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Marathon Engineering - Insurance Certificate (2)Client #: 64826 MAREN2 ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 1/25/2018 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 NAME: Ashley Myers Gulfshore Insurance, Inc SWFL A /ONN , Ext :239 435 -7156 AAC, No): 239 213 -2803 4100 Goodlette Road N E -MAIL m ers a ADDRESS: Y @9 ulfshoreinsurance.com Naples, FL 34103 01/24/2019 EACH OCCURRENCE $1,000,000 INSURER(S) AFFORDING COVERAGE NAIC # 239 261 -3646 INSURER A: Amiure Mutual Inurance Company 23396 INSURED INSURER B Marathon Engineering Corporation MED EXP (Any one person) $ 10,000 dba: Gold Medal Safety Padding INSURER C 5615 2nd Street West INSURER D Lehigh Acres, FL 33971 INSURER E: $2,000,000 INSURER F: 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. INSR LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DDfYYYY LIMITS A GENERAL LIABILITY X X CPP20956230302 01124/2018 01/24/2019 EACH OCCURRENCE $1,000,000 DAEASETO a oNTE ante $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Did OCCUR MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X PRO LOC JECT $ • AUTOMOBILE LIABILITY X X CA20956220302 0112412018 01/24/2019 COMBINED SINGLE LIMIT Ea accident $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ Is • X UMBRELLA LIAB X OCCUR CU20956240302 01/2412018 01/24/2019 EACH OCCURRENCE 1$5,000,000 AGGREGATE 1$5,000,000 EXCESS LIAB CLAIMS -MADE DED I XI RETENTION$O $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? F—Y] N/A X WC205943109 01/24/2018 01/24/2019 X I WCSTATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Gilroy Police Department City of Gilroy, its officers, officials and employees are included as Additional Insured on a primary and noncontributory basis with regards to General Liability Only as required by contract per form CG7048 1015, includes ongoing and completed operations, Waiver of Subrogation per form CG7049 1109. Certificate Holder is included as Additional Insured in regards to Auto Liability only as required by contract per form CA7171 0508, including Waiver of Subrogation. Waiver of Subrogation in (See Attached Descriptions) City of Gilroy, it officers, officials and employees 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2010105) 1 of 2 #S1237536/M1237496 0"I'l w=101 WGU Lai 9 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 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD X9;1 DESCRIPTIONS (Continued from Page 1) regards to Workers Compensation only as required by contract per form WC000313 0484 and WC040306 0484 (CA). Umbrella Follows form. These statements are subject to policy terms and conditions; where required by written contract. SAGITTA 25.3 (2010/05) 2 of 2 #S1237536/M1237496 Client #: 64826 MAREN2 ACORD. CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) TYPE OF INSURANCE 1/25/2018 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 CONTACT Ashley Myers Gulfshore Insurance, Inc SWFL P /C, , Ext :239 435 -7156 A/C No): 239 213 -2803 4100 Goodlette Road N E -MAIL ers amyers@gulfshoreinsurance.com ADDRESS: Y @9 ulfshoreinsurance.com Naples, FL 34103 DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) AFFORDING COVERAGE NAIC # 239 261 -3646 INSURER A : Amerisure Mutual Insurance Company 23396 INSURED INSURER B: GEN'L AGGREGATE LIMIT APPLIES PER POLICY X PRO- ] JECT D LOC Marathon Engineering Corporation $ 2,000,000 dba: Gold Medal Safety Padding INSURER C AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED AUTOS HIRED AUTOS FX X 5615 2nd Street West INSURER D 01124/2018 01/24/2019 COMBINED SINGLE LIMIT Eaaccideni Lehigh Acres, FL 33971 INSURER E: BODILY INJURY (Per person) $ BODILY INJURY (Per accident) INSURER F: X 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 NSR WVD POLICY NUMBER MM /DD�Y MM/LDDY� LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I—XI OCCUR X X CPP20956230302 01/2412018 01/24/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY X PRO- ] JECT D LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED AUTOS HIRED AUTOS FX X X CA20956220302 01124/2018 01/24/2019 COMBINED SINGLE LIMIT Eaaccideni $1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CU20956240302 01/24/2018 01/24/2019 EACH OCCURRENCE s5,000,000 AGGREGATE $5 OOO 000 DE X RETENTION $0 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? LY] (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A X WC205943109 - 0112412018 01124/2019 X TORYLI IT OTH- TORY LIMITS ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEEI $1,000,000 E.L. DISEASE -POLICY LIMIT 1$1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project: City of Gilroy, Gilroy, CA City of Gilroy, CA is included as Additional Insured on a primary and noncontributory basis with regards to General Liability Only as required by contract per form CG7048 1015, includes ongoing and completed operations, Waiver of Subrogation per form CG7049 1109. Certificate Holder is included as Additional Insured in regards to Auto Liability only as required by contract per form CA7171 0508, including Waiver of (See Attached Descriptions) City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2010/05) 1 of 2 #S1237535/M1237496 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 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ASH DESCRIPTIONS (Continued from Page 1) Subrogation. Waiver of Subrogation in regards to Workers Compensation only as required by contract per form WC000313 0484 and WC040306 0484 (CA). Umbrella Follows form. These statements are subject to policy terms and conditions; where required by written contract. SAGITTA 25.3 (2010/05) 2 of 2 #S1237535/M1237496