agreement to name as an additional insured, but only with
respect to liability arising out of the ownership, maintenance or use of that part of premises leased to you and
subject to the following additional exclusions:
This insurance does not apply to:
a. Any "occurrence" which takes place after you cease to be a tenant in that premises.
b. Structural alterations, new construction or demolition operations performed by or on behalf of the additional
insured manager or lessor of the premises leased to you.
However, the insurance afforded to such additional insured,
a. Only applies to the extent permitted by law; and
U- GL- 1060 -E Cw (44113)
Page 2 of 6
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
b. Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured.
2. With respect to the insurance afforded to these additional insureds, the following is added to Section 111 — Limits
of Insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
a. Required by the written contractor written agreement you have entered into with the additional insured; or
b. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
The insurance provided by this Paragraph D. shall not increase the applicable Limits of Insurance shown in the
Declarations.
E. Additional Insured — State Or Governmental Agency Or subdivision Or Political Subdivision — Permits Or
Authorizations
1. Section 11— Who Is An Insured is amended to include as an additional insured any state or governmental agency
or subdivision or political subdivision that you have agreed in a written contract or written agreement or that you
are required by statute, ordinance or regulation to name as an additional insured, subject to the following
provisions:
a. This insurance applies only with respect to operations performed by you or on your behalf for which the state
or governmental agency or subdivision or political subdivision has issued a permit or authorization.
b. This insurance does not apply to:
(1) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed
for the federal government, state or municipality; or
(2) "Bodily injury" or "property damage included within the "products- completed operations hazard ".
However, the insurance afforded to such additional insured:
a. Only applies to the extent permitted by law; and
b. Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured.
2. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits
of Insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
a. Required by the written contract or written agreement you have entered into with the additional insured; or
b. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
The insurance provided by this Paragraph E. shall not increase the applicable Limits of Insurance shown in the
Declarations.
F. Personal And Advertising Injury Coverage — Assumed Under Contract Or Agreement
1. Exclusion e. of Section I — Coverage B — Personal And Advertising Injury Liability is replaced by the following:
2. Exclusions
This insurance does not apply to:
e. Contractual Liability
"Personal and advertising injury" for which the insured has assumed liability in a contract or agreement.
This exclusion does not apply to:
(1) Liability for damages that the insured would have in the absence of the contract or agreement; or
(2) Liability for "personal and advertising injury" if:
U- GL- 1060 -E CW (04113)
Page 3 of 6
Includes copyrighted material of Insurance Services Office, Inc.. with its permission.
(a) The liability pertains to your business and is assumed in a contract or agreement that is an
"insured contract "; and
(b) The "personal and advertising injury" occurs subsequent to the execution of the contract or
agreement.
Solely for the purposes of liability so assumed in such "insured contract ", reasonable attorney fees
and necessary litigation expenses incurred by or for a party other than an insured are deemed to be
damages because of "personal and advertising injury", provided:
(i) Liability to such party for, or for the cost of, that party's defense has also been assumed in
the same contract or agreement; and
(ii) Such attorney fees and litigation expenses are for defense of that party against a civil or
alternative dispute resolution proceeding in which damages to which this insurance applies
are alleged.
2. For purposes of this "personal and advertising injury" coverage only:
Paragraph d. and the second to last paragraph under Paragraph 2. of Supplementary Payments — Coverages
A and B are replaced by the following:
d. The allegations in the "suit" and the information we know about the "occurrence" or offense are such that no
conflict appears to exist between the interests of the insured and the interest of the indemnitee;
So long as the above conditions are met, attorneys' fees incurred by us in the defense of that indemnitee,
necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at
our request will be paid as Supplementary Payments. Such payments will not be deemed to be damages for
"bodily injury", "property damage" or "personal and advertising injury" and will not reduce the limits of
insurance.
G. Insured Contract Amendment
Paragraph f. and f.(1) through f.(3) of the "insured contract" definition under the Definitions Section is replaced by
the following:
f. That part of any other contract or agreement pertaining to your business (including an indemnification of a
municipality in connection with work performed for a municipality) under which you assume the tort liability of
another to pay for "bodily injury", "property damage" or "personal and advertising injury" to a third person or
organization. Tort liability means a liability that would be imposed by law in the absence of any contract or
agreement.
Paragraph f. does not include that part of any contract or agreement:
(1) That indemnifies a railroad for "bodily injury", "property damage" or "personal and advertising injury" arising
out of construction or demolition operations within 50 feet of any railroad property and affecting any railroad
bridge or trestle, tracks, road -beds, tunnel, underpass or crossing;
(2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of:
(a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; or
(b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or
damage:
(3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage
arising out of the insured's rendering or failure to render professional services, including those listed in (2)
above and supervisory, inspection, architectural or engineering activities;
(4) That indemnifies a person or organization for "personal and advertising injury":
(a) Arising out of advertising, publishing, broadcasting or telecasting done for you or on your behalf: or
(b) To an "employee" of such person or organization that does advertising, publishing, broadcasting or
telecasting for you or on your behalf; or
(5) That indemnifies a labor leasing firm for "bodily injury" to "leased workers ".
U- GL- 1060 -E Cw (04113)
Page 4 of 6
Includes copyrighted material of Insurance Services Office, Inc., with its permission.
H. Medical Payments — Increased Reporting Period
Paragraph a. of Section I — Coverage C — Medical Payments is replaced by the following:
a. We will pay medical expenses as described below for "bodily injury" caused by an accident:
(1) On premises you own or rent;
(2) On ways next to premises you own or rent; or
(3) Because of your operations;
provided that:
(a) The accident takes place in the "coverage territory" and during the policy period:
(b) The expenses are incurred and reported to us within three years of the date of the accident: and
(c) The injured person submits to examination, at our expense, by physicians of our choice as often as we
reasonably require.
Broad Bail Bond Coverage
Paragraph 1.b. under Supplementary Payments — Coverages A And B is replaced by the following:
b. The 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.
J. Amendment — Duties In The Event of Occurrence, Offense, Claim or Suit
The following paragraphs are added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit
of Section IV — Commercial General Liability Conditions:
Notice of an "occurrence" or of an offense which may result in a claim under this insurance or notice of a claim or
"suit' shall be given to us as soon as practicable after knowledge of the "occurrence ", offense, claim or "suit' has
been reported to your officer, manager, partner or an "employee" authorized by you to give or receive such notice.
Knowledge by "employees" other than your officer, manager, partner or "employee" authorized by you to give or
receive such notice of an "occurrence ", offense, claim or "suit" does not imply that you also have such knowledge.
In the event that an insured reports an "occurrence" to your workers compensation carrier and this "occurrence" later
develops into a General Liability claim, covered by this Coverage Part, the insured's failure to report such
"occurrence" to us at the time of the 'occurrence" shall not be deemed to be a violation of this Condition. You must,
however, give us notice as soon as practicable after being made aware that the particular claim is a General Liability
rather than a Workers Compensation claim.
K. Unintentional Failure To Disclose Or Describe Hazards
Paragraph 6. Representations of Section IV — Commercial General Liability Conditions is replaced by the
following:
6. Representations
By accepting this policy, you agree:
a. The statements in the Declarations are accurate and complete:
b. Those statements are based upon representations you made to us; and
c. We have issued this policy in reliance upon your representations.
Coverage will continue to apply if you unintentionally:
(1) Fail to disclose all hazards existing at the inception of this policy; or
(2) Make an error, omission or improper description of premises or other statement of information stated in
this policy.
You must notify us in writing as soon as possible after the discovery of any hazards or any other information that
was not provided to us prior to inception of this Coverage Part.
L. Bodily Injury Redefined
The "bodily injury" definition under the Definitions Section is replaced by the following:
U- GL- 1060 -E CW (04/13)
Page 5 of 6
Includes copyrighted material of Insurance Services Office. Inc with its permission.
"Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of
these at any time. This includes mental anguish, mental injury, shock, fright or death resulting from bodily injury,
sickness or disease.
M. Two Or More Of Our Coverage Parts /Policies
The following is added to Section III — Limits of Insurance:
1. Subject to Paragraph 2. or 3. above, whichever applies, if this Coverage Part and any other Commercial General
Liability Coverage Part or policy providing Commercial General Liability insurance issued to you by us or any
other Zurich underwriting company affiliated with us apply to the same "occurrence ", only the highest available
Each Occurrence Limit under any such Coverage Part or policy applies to such "occurrence ".
2. Subject to Paragraph 2. above, if this Coverage Part and any other Coverage Part or policy providing Commercial
General Liability insurance issued to you by us or any other Zurich underwriting company affiliated with us apply
to the same offense, only the highest available Personal And Advertising Injury Limit under any such Coverage
Part or policy applies to such offense.
3. Under this Coverage Part and all other Zurich underwriting company Coverage Parts or policies to which
Paragraphs 1. and 2. above combined apply, the most we will pay for all injury or damage because of "bodily
injury" or "property damage" "occurrences ", "personal and advertising injury" offenses and medical expenses is:
a. The single highest Coverage Part or policy General Aggregate Limit; or
b. The single highest Coverage Part or policy Products- Completed Operations Aggregate Limit,
whichever applies, whether such "occurrence ", offenses or medical expenses are covered by one or more than
one Zurich underwriting company policy.
4. Any existing provisions under Paragraph 4. Other Insurance under Section IV — Commercial General Liability
Conditions that may be contrary to the provisions of this endorsement are amended to comply with the changes
in coverage as stipulated in Paragraphs 1., 2., and 3. above.
This provision does not apply to any Coverage Part or policy issued by us or any other Zurich underwriting company
affiliated with us specifically to apply as excess insurance over this Coverage Part.
N. Your Work Redefined
Paragraph a.(1) of the "your work" definition under the Definitions Section is replaced by the following:
22. "Your work ":
a. Means:
(1) Work or operations performed by you or on your behalf, but does not include work or operations
performed by another entity who joined with you to form a partnership or joint venture not shown as a
Named Insured in the Declarations, which terminated or ended prior to the effective date of this policy;
and
All other terms and conditions of this policy remain unchanged.
U- GL- 1060 -E CW (04/13)
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Includes copyrighted material of Insurance Services office. Inc., with its permission.
AGENCY CUSTOMER ID:
LOC #:
ACORO® ADDITIONAL REMARKS SCHEDULE Page of
AGENCY
NAMED INSURED
POLICY NUMBER
CARRIER NAIL CODE
EFFECTIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: FORM TITLE:
Additional Information
GENERAL LIABILITY:
'Additional Insured if required by written contract per attached FonnlTJ-GL- 1060 -E CW ( 04/13)
*Coverage Is Primary /Non- Contributory if required by written contract per auacnea U -GL- 1060 -E CW (04/13)
WORKERS' COMPENSATION:
' Covered States: California, Nevada, Oregon
At,VKU Iu I tcuuwuI f O 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
CERTIFICATE OF LIABILITY INSURANCE
F DNYYY)
12/5/2016
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 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
Arthur J. Gallagher & Co. Insurance Brokers
of California, Inc. I LIC #0726293
3697 Mt. Diablo Blvd., Suite 300
CONTACT Certificate
cafe D
FAX
PHONE . 925-299-1112 925-953-6270 AIC.
E-MAIL CertRequests @ajg.com
INSURER(S) AFFORDING COVERAGE
NAIC #
Lafayette CA 94549
INSURERA:Zurich American Insurance Company
16535
$1,000,000
INSURED
INSURER B:
$50,000
INSURER C:
MED EXP (Any one person)
Chnsp Company
43650 Osgood Road
X
DED /OCC
Fremont, CA 94539
INSURER D:
GENT AGGREGATE LIMIT APPLIES PER:
POLICY PRO-- LOC
OTHER:
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP /OP AGG
INSURER E:
INSURER F:
A
AUTOMOBILE
COVERAGES CERTIFICATE NUMBER: 120572160 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.
ILT R
LTR
TYPE OF INSURANCE
INSD
WVD
POLICY NUMBER
POLICY EFF
NUDD/YYYY
POLICY EXP
NI/DDIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE T OCCUR
BI /PD: $10,000
Y
GLO 0217730 -01
12/1/2016
12/1/2017
EACH OCCURRENCE
$1,000,000
DAMAGE TO RENTIEu-
PREMISES Ea occurrence
$50,000
X
MED EXP (Any one person)
$5,000
X
DED /OCC
PERSONAL & ADV INJURY
$1,000,000
GENT AGGREGATE LIMIT APPLIES PER:
POLICY PRO-- LOC
OTHER:
GENERAL AGGREGATE
$2,000,000
PRODUCTS - COMP /OP AGG
$2,000,000
$
A
AUTOMOBILE
IIABILITY
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY FX AUTOS ONLY
BAP 0217729 -01
12/112016
12/1/2017
Ea accident
$ 1,000,000
X
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
X
Per accident
$
$
UMBRELLA LIAB
EXCESS LIAB
OCCUR
CLAIMS -MADE
EACH OCCURRENCE
$
AGGREGATE
$
DED RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PRO PRIETOR/PARTNER/EXECUTIVE —
OFFICER/MEMBER EXCLUDED
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N /A
WC 0217731 -01
12/1/2016
12/1/2017
X PER OTH-
STATUTE I ER
E.L. EACH ACCIDENT
$1,000,000
E.L. DISEASE - EA EMPLOYE
$1,000,000
E.L. DISEASE - POLICY LIMIT 1
$1,000,000
[SEE ATTACHED SUPPL PAGE]
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
ADDITIONAL INSURED: City of Gilroy, it's officers, officials, employees, agents and volunteers.
t,LK I IrII:A I t MULULK
City of GilroyGilroy City Hall
7351 Rosanna Street
Gilroy CA 95020
USA
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
®1988 -2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
Contractors Liability Supplemental Coverages And
Conditions
ZURICH
Policy No.
Eff. Date of Pol.
Exp. Date of Pol.
Eff. Dale of. End.
Producer No.
AddT Prem
Return Prem.
0 0217730 -01
12/1/2016
12/1/2017
12/1/2016
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the:
Commercial General Liability Coverage Part
NON -OWNED WATERCRAFT SCHEDULE
Watercraft Length: feet
(If no amount is shown above, 51 feet applies.)
A. Non -owned Watercraft Liability Extended Coverage
Paragraph (2) of Exclusion 2.g. Aircraft, Auto Or Watercraft under Section I — Coverage A — Bodily Injury And
Property Damage Liability is replaced by the following:
(2) A watercraft you do not own that is:
(a) Less than the length shown in the Non -Owned Watercraft Schedule of this endorsement; and
(b) Not being used to carry persons or property for a charge;
B. Damage To Premises Rented Or Occupied By You
1. The last paragraph under Paragraph 2. Exclusions of Section I — Coverage A — Bodily Injury And Property
Damage Liability is replaced by the following:
Exclusions c. through n. do not apply to damage by "specific perils" to premises while rented to you or temporarily
occupied by you with permission of the owner. A separate Damage to Premises Rented To You Limit of
Insurance applies to this coverage as described in Section III — Limits Of Insurance.
2. The paragraph directly following Paragraph (6) in Exclusion j, of Section I — Coverage A — Bodily Injury And
Property Damage Liability is replaced by the following:
Paragraphs (1), (3) and (4) of this exclusion do not apply to "property damage" to premises (other than damage
by "specific perils "), including "property damage" to the contents of such premises, rented to you under a rental
agreement for a period of 14 or fewer consecutive days. A separate Limit of Insurance applies to Damage to
Premises Rented to You as described in Section III — Limits Of Insurance.
3. Paragraph 6. of Section III — Limits Of Insurance is replaced by the following:
6. Subject to Paragraph 5. above, the Damage To Premises Rented To You Limit is the most we will pay under
Coverage A for damages because of "property damage" to any one premises while rented to you, or in the
case of damage by one or more "specific perils" to any one premises, while rented to you or temporarily
occupied by you with permission of the owner.
4, Paragraph a. of the "insured contract' definition under the Definitions Section is replaced by the following:
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a. A contract for a lease of premises. However, that portion of the contract for a lease of premises that
indemnifies any person or organization for damage by "specific perils" to premises while rented to you or
temporarily occupied by you with permission of the owner is not an "insured contract ";
5. Paragraph (ii) under Paragraph 4.b.(1) of the Other Insurance Condition under Section IV — Commercial
General Liability Conditions is replaced by the following:
(11) That is property insurance providing coverage for "specific perils" for premises rented to you or temporarily
occupied by you with permission of the owner;
6. The following definitions are added to the Definitions Section:
"Specific perils" means fire, lightning, explosion, windstorm or hail, smoke, aircraft or vehicles, riot or civil
commotion, vandalism, leakage from fire extinguishing equipment, weight of snow, ice or sleet or "water damage ".
"Water damage" means accidental discharge or leakage of water or steam as the direct result of the breaking or
cracking of any part of a system or appliance containing water or steam.
C. Additional Insured —Lessor Of Leased Equipment— Automatic Status When Required In Lease Agreement
With You
1. Section II — Who Is An Insured is amended to include as an additional insured any person(s) or organization(s)
from whom you lease equipment when you and such person(s) or organization(s) have agreed in a written
contract or written agreement that such person(s) or organization(s) be added as an additional insured on your
policy. Such person(s) or organization(s) is an additional 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(s) or organization(s).
However, the insurance afforded to such additional insured:
a. Only applies to the extent permitted by law; and
b. Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured.
A person's or organization's status as an additional insured under this endorsement ends when their contract or
agreement with you for such leased equipment ends.
2. With respect to the insurance afforded to these additional insureds, this insurance does not apply to any
"occurrence" which takes place after the equipment lease expires.
3. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits
of Insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
a. Required by the written contract or written agreement you have entered into with the additional insured; or
b. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
The insurance provided by this Paragraph C. shall not increase the applicable Limits of Insurance shown in the
Declarations.
D. Additional Insured — Managers Or Lessors Of Premises
1. Section II - Who Is An Insured is amended to include as an additional insured any person(s) or organization(s)
that you have agreed in a written contract or written agreement to name as an additional insured, but only with
respect to liability arising out of the ownership, maintenance or use of that part of premises leased to you and
subject to the following additional exclusions:
This insurance does not apply to:
a. Any "occurrence" which takes place after you cease to be a tenant in that premises.
b. Structural alterations, new construction or demolition operations performed by or on behalf of the additional
insured manager or lessor of the premises leased to you.
However, the insurance afforded to such additional insured:
a. Only applies to the extent permitted by law; and
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b. Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured.
2. With respect to the insurance afforded to these additional insureds, the following is added to Section 111 — Limits
of Insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
a. Required by the written contractor written agreement you have entered into with the additional insured; or
b. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
The insurance provided by this Paragraph D. shall not increase the applicable Limits of Insurance shown in the
Declarations.
E. Additional Insured — State Or Governmental Agency Or subdivision Or Political Subdivision — Permits Or
Authorizations
1. Section II — Who Is An Insured is amended to include as an additional insured any state or governmental agency
or subdivision or political subdivision that you have agreed in a written contract or written agreement or that you
are required by statute, ordinance or regulation to name as an additional insured, subject to the following
provisions:
a. This insurance applies only with respect to operations performed by you or on your behalf for which the state
or governmental agency or subdivision or political subdivision has issued a permit or authorization.
b. This insurance does not apply to:
(1) "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed
for the federal government, state or municipality; or
(2) "Bodily injury" or "property damage included within the "products- completed operations hazard ".
However, the insurance afforded to such additional insured:
a. Only applies to the extent permitted by law; and
b. Will not be broader than that which you are required by the contract or agreement to provide for such
additional insured.
2. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits
of Insurance:
The most we will pay on behalf of the additional insured is the amount of insurance:
a. Required by the written contract or written agreement you have entered into with the additional insured; or
b. Available under the applicable Limits of Insurance shown in the Declarations;
whichever is less.
The insurance provided by this Paragraph E. shall not increase the applicable Limits of Insurance shown in the
Declarations.
F. Personal And Advertising Injury Coverage — Assumed Under Contract Or Agreement
1. Exclusion e. of Section I — Coverage B — Personal And Advertising Injury Liability is replaced by the following:
2. Exclusions
This insurance does not apply to:
e. Contractual Liability
"Personal and advertising injury" for which the insured has assumed liability in a contract or agreement.
This exclusion does not apply to:
(1) Liability for damages that the insured would have in the absence of the contract or agreement; or
(2) Liability for "personal and advertising injury" if:
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(a) The liability pertains to your business and is assumed in a contract or agreement that is an
"insured contract "; and
(b) The "personal and advertising injury" occurs subsequent to the execution of the contract or
agreement.
Solely for the purposes of liability so assumed in such "insured contract ", reasonable attorney fees
and necessary litigation expenses incurred by or for a party other than an insured are deemed to be
damages because of "personal and advertising injury", provided:
(i) Liability to such party for, or for the cost of, that party's defense has also been assumed in
the same contract or agreement; and
(ii) Such attorney fees and litigation expenses are for defense of that party against a civil or
alternative dispute resolution proceeding in which damages to which this insurance applies
are alleged.
2. For purposes of this "personal and advertising injury" coverage only:
Paragraph d. and the second to last paragraph under Paragraph 2. of Supplementary Payments — Coverages
A and B are replaced by the following:
d. The allegations in the "suit" and the information we know about the "occurrence" or offense are such that no
conflict appears to exist between the interests of the insured and the interest of the indemnitee;
So long as the above conditions are met, attorneys' fees incurred by us in the defense of that indemnitee;
necessary litigation expenses incurred by us and necessary litigation expenses incurred by the indemnitee at
our request will be paid as Supplementary Payments. Such payments will not be deemed to be damages for
"bodily injury", "property damage" or "personal and advertising injury" and will not reduce the limits of
insurance.
G. Insured Contract Amendment
Paragraph f. and f.(1) through f.(3) of the "insured contract" definition under the Definitions Section is replaced by
the following:
f. That part of any other contract or agreement pertaining to your business (including an indemnification of a
municipality in connection with work performed for a municipality) under which you assume the tort liability of
another to pay for "bodily injury", "property damage" or "personal and advertising injury" to a third person or
organization. Tort liability means a liability that would be imposed by law in the absence of any contract or
agreement.
Paragraph f. does not include that part of any contract or agreement:
(1) That indemnifies a railroad for "bodily injury", "property damage" or "personal and advertising injury" arising
out of construction or demolition operations within 50 feet of any railroad property and affecting any railroad
bridge or trestle, tracks, road -beds, tunnel, underpass or crossing;
(2) That indemnifies an architect, engineer or surveyor for injury or damage arising out of:
(a) Preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys,
field orders, change orders or drawings and specifications; or
(b) Giving directions or instructions, or failing to give them, if that is the primary cause of the injury or
damage;
(3) Under which the insured, if an architect, engineer or surveyor, assumes liability for an injury or damage
arising out of the insured's rendering or failure to render professional services, including those listed in (2)
above and supervisory, inspection, architectural or engineering activities;
(4) That indemnifies a person or organization for "personal and advertising injury":
(a) Arising out of advertising, publishing, broadcasting or telecasting done for you or on your behalf; or
(b) To an "employee" of such person or organization that does advertising, publishing, broadcasting or
telecasting for you or on your behalf; or
(5) That indemnifies a labor leasing firm for "bodily injury" to "leased workers ".
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H. Medical Payments - Increased Reporting Period
Paragraph a. of Section 1- Coverage C - Medical Payments is replaced by the following:
a. We will pay medical expenses as described below for "bodily injury" caused by an accident:
(1) On premises you own or rent;
(2) On ways next to premises you own or rent; or
(3) Because of your operations;
provided that:
(a) The accident takes place in the "coverage territory" and during the policy period;
(b) The expenses are incurred and reported to us within three years of the date of the accident; and
(c) The injured person submits to examination, at our expense, by physicians of our choice as often as we
reasonably require.
I. Broad Bail Bond Coverage
Paragraph 1.b. under Supplementary Payments - Coverages A And B is replaced by the following:
b. The 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.
J. Amendment - Duties In The Event of Occurrence, Offense, Claim or Suit
The following paragraphs are added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit
of Section N - Commercial General Liability Conditions:
Notice of an "occurrence" or of an offense which may result in a claim under this insurance or notice of a claim or
"suit" shall be given to us as soon as practicable after knowledge of the "occurrence ", offense, claim or "suit" has
been reported to your officer, manager, partner or an "employee" authorized by you to give or receive such notice.
Knowledge by "employees" other than your officer, manager, partner or "employee" authorized by you to give or
receive such notice of an "occurrence ", offense, claim or "suit" does not imply that you also have such knowledge.
In the event that an insured reports an "occurrence" to your workers compensation carrier and this "occurrence" later
develops into a General Liability claim, covered by this Coverage Part, the insured's failure to report such
"occurrence" to us at the time of the "occurrence" shall not be deemed to be a violation of this Condition. You must,
however, give us notice as soon as practicable after being made aware that the particular claim is a General Liability
rather than a Workers Compensation claim.
K. Unintentional Failure To Disclose Or Describe Hazards
Paragraph 6. Representations of Section IV - Commercial General Liability Conditions is replaced by the
following:
6. Representations
By accepting this policy, you agree:
a. The statements in the Declarations are accurate and complete;
b. Those statements are based upon representations you made to us; and
c. We have issued this policy in reliance upon your representations.
Coverage will continue to apply if you unintentionally:
(1) Fail to disclose all hazards existing at the inception of this policy; or
(2) Make an error, omission or improper description of premises or other statement of information stated in
this policy.
You must notify us in writing as soon as possible after the discovery of any hazards or any other information that
was not provided to us prior to inception of this Coverage Part.
L. Bodily Injury Redefined
The "bodily injury" definition under the Definitions Section is replaced by the following:
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"Bodily injury" means bodily injury, sickness or disease sustained by a person, including death resulting from any of
these at any time. This includes mental anguish, mental injury, shock, fright or death resulting from bodily injury,
sickness or disease.
M. Two Or More Of Our Coverage Parts /Policies
The following is added to Section III — Limits of Insurance:
1. Subject to Paragraph 2. or 3. above, whichever applies, if this Coverage Part and any other Commercial General
Liability Coverage Part or policy providing Commercial General Liability insurance issued to you by us or any
other Zurich underwriting company affiliated with us apply to the same "occurrence ", only the highest available
Each Occurrence Limit under any such Coverage Part or policy applies to such "occurrence ".
2. Subject to Paragraph 2. above, if this Coverage Part and any other Coverage Part or policy providing Commercial
General Liability insurance issued to you by us or any other Zurich underwriting company affiliated with us apply
to the same offense, only the highest available Personal And Advertising Injury Limit under any such Coverage
Part or policy applies to such offense.
3. Under this Coverage Part and all other Zurich underwriting company Coverage Parts or policies to which
Paragraphs 1, and 2. above combined apply, the most we will pay for all injury or damage because of "bodily
injury" or "property damage" "occurrences ", "personal and advertising injury" offenses and medical expenses is:
a. The single highest Coverage Part or policy General Aggregate Limit, or
b. The single highest Coverage Part or policy Products- Completed Operations Aggregate Limit,
whichever applies, whether such "occurrence ", offenses or medical expenses are covered by one or more than
one Zurich underwriting company policy.
4. Any existing provisions under Paragraph 4. Other Insurance under Section IV — Commercial General Liability
Conditions that may be contrary to the provisions of this endorsement are amended to comply with the changes
in coverage as stipulated in Paragraphs 1., 2., and 3. above.
This provision does not apply to any Coverage Part or policy issued by us or any other Zurich underwriting company
affiliated with us specifically to apply as excess insurance over this Coverage Part.
N. Your Work Redefined
Paragraph a.(1) of the "your work" definition under the Definitions Section is replaced by the following:
22. "Your work ":
a. Means:
(1) Work or operations performed by you or on your behalf, but does not include work or operations
performed by another entity who joined with you to form a partnership or joint venture not shown as a
Named Insured in the Declarations, which terminated or ended prior to the effective date of this policy;
and
All other terms and conditions of this policy remain unchanged.
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AGENCY CUSTOMER ID:
LOC #:
A� R" ADDITIONAL REMARKS SCHEDULE
Page of
AGENCY
NAMED INSURED
POLICY NUMBER
CARRIER
NAIC CODE
EFFECTIVE DATE:
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: _ FORM TITLE:
Additional Information
GENERAL LIABILITY:
*Additional Insured if required by written contract per attached Fom-qu-GL- 1060 -E CW (04/13)
*Coverage is Primary/Non- Contributory if required by written contract per anacnea U -GL- 1060 -E CW (04/13)
WORKERS' COMPENSATION:
" Covered States: California, Nevada, Oregon
ACORD 101
2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD