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Alvarez, Donato and Xochitl - Insurance CertificateACCOR®® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 3/22/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 TLB Insurance Services CA License #OB82095 3000 Oak Road, Suite 210 Walnut Creek CA 94597 CONTACT Heidi Gable NAME: PHONE (925) 395-2600 A No): (925)287 -0710 nooRLESS : heidi- gable @leavitt.com INSURERS AFFORDING COVERAGE NAIC # INSURERAMesa Underwriters Specialty 36838 INSURED Donato R. 6 Xochitl Alvarez 5900 Rossi Lane Gilroy CA 95020 INSURER B :National Union Fire Ins Co of PA a19445 INSURERC: INSURER D: INSURER E EACH OCCURRENCE INSURER F A COVERAGES CERTIFICATE NUMBER:17 /18 GL /Umb 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 ADDL SUBR POLICY NUMBER POLICY EFF .POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE XI OCCUR DAMAGE TO RENTED PREMISES Ea occurrence 100 000 $ � MED EXP (Any one person) $ 5,000 X MP0004004001479 3/9/2017 3/9/2018 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY ❑ PRO ❑ JECT LOC PRODUCTS - COMP /OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBaccint INED SINGLE LIMIT Ea de $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Par. xident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 4,000,000 X AGGREGATE $ 4,000,000 B EXCESS UAB CLAIMS -MADE DED I I RETENTION $ BE033341942 3/9/2017 3/9/2018 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE H STATUTE ER E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) E.L. DISEASE - EA EMPLOYE $ ff es, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached K more space Is required) 10 days notice of cancellation for non payment of premium. RE: Lease of Land between City of Gilroy and Insured for land at Obata Way and Southside Drive, Gilroy, CA 95020. The City of Gilroy, its elected officials, officers, agents and employees are named as additional insured with respect to general liability. City of Gilroy Attn: City Clerk 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. AUTHORIZED REPRESENTATIVE idi Gable /HEGABL ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)