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Maggiora Bros. Drilling - Insurance Certificate283659 ®® CERTIFICATE OF LIABILITY INSURANCE DATE (MM13D/YYYY) 9/14/2017 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 Commercial Lines - (415) 644 -7700 Wells Fargo Insurance Services USA, Inc - CA Lic# OD08408 CONTACT PHONE FAX Arc Na Ext .866- 358 -1487 A/c No ,E- -AIL e, : CertRequests @wellsfargo com 45 Fremont Street, Suite 800 INSURER(S) AFFORDING COVERAGE X San Francisco, CA 94105 -2259 INSURER A Valley Forge Insurance Company _NAIC9 20508 INSURED Maggiora Bros Drilling Inc INSURER B. Continental Casualty Company 20443 INSURER C. National Fire Insurance Company of Hartford 20478 595 Airport Boulevard INSURER D: Redwood Fire and Casualty Insurance Company 11673 INSURER E Watsonville, CA 95076 INSURER F COVERAGES CERTIFICATE NUMBER: 12230459 REVISION NUMBER: See below 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 UBR POLICY NUMBER POLICY EFF MM/DDlYYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY X 4015556058 9/19/2017 1/1/2018 EACH OCCURRENCE S 1,000,000 CLAIMS MADE OCCUR PREMISES Ea occurrence S 100,000 X MED EXP (Any one person) S 15,000 BI /PD [)ad $5,000 X XCU Included PERSONAL & ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S 2,000,000 POLICY � PRO ❑ JECT LOC PRODUCTS - COMP /OP AGG S 2000,000 OTHER I S B AUTOMOBILE LIABILITY X 4016912684 - - 9/19/2017 1/1/2018 COMBINED SINGLE LIMIT Ea accident 5 1,000,000„ X BODILY INJURY (Per person) S ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accldenl S S C X UMBRELLAUAB X OCCUR 416912670 09/19/2017 01/01 /2016 EACH OCCURRENCE S 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION$ 10,000 $ D AND YERS' COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A MAWC811672 1/1/2017 1/1/2018 X STATUTE ERH E L EACH ACCIDENT 1,000,000 $ E L DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If ycs describe undar DESCRIPTION OF OPERATIONS below E L DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SCA23500D (Ed 10/1 1 ),CNA75079XX(1-15) The City of Gilroy, Its officers, and employees is named as additional Insured as respects general liability and automobile liability per endorsements attached - _ —. I ILJIV City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 613 Old Gilroy St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE L g( -1- The ACORD name and logo are registered marks of ACORD @ 1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) 1 1111111 III 1111111 I II !1111 1111111111111111111111111 HILL IIIII 11111111111 HILL 1 e C POLICY NUMBER: 4016912684 SCA 23 500D (Ed. 10/11) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXTENDED COVERAGE ENDORSEMENT - SA PLUS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM I. LIABILTY COVERAGE A. Who Is An Insured The following Is added to Section 11, Paragraph A.1., Who Is An Insured: 1. a. Any Incorporated entity of which the Named Insured owns a majority of the voting stock on the date of Inception of this Coverage Form; provided that, b. The insurance afforded by this provision A.1. does not apply to any such entity that Is an "Insured" under any other liability "policy" providing "auto" coverage. 2. Any organization you newly acquire or form, other than a limited liability company, partnership or joint venture, and over which you maintain majority ownership interest. The Insurance afforded by this provision A.2.: a. Is effective on the acquisition or formation date, and is afforded only until the end of the policy period of this Coverage Form, or the next anniversary of Its Inception date, whichever Is earlier. b. Does not apply to: (1) "Bodily injury" or "property damage" caused by an "accident" that occurred before you acquired or formed the organization; or (2) Any such organization that Is an "Insured" under any other liability "policy" providing "auto" coverage. 3. Any person or organization that you are obligated to provide Insurance where required by a written contract or agreement Is an Insured, but only with respect to legal responsibility for acts or omisslons of a person for whom Liability Coverage Is afforded under this policy. 4. An "employee" of yours Is an "insured" while operating an "auto" hired or rented under a contract or agreement In that "employee's" name, with your permission, while performing duties related to the conduct of your business. 1. Which are no longer In force; or 2. Whose limits have been exhausted. B. Ball Bonds and Loss of Earnings Section II, Paragraphs A.2,a.(2) and A.2.a.(4) are revised as follows: 1. In a.(2), the limit for the cost of bail bonds is Increased from $2,000 to $5,000, and 2. In a.(4), the limit for the loss of earnings Is Increased from $250 to $500 a day. C. Fellow Employee Section 11, Paragraph Bar does not apply. Such coverage as is afforded by this provision C. Is excess over any other collectible Insurance. II. PHYSICAL DAMAGE COVERAGE A. Towing Section Ill. Paragraph A.2., Is revised to Include Light Trucks up to 10,000 pounds G.V.W. B. Glass Breakage — Hitting A Bird Or Animal -- Falling Objects Or Missiles The following Is added to Section Ill, Paragraph A.3.. With respect to any covered "auto," any deductible shown In the Declarations will not apply to glass breakage If such glass Is repaired, In a manner acceptable to us, rather than replaced. C. Transportation Expenses Section III, Paragraph A.4.a. Is revised, with respect to transportation expense Incurred by you, to provide: a. $60 per day, In lieu of $20; subject to b. $1,800 maximum, in lieu of $600. D. Loss of Use Expenses Section III, Paragraph AA.b, is revised, with respect to loss of use expenses incurred by you, to provide: a. $1,000 maximum, in lieu of $600. "Policy," as used In this provision A. Who Is An E. Personal Property insured, Includes those policies that were In force The following is added to Section 111, Paragraph on the inception date of this Coverage Form but: A.4. SCA 23 500D Copfttfl, CNA Oorporatlon, 2000. Page 1 of 3 (Ed. loll 1) Inoludos copyrlghtad matodal of 1ho Insuranoo SoMm Office used With Its parmisslon SCA 23 500D (Ed. 10 /11) c. We will pay up to $500 for loss to Personal a. Any covered "auto" you lease, hire, rent or Property which is: borrow without a driver; and (1) Owned by an "insured "; and b. Any covered "auto" hired or rented by your (2) In or on the covered "auto." "employee" without a driver, under a contract In that Individual employee's This coverage applies only in the event of a total name, with your permission, while theft of your covered "auto." performing duties related to the conduct of This Insurance Is excess over any other your business. collectible insurance and no deductible applies. c. The most we will pay for any one "accident" F. Rental Reimbursement or "loss" Is the actual cash value, cost of repair, cost of replacement or $75,000 The following Is added to Section 111, Paragraph whichever Is less minus a $500 deductible AA.: for each covered auto. No deductible applies to "loss" caused by fire or lightning. d. We will pay for rental reimbursement expenses Incurred by you for the rental of an "auto" because of "loss" to a covered "auto," Payment d. The physical damage coverage as Is applies In addition to the otherwise applicable provided by this provision will be limited to amount of each coverage you have on a the types of physical damage coverage(s) covered 'auto." No deductibles apply to this provided on your owned "autos." coverage. e. Such physical damage coverage for hired 1. We will pay only for those expenses "autos" will: Incurred during the policy period beginning (1) Include loss of use, provided It Is the 24 hours after the "loss" and ending, consequence of an "accident' for which regardless of the poilcy's expiration, with the the Named Insured Is legally liable, and lesser of the following number of days: as a result of which a monetary loss is (a) The number of days reasonably sustained by the leasing or rental required to repair or replace the concern. covered "auto "; or, (2) Such coverage as Is provided by this (b) 15 days. provision G.e.(1) will be subject to a limit of $750 per "accident." 2. Our payment Is limited to the lesser of the following amounts: H. Airbag Coverage (a) Necessary and actual expenses The following Is added to Section III, Paragraph Incurred; or, 8.3. (b) $25 per day subject to a maximum of The accidental discharge of an airbag shall not be $375. considered mechanical breakdown. 3. This coverage does not apply while there 1. Electronic Equipment are spare or reserve "autos" available to Section III, Paragraphs BA.c and iBALd. are you for your operations. deleted and replaced by the following: 4. If "loss" results from the total theft of a c. Physical Damage Coverage on a covered covered "auto" of the private passenger "auto" also applies to "loss" to any type, we will pay under this coverage only permanently Installed electronic equipment that amount of your rental reimbursement including Its antennas and other expenses which Is not already provided for accessories under the Physical Damage Coverage Extension. d. A $100 per occurrence deductible applies to G. Hired "Autos" the coverage provided by this provision. The following is added to Section III. Paragraph A.: J. '1,0Iminutlon In Value S. Hired "Autos" The following Is added to Section III, Paragraph 6.6. If Physical Damage coverage is provided under Subject to the following, the "diminution in value" this policy, and such coverage does not extend exclusion does not apply to: to Hired Autos, then Physical Damage coverage is extended to: SCA 23 500D Copyright, CNA Corporation, woo Page 2 of 3 (Ed. 10/11) Includes copyrighted material of the insumnee services olflce used w]th Its permission. a. Any covered "auto" of the private passenger type you lease, hire, rent or borrow, without a driver for a period of 30 days or less, while performing duties related to the conduct of your business; and b. Any covered "auto" of the private passenger type hired or rented by your "employee' without a driver for a period of 30 days or less, under a contract In that Individual "employee's" name, with your permission, while performing duties related to the conduct of your business. c. Such coverage as is provided by this provision is limited to a "diminution in value" loss arising directly out of accidental damage and not as a result of the failure to make repairs; faulty or Incomplete maintenance or repairs; or the Installation of substandard parts. d. The most we will pay for "loss" to a covered "auto" in any one accident is the lesser of: (1) $5,000; or (2) 20% of the "auto's" actual cash value (ACV) Ill. Drive Other Car Coverage — Executive Officers The following Is added to Sections 11 and III: 1. Any "auto" you don't own, hire or borrow is a covered "auto" for Liability Coverage while being used by, and for Physical Damage Coverage while In the care, custody or control of, any of your "executive officers," except: a. An "auto" owned by that "executive officer" or a member of that person's household; or b. An "auto" used by that "executive officer" while working in a business of selling, servicing, repairing or parking "autos." Such Liability and/or Physical Damage Coverage as is afforded by this provision will bo: (1) Equal to the greatest of those coverages afforded any covered "auto "; and (2) Excess over any other collectible insurance. 2. For purposes of this provision, "executive officer" means a person holding any of the officer positions created by your charter, constitution, by -laws or any other similar SCA 23 500D (Ed. 10111) governing document, and, while a resident of the same household, includes that person's spouse. Such "executive officers" are 'Insureds" while using a covered "auto" described In this provision. IV. BUSINESS AUTO CONDITIONS A. Duties In The Event Of Accident, Claim, Suit Or Loss The following is added to Section IV, Paragraph A.2.a. (4) Your "employees" may know of an "accident" or "loss." This will not mean that you have such knowledge, unless such "accident" or "loss" is known to you or If you are not an individual, to any of your executive officers or partners or your Insurance manager. The following is added to Section IV, Paragraph A.2.b. (6) Your "employees" may know of documents received concerning a claim or "suit." This will not mean that you have such knowledge, unless recelpt of such documents is known to you or If you are not an Individual, to any of your executive officers or partners or your Insurance manager. B. Concealment, Misrepresentation or Fraud The following is added to Section IV, Paragraph B.2. Your failure to disclose all hazards existing on the date of Inception of this Coverage Form shall not prejudice you with respect to the coverage afforded provided such failure or omisslon Is not Intentional. C. Policy Period, Coverage Territory Section IV, Paragraphs 7.(5).(a). Is revised to provide: a. 45 days of coverage In lieu of 30 days V. DEFINITIONS Section V. Paragraph C. Is deleted and replaced by the following: "Bodily Injury" means bodily injury, sickness or disease sustained by a person, Including mental anguish, mental injury or death resulting from any of these SCA 23 500D copyright, CNA Corporation, 2000. Page 3 of 3 (Ed. 10/11) Includes copyrighted metedul of the Insuronco SarAcos Office used wlth Us permission. 1111111 Ill 1111111111111111111111111111111111111111111111111111111111111111111111111111111 _._ „/D5/0_ CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products - Completed Operations Coverage Endorsement This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART It is understood and agreed as follows* I. The WHO IS AN INSURED section is amended to add as an Insured any person or organization whom the Named Insured is required by written contract to add as an additional Insured on this coverage part, including any such person or organization, if any, specifically set forth on the Schedule attachment to this endorsement. However, such person or organization Is an Insured only with respect to such person or organization's liability for. A. unless paragraph B. below applies, 1. bodily injury, property damage, or personal and advertising injury caused In whole or in part by the acts or omissions by or on behalf of the Named Insured and In the performance of such Named Insured's ongoing operations as specifted in such written contract; or 2. bodily Injury or property damage caused in whole or in part by your work and Included In the products - completed operations hazard, and only if a. the written contract requires the Named Insured to provide the additional insured such coverage; and b. this coverage part provides such coverage. B. bodily injury, property damage, or personal and advertising injury arising out of your work described in such written contract, but only if: 1. this coverage part provides coverage for bodily injury or property damage included within the products completed operations hazard; and 2. the written contract specifically requires the Named Insured to provide additional insured coverage under the 11 -85 or 10 -01 edition of CG2010 or the 10 -01 edition of CG2037. II. Subject always to the terms and conditions of this policy, including the limits of insurance, the Insurer will not provide such additional insured with: A. coverage broader than required by the written contract; or B. a higher limit of insurance than required by the written contract. Ili. The insurance granted by this endorsement to the additional Insured does not apply to bodily injury, property damage, or personal and advertising injury arising out of: A. the rendering of, or the failure to render, any professional architectural, engineering, or surveying services, including: 1. the preparing, approving, or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. supervisory, inspection, architectural or engineering activities; or B. any premises or work for which the additional insured is specifically listed as an additional insured on another endorsement attached to this coverage part. . IV. Notwithstanding anything to the contrary in the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS, the Condition entitled Other Insurance, this insurance is excess of all other insurance available to the additional insured whether on a primary, excess, contingent or any other basis. However, if this insurance is required by written CNA75079XX (1 -15) Page 1 of 2 VALLEY FORGE INSURANCE COMPANY Insured Name: MAGGIORA EROS. DRILLING INC. Policy No: 4015556058 Endorsement No: Effective Date: 9/19,/17 Copyright CWt AO Rights Roserved. Includes copyrighted matenal of Insurance Services Office, Inc. wRh Its permission. 1111111 Ill 1111111111111111111111111111111111111111111111111111111111111111111111111111111 -CY501A141000198/06107/0101[V0* CNA CNA PARAMOUNT Blanket Additional Insured - Owners, Lessees or Contractors - with Products - Completed Operations Coverage Endorsement contract to be primary and non- oontributory, this insurance will be primary and non - contributory relative solely to insurance on which the additional insured Is a named insured. V. Solely with respect to the insurance granted by this endorsement, the section entitled COMMERCIAL GENERAL LIABILITY CONDITIONS Is amended as follows: The Condition entitled Duties In The Event of Occurrence, Offense, Claim or Suit is amended with the addition of the following: Any additional insured pursuant to this endorsement will as soon as practicable: 1. give the Insurer written notice of any claim, or any occurrence or offense which may result In a claim; 2. except as provided In Paragraph IV. of this endorsement, agree to make available any other insurance the additional Insured has for any loss covered under this coverage part; 3. send the Insurer copies of all legal papers received, and otherwise cooperate with the Insurer in the investigation, defense, or settlement of the claim; and 4. tender the defense and indemnity of any claim to any other insurer or self Insurer whose policy or program applies to a loss that the Insurer covers under this coverage part. However, if the written contract requires this Insurance to be primary and non - contributory, this paragraph (4) does not apply to insurance on which the additional insured is a named insured. The Insurer has no duty to defend or indemnify an additional insured under this endorsement until the Insurer receives written notice of a claim from the additional insured. Vl. Solely with respect to the Insurance granted by this endorsement, the section entitled DEFINITIONS is amended to add the following definition: Written contract means a written contract or written agreement that requires the Named Insured to make a person or organization an additional insured on this coverage part, provided the contract or agreement: A. is currently in effect or becomes effective during the term of this policy; and B. was executed prior to: 1. the bodily Injury or property damage; or 2. the offense that caused the personal and advertising injury for which the additional insured seeks coverage. Any coverage granted by this endorsement shall apply solely to the extent permissible by law. All other terms and conditions of the Policy remain unchanged. This endorsement, which forms a part of and is for attachment to the Policy issued by the designated Insurers, takes effect on the effective date of said Policy at the hour stated inI said Policy, unless another effective date is shown below, and expires concurrently with said Policy. CNA75079XX (1 -15) Policy No: 4015556058 Page 2 of 2 Endorsement No: VALLEY FORGE INSURANCE COMPANY Effective Date: 9/19/17 Insured Name: MAGGIORA BROS. DRILLING INC. Copyright CNAA!! Rlghis Reserved. Indudes copyAghled material of rnsurenoe Services office, Inc.. wfth fts permisslon.