Tiburon Subcontractor - Coplogic'4` ° °® CERTIFICATE OF LIABILITY INSURANCE
DATE(MMr2016 Y1)
12/22/2D,6
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 Northeast, Inc.
Boston MA office
CONTACT
-NAME:
PHONE (866) 283 -7122, FAX (800) 363 -0105
WC. No. El): A/C. No.):
E -MAIL
ADDRESS:
One Federal street
Boston MA 02110 USA
INSURER(S) AFFORDING COVERAGE
NAIC #
INSURED
INSURER A: Zurich American Ins CO
116535
Conlogic, a RELX Inc COmpanY
231 Market Place
Suite 520
INSURER B: ACE American Insurance Company_
22667
-
INSURER C: Lloyd's syndicate No. 2623
AA1128623
San Ramon CA 94583 USA
INSURER D: Zurich Insurance Plc
AA1780059
INSURER E:
-
PREMISES Ea occurrence -
INSURER F:
MED EXP (Any one person) _
COVERAGES CERTIFICATE NUMBER: 570064897626 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
INSIR
LTR
--
TYPE OF INSURANCE
INSD
WVD.
POLICY NUMBER
MMIDp
MMID
LIMITS
-_ -_ -
B_
X
COMMERCIAL GENERAL LIABILITY
OGLG
IJ1CH OCCURRENCE
$1,_000'000
CLAIMS -MADE X❑OCCUR
-
PREMISES Ea occurrence -
$1,000,000
MED EXP (Any one person) _
_ _ _ $5-,-000
PERSONAL & ADV INJURY
$1.,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
_ _ _ $_2 , 000 , 000
X POLICY E] PRO_ ❑LOC
JECT
PRODUCTS - COMP /OPAGG
_
$2,000,000
'OTHER:
A
AUTOMOBILE. LIABILITY
8376848 18
01/01/2017
01/01/2018
COMBINED SINGLE LIMIT
Ea accident
$ 5 , 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
D
UMBRELLALWB
X
OCCUR
GBCGP1700045
0110112017
12/31/2017
EACH OCCURRENCE
$5,000,000
X
EXCESS LIAR
CLAIMS -MADE
AGGREGATE
$5,000,000
DED I RETENTION
A
WORKERS COMPENSATION AND
.EMPLOYERS' LLABILITY YIN N
ANY PROPRIETOR / PARTNER/ EXECUTIVE [N
OFFICER/MEMBER EXCLUDED9 N
(Mandatory in NH)
N/A
837684518
01 01/2017
01/01/2018
X PER
.STATUTE
OTH-
ER
E.L. EACH ACCIDENT
-
$1,000,000
E.L. DISEASE -EA EMPLOYEE
$1,000,000
If yyes, describe under
DESCRIPTION OF OPERATIONS below
E.L .DISEASE- POLICY LIMIT
$1,000,000
C
E&o -PL- Primary
QK17704205
01/01/2017101/01/2018
Aggregate Limit
$3,000,000
SIR applies per policy terms
& condi
ions
Per occurence
$1,000,000
DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (ACORD 101, Additional, Remarks Schedule, may be attached if more space Is required)
City of Gilroy is added as additional insured on the General Liability subject to the policy limitations, conditions and
exclusions.
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
01988 -2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD
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