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Calstate Construction (subcontractor) - Insurance CertificateACC)R °> CERTIFICATE OF LIABILITY INSURANCE DAr1/25/2018 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 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 (OR) Heffernan Insurance Brokers 5100 SW Macadam, Suite 440 CONTACT NAME: PHONE FAX A/c No Ext: 503 - 226 -1320 A/c No): 503-226-147 8 Portland OR 97239 ADDRIESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA: Nationwide Mutual Insurance Company 23767 1/2412019 INSURED NORCPOR -01 NorCal Portable Services, Inc., a California Corpo P.O. Box 53328 INSURER B: Technology Insurance Company, Inc. 42376 INSURER C: $ 100,000 INSURER D: MED EXP (Any one person) San Jose CA 95153 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1400728774 REVISION NIIMRFR- 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. ILTR TYPE OF INSURANCE ADS L WVD POLICY NUMBER MM /DID EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1K OCCUR Y ACP3027549481 1/24/2018 1/2412019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: JECT X PRO - POLICY 1-1 PRO ❑ LOC GENERALAGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY ACP3027549481 1/24/2018 1/24/2019 COMBINED SINGLE LIMIT Ea accident $1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS I (Per accident) BODILY INJURY idt $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ H AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN TWC3690996 1/24/2018 1/24/2019 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? Y NIA 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 A Auto Pollution Liab. CA9948 10 -13 ACP3027549481 1/24/2018 112412019 Each Occurence Included in CSL DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space is required) The General Liability Policy contains the attached Residential and /or Wrap -Up exclusion endorsement. Re: As Per Contract or Agreement on File with Insured. City of Gilroy is included as Additional Insured on the General Liability per the attached endorsement, if required. CERTIFICATE HOLDER CANCELLATION ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 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 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD COMMERCIAL AUTO CA 99 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLLUTION LIABILITY - BROADENED COVERAGE FOR COVERED AUTOS - BUSINESS AUTO AND MOTOR CARRIER COVERAGE FORMS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorser modified by the endorsement. A. Covered Autos Liability Coverage is changed as follows: 1. Paragraph a. of the Pollution Exclusion applies only to liability assumed under a contract or agreement. 2. With respect to the coverage afforded by Paragraph A.I. above, Exclusion B.6. Care, Custody Or Control does not apply. B. Changes In Definitions For the purposes of this endorsement, Paragraph D. of the Definitions Section is replaced by the following: D. "Covered pollution cost or expense" means any cost or expense arising out of: 1. Any request, demand, order or statutory or regulatory requirement that any "insured" or others test for, monitor, clean up, remove, contain, treat, detoxify or neutralize, or in any way respond to, or assess the effects of "pollutants "; or 2. Any claim or "suit" by or on behalf of a governmental authority for damages because of testing for, monitoring, cleaning up, removing, containing, treating, detoxifying or neutralizing, or in any way responding to or assessing the effects of "pollutants ". nent, the provisions of the Coverage Form apply unless "Covered pollution cost or expense" does not include any cost or expense arising out of the actual, alleged or threatened discharge, dispersal, seepage, migration, release or escape of "pollutants ": a. Before the "pollutants" or any property in which the "pollutants" are contained are moved from the place where they are accepted by the "insured" for movement into or onto the covered "auto "; or b. After the "pollutants" or any property in which the "pollutants" are contained are moved from the covered "auto" to the place where they are finally delivered, disposed of or abandoned by the "insured ". Paragraphs a. and b. above do not apply to "accidents" that occur away from premises owned by or rented to an "insured" with respect to "pollutants" not in or upon a covered "auto" if: (1) The "pollutants" or any property in which the "pollutants" are contained are upset, overturned or damaged as a result of the maintenance or use of a covered "auto "; and (2) The discharge, dispersal, seepage, migration, release or escape of the "pollutants" is caused directly by such upset, overturn or damage. CA 99 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 72 58 09 08 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - OPERATIONS COVERED BY A CONSOLIDATED (WRAP -UP) INSURANCE PROGRAM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The following exclusion is added to paragraph 2., Exclusions of COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section I — Coverages): This insurance, including any duty to defend, does not apply to "bodily injury" or "property damage" arising out of either your ongoing operations or operations included within the "products- completed operations hazard" at any location where a consolidated (wrap -up) insurance program has been provided by the prime contractor /project manager or owner of the construction project in which you are involved. This exclusion applies whether or not the consolidated (wrap -up) insurance program: (1) Provides coverage identical to that provided by this Coverage Part; (2) Has limits adequate to cover all claims; or (3) Remains in effect. All terms and conditions of this policy apply unless modified by this endorsement. CG 72 58 09 08 INSURED COPY Page 1 of 1 CG 73 23 12 16 This insurance is primary to any expanded property damage coverage provided by a separate endorsement attached to this policy, and it will supplant any deductible in said endorsement E. Damage To Premises Rented To You 1. Under Section I — Coverages, Coverage A Bodily Injury And Property Damage Liability, the last paragraph of 2. Exclusions is replaced with: If Damage To Premises Rented To You is not otherwise excluded, Exclusions c. through n. do not apply to damage by fire, lightning, explosion, smoke, or sprinkler leakage to premises while rented to you or temporarily occupied by you with permission of the owner. 2. Under Section III — Limits Of Insurance, Paragraph 6 is replaced with: 6. Subject to 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 fire, lightning, explosion, smoke or sprinkler leakage, while rented to you or temporarily occupied by you with permission of the owner. The limit is increased to $1,000,000. 3. Under Section IV — Commercial General Liability Conditions, 4. Other Insurance, b. Excess Insurance (1) (a) (ii) is replaced with: (ii) That is Fire, Lightning, Explosion, Smoke or Sprinkler leakage insurance for premises rented to you or temporarily occupied by you with permission of the owner. Supplementary Payments Under Section 1 — Coverages, Supplementary Payments — Coverages A and B Paragraphs 1.b and 1.d. are replaced with: b. Up to $2,500 for 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. d. All reasonable expenses incurred by the insured at our request to assist us in the investigation or defense of the claim or "suit ", including actual loss of earnings up to $500 a day because of time off from work. G. Newly Formed And Acquired Organizations Under SECTION II — WHO IS AN INSURED Paragraph 3.a. is replaced with: a. Coverage under this provision is afforded only until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier; H. Additional Insured — Automatic Status When Required In An Agreement Or Contract With You Section II — Who Is An Insured is amended to include: 1. Any person(s) or organization(s) described in Paragraph a. — d. below with whom you have agreed in writing in a contract or written agreement that such person or organization be added as an additional insured on your policy during the policy period shown in the Declarations. 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. The person or organization added as an insured by this endorsement is an insured only for liability due to: a. Lessors of Leased Equipment — with respect to their 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). This insurance does not apply to any "occurrence" which takes place after the equipment lease expires. However, their status as additional insured under this policy ends when their lease, contract, or agreement with you for such leased equipment expires. b. Managers or Lessors of Premises — with respect to liability arising out of the ownership, maintenance, or use of that part of the premises you own, rent, lease, or occupy. Page 2 of 5 Includes copyrighted material of Insurance Services Office, Inc., CG 73 23 12 16 with its permission. C. M CG 73 23 12 16 This insurance does not apply to: (1) Your acts or omissions; or (1) Any "occurrence" which takes place (2) The acts or omissions of those after you cease to be a tenant in acting on your behalf; in the that premises. performance of your ongoing (2) Structural alterations, new con- operations performed for that struction, or demolition operations additional insured, whether the work performed by or on behalf of the is performed by you or on your person or organization. behalf. However, their status as additional The insurance does not apply to: insured under this policy ends when you (1) "Bodily injury", "property damage ", cease to be a tenant of such premises. or "personal and advertising injury" State or Political Subdivision — arising out of the rendering of or the Permits Relating to Premises — with failure to render any professional respect to the following hazards for architectural, engineering, or survey which the state or political subdivision services, including: has issued a permit or authorization in (a) The preparing, approving, or connection with premises you own, rent, failing to prepare or approve or control and to which this insurance maps, shop drawings, opinions, applies. reports, survey, field orders, (1) The existence, maintenance, repair, change orders, or drawings and construction, erection, or removal of specifications; or advertising signs, awnings, (b) Supervisory, inspection, archi- canopies, cellar entrances, coal tectural or engineering activities. holes, driveways, manholes, This exclusion applies even if marquees, hoist away openings, the claims against any insured sidewalk vaults, street banners, or allege negligence or other decorations and similar exposures; wrongdoing in the supervision, or hiring, employment, training or (2) The construction, erection, or monitoring of others by that removal of elevators; or insured, if the "occurrence" (3) The ownership maintenance or use which caused the "bodily injury" of any elevators covered by this or "property damage ", or the insurance. offense which caused the "personal and advertising This insurance does not apply to: injury ", involved the rendering (1) "Bodily injury" or "property damage" of, or failure to render, any or "personal or advertising injury' professional, architectural, arising out of operations performed engineering, or surveying for the state or municipality; or services. (2) "Bodily injury" or "property damage" (2) "Bodily injury" or "property damage" included within the "products- occurring after: completed operations hazard ". (a) All work, including materials, However, such state or political parts, or equipment furnished in subdivision's status as additional connection with such work, on insured under this policy ends when the the project (other than service, permit ends. maintenance, or repairs) to be Owners, Lessees, or Contractors — performed by or on behalf of the with respect to liability for "bodily injury", additional insureds) at the location of the covered it damage ", or "personal and operations has been completed; advertising injury" caused in whole or in or part, by: CG 73 23 12 16 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 5 with its permission.