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Monterey Peninsula Engineering - Insurance Certificate (2018)
CERTIFICATE OF LIABILITY INSURANCE �ATE��II�IIDDNYYYY' aNS,arr�TE 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 coRlflcate holder Is an ADDITIONAL INSURED, the policy(les) roust have ADDITIONAL INSURED provisions or he 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). PROOUCER Aon Risk insurance Services West Zn €. San lose CA office CONTACT NAVE: tir.v�,E Carsa7 za3.7>zz .oe.: (eao) ifiTatos 177 Park Avenue, Suite 200 san Jose CA 45113 USA E -MAIL ADCR =ss: INSURE.R(S) AFFORDING COVERAGE lr a CO- A General Liability INSURED INSURERA; Travelers Property Cas Cc of ,k ^_�ici ;_74 Monterey Peninsula Enqineerinq P 0 Box 406 - INSURER Be INSURER C_ Marina CA 93933 USA $5,000 INSURER D_ neTENTINIV f0 INSURER E: INSURER F, L:UVI;KALotS Ut:KIIFIUATt: NUMML -K: b /UU /1b"41ti REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISPED BELOW HAVE BEEN ISSUEQ TO THE INSURED NAM' =D ABOVE FOR THE POLICY PERIOD icN INDICATED_ NOTW[THSTAND NG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCL!VT V41TH RESPECT TD WHICH THIS CERTIFICATE MAY BE IaSI;ED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIEED HEREIN IS SUBJECT TO /..LL THE TERMS„ EXCLUSSONS AND CONDITIONS OF SUCH POLICIES. LNAI TS SHOWN MAY HAVE BEEN REDUCED BY PAID CLA iS, Limits shown are as requested LTR TYPE OF WSURANCL INSD: VaM PW- OV R9Ye1 R MrI2D1Y YYS fNM1DMrfYY1A LIWITS X COMM -ERCIALGENERALL1ASILrY CLnWS4,A0S �oCCU.A Y CO- A General Liability / 1 20LB EACHOCCURR. -KEE 52,00A,0a0 - �� 10 PRgmisas (Ss o Jrrdn:e 53a0,60a MEDEXP(Anyoneoorsoni $5,000 neTENTINIV f0 PERSO•NALNN ADV INJURY 52,000,000 GENiAGG emeLIAITA'minPER. GD49RALAGORSGAE S 4,000,000 POLICY DJECCT` 1:1LCC OTHER: PRODUCTS- COMpKIPAGG $4,000,000 A 'AUTDjIOB1ELIABILITY Y L816-4LS81240- TC'T -17 AU a ,08/01/261908/01 /2018 COMBI*NEDS. \'6LELIMIT -a sm�arc S110001060 BODILY INJURY(P*r parsgr) X ANYAUTO ON". a SCN•E- v'7ULEC AurOS+JNLV AUTOS X HIReDAUTOa X NON,CriVNEG, ONLY AUTOS ONLY BODILY INJURY IP61 SrdderQ P1111 YN7A7A4GE Me, .1 A X UMBRELLALIAB E %CMSSLlAB X OCrUR GLAp,tS51A-7E CUP4310 049 Umbrella Liability 08/0112017 08J01/2018 6N *i OuniiENCS $8,400,000 aGGREGAT@ 58,000,000 X OE0 RETEKr10`N iL0,000 A WORKERS COAIPINSAT ION A.ND EMPLOYERS'LIJIBU -" YrM1 ARYPRORAM10R I PAtr1fit It I I XECUTNt r`:"' CI7ICERAAEMBER =XCLLCE47 III (Nandalaryln NHl NIA Y IUB- 4A195958 -17 'Norkers Compensation 08/0112017 08/01/2015 X PcaSTATUTE -- dTH. R -- E,L.ECH ACCq�NT $1,000,000 E.L. DISEASE-EA EMPLOYEE 51,000,000 Y ins, dasoft undar Of aCRIPTION OP OPFRA71O NS aali- E.L. DISEASE-POLICYLIMJT S1,000,000 DESCRIPTION OF CPERAFIDtiS P LNSCA7i0,NS7 VEHICLES IACORD 101, AdAhlunal Remadis schedule, may be eltaahed Y mars spaen In mqulrod7 RE: First Street Water Utility improvements The City, its officials, officers, employees, and volunteers are named as Additional insured with respects to the General Liability and Automobile Liability provided a written contract or agreexent is Tn place. Primary and non - contributory vlording per the attached endorsements. 30 Day Notice of Cancellation with respects to tine General Liability, Automobile Liability and Workers' compensation Liability. Waiver of Subrogation applies to General Liability, Automobile Liability and Workers' Compensation Liability. Umbrella is following form. Endorsement(s) Attached: CERTIFICATE HOLDER CANCELLATION SH04ULD ANY aF THE ABOVE oESCRIeEO P43UC19S e- CANCELLED BEFORE THE EXPIRATION 00.7E THEREOF, NOTICE WILL BE DELIVMM W ACCOAWNC=_ IVITH THE I.GY PROVISIONS. city of Gilroy A' :THQRIZED REPRESENTATIVE 613 old Gilroy Rd ciircy CA 95t1 a USA 13ii 988 -2015 ACORD CORPORATION, All rights reserved. ACORD 25 (2016103) The ACORD name and 10go are registered marks of ACORD ARK AGENCY CUSTOMER ID: 570000064273 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of AGENCY Aon Risk insurance Services West, Inc. NWED WS`.1RE-3 Monterey Peninsula Engineering POLICYNUFABER see certificate Number. 570071622478 CARRIER See certificate Number: 570071622478 COOS EFFECTIVE DATE ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: AGORO 25 FORM TITLE: Cer0cete of Liability Insurance AEEitianel Oa1t+i�tiCn d Cpma Was t Lacat M51 Vehdar General Liability Additional Insured General Liability Primary General Liability Waiver of Subroggation General Liability 30 Day Notice of cancellation Automobile Liability Additional insured Automobile Liability Primary Automobile Liability Waiver of Subrogation AUtumabile Liability 30 pay Notice o, cancellation Workers' compensation waiver of Subrogation Workers' compensation 30 Day Notice of cancellation Ini raenainn The ACORp name and logo are regtatered marks OACQRD POLICY NUMBER: DT22- CO- 4A202128 -TCT 17 ISSUE DATE: 05 /23/2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSONS OR ORGANIZATIONS This endorsement modifies insurance provided under the fallowing: MEDFIRST PRODUCTS ICOMPLETEb OPERATIONS, ERRORS AND OMISSIONS, AND INFORMATION SECURITY LIABILITY COVERAGE FORM SCHEDULE OF DESIGNATED PERSONS OR ORGANIZATIONS City of Gilroy, its afFICers, official and Employees 7351 hosanna Street Gilroy, CA 95020 Service Agreement. Construction Services performed by ;Monterey Say Peninsula, covers City of Gilroy, its officers, officials and employees are named as an additional insured, per the arached endorsement PROVISIONS b. For the purposes of Coverage 8 and The following is added to SECTION II - WHO Coverage C, only with respect to liability IS AN INSURED: for loss caused, In whole or in part, by your acts or omissions. Any person or organization shown in the Schedule Of Designated Persons Or Organi- zations is an insured, but_ a. For the purposes of Coverage A. only with respect to liability for "bodily in- iury" or "Property damage" caused, in whole or in part, by your acts or omis- slons; and If you agreed In a written contract or agreement to include such person or organi- zation as an additional insured on this policy, the limit of insurance provided to such person or organization will be the limit which you agreed to provide in that written contract or agreement, or the limit shown in the Declarations, whichever is less. CG Dr 86 01 13 0 2011 The Traveteps Inde me ty Company. All rights resemau, Page i of 1 Ir,rlud6s Mpynghted nwanal of tnsigance ftvices otdiCO, Inc. with its WjWgCW_ POLICY NUMBER DT- CG- 4A202118- TCT -17 ISSUE DATE: 48 -01 -13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, DESIGNATED ENTITY - NOTICE OF CANCELLATIGNMONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SEHEDULE, CANCELLATION: Number of Days Notice of Cancellation: 30 NONRENEWAL: Number of Days Notice of Nonrenewat: 30 PERSON OR ORGANIZATION: ANZY PERSON OR ORGANIZATION TEiAT IS A CERTIFICATE HOLDER OR A CERTIFICATE OF INSURANCE ISStMD FOR YOU TKhT: 1. REFERS TO THIS POLICY AND STATES THAT NOTICE OF CA14CEiLLALTION OR NOMMINWAL OF MS POLICY WILL BE PRO+iI M TO TEAT PIMSON' OR ORGMIZATION; A11D 2. IS IN EFFECT, AMID IS ON FILE AT TBE OFFICE OF YOUR AGENT OR BROKER FOR THIS POLICY, AT THE TIME OF THE CANCELLATION OR A'OrRMNEWAL. ADDRESS. THE ADDRESS SHOWN FOR OF INSURANCE. PROVISIONS: THAT PERSON OR ORGANISATION IN THAT CERTIFICATE A. If we cancel this policy for any statutorily permit- ted reason other than nonpayment of premium, and a number of flays is shown for cancellation in the schedule above, we will mail notice of cancel- lation to the person or organization shown in the schedule above, We will matt such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of can- cellation. B. If we decide to not renew this policy for any statu- torily permitted reason, and a number of days is shown fcr nonrenival In the schedule above, we will mail notice of the nonrenewal to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of clays shmvn for nonrenewal in the schedule above be- fore the expiration date. POLICY NO. CO.0202118 -TCT 17 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CONTRACTORS XTEND ENDORSEMENT This endorsement modifies Insurance provided under the following; COMILPIERCIAL GENERAL LIABILITY COVERAGE PART GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage However, coverage for any injury. damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to this Coverage Part, and these coverage broadening provisions do not apply to the extant that coverage Is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine. rights, duties, and what is and is not Cowered. A. Aircraft ^hartared With Pilot B. Damage To Premises Rented To You C. Increased Supplementary Payments D. Incidental hied +cal Malpractice E. VVno Is An Insured -- Newly Acquired Or Farmed Organi2ations F. Who Is An Insured — Broadened Named insured — Unnamed Subsidiaries G. Blanket Additional Insured — Owners, Managers Or Lessors Of Premises PROVISIONS A. AIRCRAFT CHARTERED WITH PILOT The folltrving is added to Exclusion g., Aircraft, Auto Or Watercraft, in Paragraph 2. of SECTION I — COVERAGES — COVERAGE A BODILY IN- JURY AND PROPERTY DAMAGE LIABILITY, This exclusion does not apply to an a`rcraft that Is: (a) Chartered with a pilotto any insured. (b) Not owned by any insured; and (c) Not tieing used to carry any person or prop- erty for a charge_ S. DAMAGE TO PREMISES RENTED TO YOU 1. The first paragraph of the exceptions in Ex- clusion j., Damage. To Property, in Para- graph 2. of SECTION I — COVERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY Is deleted. 2. The following replaces the last paragraph of Paragraph 2., Exclusions, of SECTION I — COVERAGES — COVERAGE A. BODILY H. Blanket Additional Insured — Lessors Of Leased Equipment 1. Blanket additional Insured — States Or Political Subdivisions — Permits J. Knowledge And Notice Of Occurrence Or Offense K. Unintentional Omission L. Blanket Waiver Of Subrogatlon M. Amended Bodily Injury Definition N. Contractual Liability — Railroads INJURY AND PROPERTY DAMAGE LI- ABILITY: Exclusions o. and g. through n. do not apply to " prerises damage ". Exclusion f.(1)(a) does not apply to "premises dam2;e" caused by., a. Fire; b. Explosion; c. Lightning-, d. Smoke resulting from such tire, explosion, or lightning; or e. Water, unless Exclusion f. of Section I — Coverage A Bodily Injury And Property Damage Liability is replaced by another endorsement to this Coverage Par, that has Exclusion — All Pollu- tion Injury Or Damage or Total Pollution Ex- clusion in its title, A separate limit of insurance applies to "premises damage' as described its Para- graph S. of SECTION III — LIMITS Of IN- SURANCE, CG D3 16 11 11 S 2011 The Travelers lndemniq Company. All rights reserved, Page 1 of 6 COMMERCIAL GENERAL LIABILITY 3. The following replaces Paragraph S. of SEC - TION III -- LIMITS OF INSURANCE: Subject to S. above, the Damage To Prem- ises Rented To You Limit is the most we will pay under Coverage A for damages because of "premises damage'' to any one premises. The Damage To Premises Rented To You Limit will apply to all "property damage" proximately caused by the same "occur- rence", whether such damage results from: tire; explosion; lightning; smoke resulting from such fire, explosion, or lightning; or water, or any combination of any of these causes. The Damage To Premises Rented To You Limit will be. a. The amount shown for the Damage To Promises Rented To You Limit on the Declarations of this Coverage Part; or b. $300,000 If no amount is shown for the Damage To Premises Rented To You Limit on the Declaratione.of this Coverage Part. 4. The following replaces Paragraph a. of the definition of "insured contract" in the DEFINI- TIONS Section: a. A contract for a tease of premises. How- ever, that portion of the contract for a lease of premises the! indemnifies any person or organization for "premises dainage" is not an "insured contract"; 6. The following is added to the DEFINITIONS Section: "Premises damage" means "property dam- age" to, a. Any premises while rented to you or tem- porarily amupied by you with permission of the owner; or b. The contents of any premises while such premises is rented to you, if you rent sucii premises for a .period of seven or fewer consecutive days. 6. The following replaces Paragraph 4.b.(1)(b) of SECTION IV - COMMERCIAL GENERAL UAE1LtTY CONDITIONS: (b) That is insurance for "premises damage' or 7. Paragraph 4.b.(1)(c) of SECTION iV - COMMERCIAL GENERAL LIABILITY CON - DITIONS is deleted. C. INCREASED SUPPLEMENTARY PAYMENTS 1. The followng replaces Paragraph 1.b. of SUPPLEMENTARY PAYMENTS - COVER- AGES A AND 8 of SECTION I - COVER- AGE: b. Up to $2,500 for the cost of hail 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 fur - nish these bands, 2. Tho falfaMng replaces Paragraph 14 of SUPPLEMENTARY PAYMENTS - COVER- AGES A AND B of SECTION i - COVER- AGES: 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 uup to $500 a day because of time off from work. D. INCIDENTAL MEDICAL MALPRACTICE 1. The following is added to the defir±ilion o" 'oc- currence" in the DEFINITIONS Section: "Occurrence" also means an act or omission . committed in providing or failing to provide "incidental medical services ", first aid or "Good Samaritan services" to a person. 2. The foilovr'rng is added to Paragraph 2.a.(1) of SECTION If - WHO IS AN INSURED: Paragraph (1)(d) above does not apply to "bodily injury" arising out of providing or fail- ing to provide; (i) "Incidental medical services by any of your "employees" who is a nurse practi- tioner, registered nurse, licensed practical nurse, nurse assistant, emergency medi- cal technician or paramedic; or (i1) First aid or "Good Samaritan services" by any of your " employaes" or "volunteer warkens , other than an employed or vol- unteer doctor. Any such "employees" or "volunteer workers" providing or failing to provide first aid or "Good Samaritan ser- vices!' during their work hours for you will be deemed to be acting within the Scope of their employment by you or performing duties related to the conduct of your busi- ness. Page 2 of 6 0 2011 The Travelirr, indemnity Gompany. Alt rights resented. CG D3 16 11 11 3. The following is added to Paragraph S. of SECTION III — LIMITS OF INSURANCE: For the purposes of determining the applica- ble Each Occurrence Limit, all related acts or omissions committed in providing or failing to provide "incidental medical services ", first aid or "Good Samaritan services" to any one per- son will be deemed to be one "occurrence ". 4. The following exclusion is added to Para- graph 2., Exclusions, of SECTION I — COV- ERAGES — COVERAGE A BODILY INJURY AND PROPERTY DAMAGE LIABILITY: Sate Of Pharmaceuticals "Bodily injury' or "property damage" arising out of the willful violation of a penal statute or ordinance relating to the s3l3 of pharmaceuti- cals committed by, or with the knowledge cr consent of; tale insured. a. The following Is added to the DEFINITiONS Section: 1rictdedtal medical services" means: a. Medical. surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or heveT2ges; or b. The furnishing at dispensing of drugs at medical, dental, or surgical supplies of appliances. "Good Sarnardan services" means any emer- gency medical services for which no compen- sation is demanded or received. S. The following is added to paragraph 4,b.. Ex- cess Insurance, of SECTION IV — COM- MERCIAL GENERAL LIABILITY CONDI- TIONS: The insurance is excess over any valid and Collectible other insurance available to the in- sured, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" or "volunteer workers" for "bodily injury" that arises out of providing or failing to provide "incidental medical ser- vices", first aid or "Good Samaritan services" to any person to the extent not subject to Paragraph 2.a. (i) of Section 11 — Who Is An Insured. E. WHO IS AN INSURED — NEWLY ACQUiRED OR FORMED ORGANIZATIONS The following replaces Paragraph 4. of SECTION II —WHO IS AN INSURED: Ct_iMPOERCLAL GENERAL LIABILiTY 4. Any organization you newly acqu're or Form, other than a partnership, joint venture or lim. ited liability company, of which you are the sale owner or in which you Maintain the ma- jority ownership interest, Mll qualify as a Named Insured if there is no other insurance which provides simiiar coverage to that or- ganization. Hoaiever. a. Coverage under this provision is afforded only. (1) Until the 180th day after you acquire or form the organization or the end of the policy period, whichever is earlier. It you do not report such organization In writing to us within 184 days after you acquire or form a; or (2) until the end of the policy period, When that date is later then 180 days after you acquire or form such organization, i; you report such organization in writing to us vrthin 18Q days after you acquire or form It, and we agreia In writing that it Wil con- tinue to be a Named Insured unfit the end of the policy period; b, Coverage A does not apply to "bodily injury„ or "property damage" that occurred before you acquired or formed the organization; and c. Coverage B does not apply to "personal in- jury" or "advertising injury" arising out of an offense committed before you racquired or formed the organization. F. WHO I5 AN INSURED — BROADENED NAMED INSURED— UNNAMED SUBSIDIARIES The following is added to SECTION II — WHO IS AN It+wswterx Any of your subsidiaries, otherthan a partnership, joint venture or tinted liability company. That is riot shown as a Named Insured in the Declara- tions is a Named Insured If you maintain an tatr,- ership interest of more than 5014 In such subsidi- anp cn the first day of the policy period. No such subsidiary is an insured for " bodily injury" or "property damage" that occurred, or "personal injury' or "advertising injury" caused by an of. fense committed after the date, if any. during the policy period, that you no longer maintain an ownership interest of more than 509 in such sui3- sidia;y- CG D3 1611 11 r-; 2G11 Tilt Troverera rndomnity Company. All rights reserved, Page 3 of 6 COMMERCIAL GENERAL LIABILITY G. BLANKET ADDITIONAL INSURED — OWNERS, MANAGERS OR LESSORS OF PREMISES The following is added to sEcTION li — WHO IS AN INSURED: Any person or organization that is a promises owner, manager or lessor and that you have agreed in a written contract or agreement to in- clude as an additional insured on this Coverage Part is an Insured, but only with respect to liability for "bodily injury" "property damage ". '`personal injury" or "advertising injury' that. a. is "bodily injury' or "property damage" that occurs, or is "personal injury" or "advenrsing injury'° caused by an offense that is COMA - ted, subsequent to the execution of that con- tract or agreement: and b. Arises out of, the ownership, maintenance or, use of that part of any premises leased to you. The insurance provided to such premises owner, manager or lessor is Subject to the follovving pro- visions: a. The limits of insurance provided to such premises owner, manager or lessor will be the minimum limits which you agreed to pro- vide in the written contract or agreement, or the limits shown on the Declarations, which- ever are less, b. The insurance provided to such premises owner, manager or lessor does not apply to: (1 ) Any "bodily injury" or "property damage„ that occurs, or "personal injury' or "adver tiling injury" caused by an offense that Is committed, after you cease to be a tenant in thatprernises; or (2) Structural alterations, new construction or demolition operations performed by or on behalf of such premises owner, lessor or manager. c. The insurance provided to such promises owner, manager or lessor is excess over any valid and calleciible other insurance available to such premises owner, manager or lessor, whether primary, excess, contingent or on any other basis, unless you have agreed in the written contract or agreement that this in- surance must be primary to, or non- contributory with, such other Insurance, in which case this insurance will be primary to, and non- contributory with. such other Insur- anve, H. BLANKET ADDITIONAL INSURED — LESSORS OF LEASED EQUIPMENT The fol<ouring is added to SECTION I1— WHO IS AN INSURED: Any person or organization that is an equipment lessor and that you have agreed In s written con- tract or agreement to Include as an Insured on this Coverage Part is an insured, but only with re- spect to liability for "bodily injury", " property dam- ace". "personal injury" or "advertising injury" that a. Is "bodily injury" or 'property damage" that occurs, or is 'personal injury" or "advertising injury" caused by an offense that is commit led, subsequent to the execution of that con- tract of agreement: and b. is caused, in whole or in part, by your acts or grnission.s in. the maintenance, oraralion or use of equipment teased to you by such equipment lessor. The insurance provided to such equipment lessor is subject to the followi ig provisions: a. The tlmils of Insurance provided to such equipment lessor Wit be the minimum limits which you agreed to provide in the written contract or agreement, or the limits shown on the Declarations; whichever ere less, b. The insurance provided to such equipment lessor does not apply to any "bodily Injury" or "property damage" that occurs, or „personal Injury" or "advertising injury' caused by an of- fense that Is committed, after the equipment lease expires. c. The insurance provided to such equipment lessor is excess over any valid and collectible other insurance available to such equipment lessor, whether primary, excess, contingent or on any other basis, unless you have agreed in the written contract or agreement that this insurance must be primary lb, or non - contributory ♦with, such other insurance, in which case this insurance will be primary to, and non - contributory with, such other in- surance. t. BLANKET ADDITIONAL INSURED — STATES OR POLITICAL SUBDIVISiONS — PERMITS The following is added to SECTiON Il — WHO iS AN INSURED. Any state or political subdivision that has issued a permit in connection with operations performed by you or on your behalf and that you are required Page 4 of 0 T 2011 Th= Travet:;rs tr'dan:niiy Cwripdry. M tights reserveil. CG D3 16 11 11 by any ordinance. law or building code to include as an additional Ensured on this Coverage Part is an insured, but only With respect to liability for "bodily injury", "property damage" "personal in- jury" or "advertising injury' arising out of such op- erations. The insurance provided to such state or political subdivision does not apply to'. a. Any "bodily injury," "property damage," "per - sanal injury" or "advertising injury" arising out of operations performed for that state or po- litical subdivision: or b. Any "bodily injury" or "property damage" in- cludcd in the "products- ccmpteted operations hazard ". J. KNOWLEDGE AND NOTICE OF OCCUR- RENCE OR OFFENSE The following is added to Paragraph 2., Duties In The Event of Occurrence, Offense, Claim or Suit, of SECTION IV — COMMERCIAL GEN- ERAL LIABILITY CONDITiONS. e. The following provisions apply to Paragraph a. above, but only for the purposes of the in- surance provided under this Coverage part to you or any insured listed in Paragraph 1. or Z of Section II — Who Is An insured; (1) Notice to us of such "occurrence" or of- fense roust be given as soon as practica- ble only after the "occurrence" or offense is known by you (if you are an individual}, any of your partners or members who is an individual (if you are a partnership or joint venture), any of your managers who is an individual (if you are a limited liability company), any of your "executive offi- cers" or directors (if you are an organiza- tion other than a partnership, joint venture or limited liability company) or any "em- ployee" authorized by you to give notice of an "occurrence" or offense, (2) if you are a partnership, joint venture or limited liability company, and none of your }partners, joint venture members or man- agers are individuals, notice to us of such "occurrence" or offense must be given as soon as practicable only after the "occur= rence" or offense is known lay: (a) Any individual who is. (1) A partner or member of any part- rership or joint venture; COMMERCIAL GENERAL LIABILITY (fi) A manager of any limited liability company, or (iii) An executive officer or director of any lather organization: that is your partner, joint venture member or manager, or (b) Any "employee" authorized by such partnership, joint venture, limited li- ability company or other organization to give notice of an "occurrence" or offense. (3) Notice to us of such "occurrence" or of an offense W11 be deemed to be givers as soon as practicable if it Is given in good faith as soon as practicable to your vrortt- eW compensation insurer. This applies only if you subsequently give nobca to us of the "occurrence" or offense as soon as practicable after any of the persons de- scribed in Paragraphs a. (1) or (2) above discovers that the `'Occurrence" or offense may result in sums to which the insurance provided under this Coverage Part may apply, However, if this Coverage Part includes an en- dorsement that provides limited coverage for "bodily injury" or "property damage" or pollution costs arising out of a discharge, release or es- cape of "pollutants" which contains a requirement that the discharge. release or escape of "pollut- ants" must be reported to us Wthin a specific number of days after its abrupt commencement, this Paragraph e. does not affect that require- ment. K. UNINTENTIONAL OMISSION The following is added to Paragraph 8.. Repre- sentations, of SECTION IV — COMMERCIAL GENERAL LIA131LITY CONDITIONS' The unintentional omission of, or unintentional error in, any information provided by you which we relied upon in Issuing this policy vnll not preju- dice your rights under this insurance. However, this provision does not affect our right to collect additional premium or to exercise our rights of cancellation or nonrenewal in accordance with applicable insurance laws or regulations: L. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph ti., Transfer Of Rights Of Recovery Against: Others To Us. of SECTION IV — COMMERCIAL GENERAL LI- ABILITY CONDITIONS: CG D3 16 11 11 0 2011 The rfavclars Indemnity ConVany. All rights reserved. Page 5 of 6 COMMERCIAL GENERAL LIABILITY If the insured has agreed in a contract or agree- ment to waive that7 insureds right of recovery against any person or organization, ;ale vraive our right of recovery against such person or organiza- tion, but only for payments vve make because of a, "Bodily injury" or 'property damage" that oc- curs; or b. "Personal injury" or "advertising injury" caused by an offense that is committed; subsequent to the execution of that contract or agreement_ M. AMENDED BODILY INJURY DEFINITION The follouring replaces the definition of "bodily injury" In the DEFINITIONS Section: 3. "Bodily Injury`' means bodily injury, mental anguish, mental injury, shock, fright, disabilibr, humiliation, sickness or disease sustained by a person, including death resulting from any cf these at any time, N. CONTRACTUAL LIABILITY— RAILROADS 1. The following replaces Paragraph c, of the definition of "insured contracC in Me DEFINI- TIONS Section: c, Any easement or license agreement; 2. Paragraph f -(1) of the definition of "insured contract" in the DEFINITIONS Souion is de- leted, Page 6 of 6 0 2011 The Travelers Indemnity Company. AEI fights reserved, CG D3 16 111111 POLICY NO- 81 0- 4A881240 TCT -17 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply un:ess modi- fied by the endorsement. GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. Hovrever, coverage for any Injury, damage or medical expenses described in any of the provisions of this endorsement may be eKcludett or limited by another endorsement to the Covaraae Part, and these coverage broadening prcAslons do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover. age description only_ UMhation s and exclusions may apply to these m,)erages. React all the provisions of this en, dorsement and the rest of your policy carefully to determine rights, duties, ana what is and is not covered. A_ BROAD FORM NAMED INSURED S. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIDED AUTO 0. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COVERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE —GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — LIABIUTY COV- ERAGE.: Any organization you newly acquire or form dur- Ing the policy period over which you maintain 50ra or more ownership interest and that is not separately Insured fcr Business Auto Coverage, Coverage under thls provision is afforded only un- til the 18Gth day after you acquire or fort the or- ganization or the end of the policy period, wl3tch. ever is earlier B, BLANKET ADDITIONAL INSURED H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT 1. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL EFFECTS K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS NI, BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS executed by you before the "bodily injury' or `Property damage" occurs and that is in effect. during the policy period, to be named as an ad& tional insured is an 'Snsured" for Liabmlay Cover- age, but only for damages to which this insurance applies and only to the extent that person or or- ganization qualifies as an "Insured" under the Who Is An Insured provision contained in Section it. C. EMPLOYEE HIRED AUTO 1. The following Is added to Paragraph A.1., Who Is An Insured, of SECTION If — LI. ABILITY COVERAGE: The following Is added to Paragraph c. in A.1., An "employee" of yours Is an " insured" while Who Is An Insured, of SECTION 11— LIABILITY operating an "auto" aired or rented under a COVERAGE: contract or agreement in that "employee's" Any person or arganizadan who is rerlulree under name, with your permission, while performing a v:rinan contractor agreement betv:aen you and duties related to tyre conduct of your b>:sF Hess. that person or organization, that is signed and CA T3 53 ©310 02omaTnaTradve ^.ersi,demnityCompany. Page 1 of 4 Inclu -ae tcPYrightes matmal ar inswon a Services orrica. IRC with its �ereml5 u m. COMMERCIAL AUTO 2. The foll rwing replaces Paragraph b. in B.5., within such country or Jurisdiction, for Liability Other Insurance, of SECTION IV — BUSI- Coverage for any covered "auto` that you NESS AUTO CONDITIONS: lease, hire, rent or borrow without a driver for b. For Hired Auto Physical Damage Cover- a period of 30 days or less and that is not an age, the folkming are deemed to be cov- "auto" you least:, hire, rent or borrow front ered *autos" you own: any or your `employees ", Partners (:f you are (1) Any covered "auto" you lease, hire. a partnership), members (if you are a limited liabhy company) or members of their house- rent or borrow; and, holds, (2) Any covered "auto' hired or rented by t Sal respect o any claim made "suit your "employee" under a contraot in brought 6ra:ght outside tho United States of at that individual "employees" ,same, America, the tarritaries_sn' d possessions with your peerrnlssion, while Perform- ing duties related to the conduct of of the United States of America. Puerto your business. Rico and Canada: However, any *auto" that is leased, hired, (1) You must arrange t4 defersd the "in- rented or borrowed with a driver is not a `auto ". sated" against, and investigate or set - tle any such claim or "suit" and keep covered us advised of all proceedings and ar- D. EMPLOYEES AS INSURED lions, The following is added to Paragraph A.i., Who Is (it) Neither you nor any other involved An Insured, of SECTION It — LIABILITY COV- "insured' wall matte any settlement ERAGE: without our consent. Any "employee" of yours is an "insured- white us- (ill) We may, at our discretion, participate fhg a covered "auto" you don't own, hire or borrow in defending the insured" against, or in your business or your perssonai affairs; in the settlement of, any dsiTn or E. SUPPLEMENTARY PAYMENTS — INCREASED "suit ". LIMITS (Iv) We will reimburse the 'Insured" for 1. The following replaces Paragraph A.2.a.(2), sums that the insured" legally must of SECTION II — LIABIIJTY COVERAGE!. pal' as damages because of `bodly (2) Up to $3:000 for cost of bail bonds (in- injury" or "property damage to which this insurance applies, thou the "in- cluding bands for related traffic la:v vials- sured" pays with our consent, but tions) required because of an "accident" only up to the limit described in Para - we cover, We do not have to furnish graph C., Limit Of insurance, of SEC- SEC- these bonds. TION 11— LIABILITY COVERAGE 2. The following replaces Paragraph A.2.a.(4), (v) We viii reimburse the "insured" for of SECTION tf — LIABILITY COVERAGE. the reasonable expenses incurred (4) All reasonable expenses incurred by the with our consent for your Investiga- "insured" at our request; Including actual Lion of such claims and your defense loss of earnings up to $500 a day be- of the " inswed- against any suc, cause of time off from work. "suit ", but only up to and included F. HIRED AUTO — LIMITED WORLDWIDE COV- within the limit described in Para - ERAGE — INDEMNITY BASIS graph C.. Limit Of Insurance, of SECTION 11 — LIABILITY COVER - The following replaces Subparagraph (b) in Para- AGE, and not in addition to such limit graph B.T., Polfay Period, Coverage Territory. Our duty to make such payments of SECTION iV — BUSINESS AUTO CONDI- ends when vie have used up the ap- TIONS: plicable iirnit of insurance in pay - (5) Anywhere in the world, except any country cr ments for damages, settlements or jurisdiction while any trade sanction, em- defense expenses. bargo, or similar regulation unposed by the (b) This insurance is excess over any valid United States of America applies to and pro- and collectible other insurance available hibits the transaction of business with or Page 2 of d 02010 The Tmveltas In-gemruly Cora "V, CA T3 63 03 10 lr4wdes copyNhted maaeridV ar huuraet o Sorvices Offim, tic. w4h its ponvission. to the '"insured" whether primary, excess Contingent of on any other basis. (c) This insurance is not a subsriivie for re- quired or compulsory insurance in any oauntry outside the United States, its ter- ritories and possessions, Puerto Rico and Canada, You agree to maintain W required or compulsory insurance in any such coun- try up to the minimum limits required by local law. Your failure to comply with compulsory insurance requirements will not invalidate the coverage=_ afforced by this policy, but we gill only be liable to the same extent we would have been tiabte had you compiled with the compulsory in- surance requirements. (d) It is understood that we are not an admit- ted of authorized insurer outside the United States of America, its territories and possesslans; Puerto Rico and Can- ada. We assume no responsibilily for the furrashing of Ceriificates of insurance, at for compliance in any way vtdth the laws of other countries relating to insurance. G. WAIVER OF DEDUCTIBLE -GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III - PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than reotaced. H. HIRED AUTO PHYSICAL DAMAGE - LOSS OF USE - INCREASED LIMIT The fallowing replaces the last sentence of Para- graph AA,b., Loss Of Use Expenses, of SEC - TION IiI - PHYSICAL DAMAGE COVERAGE: However, the most vn will pay far any expenses for loss of use is $55 per day, to a maximum of $750 far any one "accident I. PHYSICAL DAMAGE - TRANSPORTATION EXPENSES- INCREASED LIMIT The following replaces the first sentence in Parr graph A.4.a., Transportation Expenses, of SECTION III - PHYSICAL DAMAGE COVER- AGE We will Tray up to $50 per day to a maximum of S1,W0 for temporary transportation expense in- cuffed by you because of the total ;heft of a cov- ered "auto" of the private passenger type. COMMERCIAL AUTO J. PERSONAL EFFECTS The failawing is added to Paragraph AA, Cover- age Extensions, of SECTION 111 - PHYSICAL DAMAGE COVERAGE- Personal Effects We will pay up to $400 for °lass" to wearing ap- parel and other personal effects which are. (1) Owned by an "insured "; and (2) In or on your covered "aura'. This coverage applies only in the event of a total theft of your covered "auto ". No deduccbles apply to this Personal Effects coverage_ K. AIRBAGS The following is added to Paragraph 8.1. Exclu- sions, of SECTION iII - PHYSICAL DAMAGE COVERAGE: Exclusion 8,& doe_ s not apply to "loss` to one or more airbags in a covered "auto" you rno that In- flate due to a causa other than a cause of'Yoss" set forth in Paragraphs A.1.b. and AA.c., but only: a. If that 'auto" is a covered "auto" for Compre- hensive Coverage under this policy, b. The airbags are not covered under any war- ranty, and C. The airbags Were not intentionally inflated, We Hill pay up to a maximum of S1,000 for any one "loss". L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS The following is adders to Paragraph A.2,8., of SECTION IV -BUSINESS AUTO CONDITIONS' Your duty to give us cr our authorized representa- tive prompt notice cf, the "accident" or lose' ap- plies only when the "accident or "loss" Is kno-14i to: (9) You (if you are an individual); (b) A partner Of you are a partnership), (c) A member (if you are a limited liatsilily com- pany); (d) An executive officer, director or Insuranr%- manager (if you are a corporation or other or- ganiz2tion); or (e) Any "employee" authorized by you to give no- tice of the "accident" or "'loss " - CA T3 53 03 10 020140 Ina TraWats tndamra;iy Coetparee. Page 3 of 4 IMU92 repyrightcd +M301141 0 Trtsutance Semmes Cruet. Int ivj.,h its perrj%t55 On. COMMERCIAL AUTO M. al-ANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of fRighte Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: S. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or afganiintion to the ex- tant required of you by a written contract signed and executed prior to any "accident" Or' loss ", provided that the 4accident° or "=V' arises out of operations contemplated by such contract The waiver appties only to the person or organizatlen designated In such contract. N. UNINTENTIONAL ERRORS OR OMISSIONS The folloiNing is added to Paragraph 8.2., Can. cealment, Misrepresentations Or Fraud. of SECTION IV — BUSINESS AUTO CONDITIONS: The unintentional arnission of, or unintentional error in, any information given by you shall not prejudice your rights under this insurance. Hovw ever this provision does not affect cur tight to col. lect additional premium or exercise our right of cancellation or non - renewal. Page 4 of 4 0 2010 The Trpverers Indeirnity Company- CA T3 53 03 10 intkidesempytighted metrfal or Insurance Survives Orftce. Ire, %* ns permissions. Policy"' 810- 4A881240- TGT-17 COMMERCIAL AUTO 4. Loss Payment — Physical Damage Covers son or organization holding, storing or trans - ages porting property for a fee regardless of any At our option, we may other provision of this Coverage Form. a. Pay for, repair or re place damaged or sto. 5. Outer Insurance len property, a. For any covered "auto" you mw, this b. Return the stolen property, at our ex- Coverage Form provides primary insur- pense. We viii pay for any damage that ance. For any covered "auto" you don't results to the "auto" from the theft; or own. the insurance provided toy this Cov- Cov- e, Take all or any part of the damaged or erage Form is excess over any olher col - lectible Insurance. However, vAille a cov- stolen property at an agreed or appraised value, ered "auto" which is a "trailer" is can - nected to another vehicle, the Ccvered if we pay for the - loss", our payment will in- Autos Liability Coverage this Coverage elude the applicable sales tax for the darn- Form provides for the "trailer" is- aged or stolen property. (1) Excess while It is connected to a mo- 5. Transfer of Rights Of Recovery Against for vehicle you do not own; or Others To Us (2) Primary while it is connected to a If any person or organization to or for whom covered "auto" you awn. we make payment under this Coverage Form has fights to recover damages from another, b. For Wed Auto Physical Damage Cover. "auto" those tights are transferred to us. That person age, any covered you lease, hire, rent or borrow m deemed to be a covered or organization must do everything necessary auto" you own. However, any -auto^ that to secure our rights and roust do nothing after "accident" or "loss' to impair them, is leased, hired, rented or borrowed with "auto a driver Is not a covered ". G. General Conditions c. RegardlPSS of the provisions, of P2ra - 1. Bankruptcy graph a. above, this Coverage Form's Bankruptcy or insolvency of the "insured" or Covered Autos Liability Coverage is prl- the gnsured's" estate will not relieve us of any mary for any liability assumed under an obligations under this Coverage Form. " insured contract'. 2. Concealment, Misrepresentation Or Fraud d. When this Coverage Form and any other This Coverage Form is void in any case of Coverage Form or policy covers on the same basis, either excess or primary, we fraud by you at any time as it relates to this will pay only our share. Our share Is the Coverage Form. it is also void if you or any "insured proportion that the Limit of insurance of other ", at any time, intentionally con- our Coverage Form bears to the total of ceals or misrepresents a material fact con- the Omits of off the Coverage Forms and ceming: policies covering on the same basis. a. This Coverage Form; S. Premium Audit b. The covered "auto",, a. The estimated premium for this Coverage e. Your interest in the covered "auto "; or Form is based on the exposures you told d. A claim under this Coverage Form. u5 you would have when this pcllcy be- 3. Liberalization gan. We will compute the final premium due when %,e determine your actual ex- If wm revise this Coverage Form to provide posures. The estimated total premium will more coverage without additional premium be credited against the final premium dire charge, your policy will automatically provide and the first Named insured will be billed the additional coverage as of the day the re- for the balance, if any. The due date for vision is effective In your state, the final premium or retrospcetiva *pre - 4. No Benefit To Baties — Physical Damage mium is the date shown as the clue date Coverages on the bill. If the estimated total premium We wrill not recognize an assignment or y g exceeds the final premium due, the first Named insured will get a refund. grant any coverage for the benerit of any per- CA 00 01 1013 V Insurance Services trice, inc,, 2011 Page 9 of 12 POLICY NUMBER; DT- 810- .4A881240- TCT -17 ISSUE DATE- 08 -01.17 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE BEAD IT CAREFULLY. DESIGNATED ENTITY - NOTICE OF OAANOELLATIONINONRENEWAL PROVIDED BY US This endorsement modifies insurance provided under the fallowing: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 3o NONRENEWAL. Number of Days Notice of Nonrenewai: 30 PERSON OIL ORGANIZATION: ANY PERSON OR ORGANIZATION TEAT IS A CERTIFICATE FOLDER OF A CERTIFICATE OF IN9UR428CE ISSIND FOR YOU TKATt 1. REFERS TO THIS POLICY MM STATES THAT NOTICE OF CANCErjL ►TTON OR NONRENZWAL OF THIS POLICY WILL BE PROVInPED TO TWAT PEif,SON OR ORGANIZATION, AM 2. TS TN EFFECT, p.ND IS ON FILE AT TRS OFFICE or YOUR AGENT OR BROUR FOR THIS POLICY, AT THE TJYR OF TIM Cm=LY,AmoN OR .NON"N: WAL . ADDRESS: THE ADDR999 SHOWN FOR TFrAT PERSON Olt ORGANIZATION IN TXAT CERTIFICATE OF INSURANCE. PROVISIONS: A. If we cancel this policy for any statutorily permit- ted reason other than nonpayment of premium, and a number of days is Shawn for cancellation in the schedule above, we will mail notice of cancel- lation to the person or orgardtation shown in the schedule. above. We %vill mail such notice to the address shown in the schedule above at least the number of days shown for cancellation in the schedule above before the effective date of can- cellation. S. If wv decide to not renew this policy for any sWu- torily permitted reason, and a number of days is shown for nonrenewai In the schedule above, we will mall notice of the nonrenewal to the person or organization shown in the schedule above. We :will mail such notice to the address shown in the schedule above at least the number of days shown for nonrenewal in the schedule above be- fore the expiration date. IL T4 0012 09 0 2009 The Travelers Indemnity Camperiy Page 1 Of i POLICY NUMSER; DT. US- dAt9u98.8 -i7 ISSUE DATE. 06 -o1 -17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED ENTITY -•- NOTICE CAE CANGELLATIONMONRENEWAL PROVIDED BY US This endor5emen€ modifies Insurance provided under the follov'ing- ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice of Cancellation: 30 NONRENEWAL: Number of Days Notice of Nonrenewai: 30 PERSON OR ORGANIZATION: Any person or organization that is a certificate holder of a certificate of Insurance issued for you that: 1. Refers to this policy and states that notice of cancellation or nonrenewai of this policy will be provided to that person or organization; and 2. Is in effect, and is on file at the office of your agent or broker for this policy, at the time of the cancellation or nonrenewai, ADDRESS, The address shown for that person or organization in that certificate of insurance, PROVISIONS. A. if we cancel this policy for any statutorily permit- ted reason other than nonpayment of premium, and a number of days is shoym for cancellation in the schedule above, we vAll mail notice of cancel- lation to the person or organization shown in the schedule above. We will mail such notice to the address shown in the schedule above at least the number of days shovrn for cancellation in the schedule above before the effective date of can- cellation. 9, if we decide to not renew this policy for any statu- torily permitted reason, and a number of days is shown for nonrenowai in the schedule above, we will mail notice of the nonreneyml to the person or organization shown In the schedule above. We will mail such notice to the address shovrn in the schedule above at least the number of days shown for nonrenek►ral in the schedule above be- fore the expiration eats, IL T4 00 12 09 FD 2009 The Travelers Indeinnirf CorrWany Page ' of 1 FAEIG>5,1 WORKERS COMPENSATION f AND aim TWER SoVAPE EMPLOYERS LIABILITY POLICY :iA A FORD. CS 06183 ENDORSEMENT WOOS 03 76 ( Aj - 001 POLICY NUMBER: (DT,70a- 4A13595 -8 -17) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this policy We will not enforce our right against the person or organization named in the Schedule. The addltional premium for this endorsement shall be 02.000 % of the California +Atorkers' compensation pre- mium: Schedule Person or Organization Job Description ANY PERSON OR ORGANIZATION FOR WHICH THS ?NSURED HAS AGR9ED BY WRITTEN CONTPACT EXECUTED PRIOR To LOBS To wuRrazsH THEs WATVX_t . This endorsement changes the polkCy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below is required only when this endorsement is Issued subsequent to preparation of the policy.) Endorsement Effective: 0810IJ2017 Policy No. DTJU6 4A19595 -8 -17 E=ndorsement No. Insured: Monterey Peninsura Engineering Premium Insurance Company Countersigned by DATE OF ISSUE: 08-01-17 ST ASSIGN: Rage 1 of 1 ACORO EVIDENCE OF PROPERTY INSURANCE DATE IM5 /201YYY) �� 06/25/2018 THIS EVIDENCE OF PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. AGENCY IPHONE _ COMPANY Aon Risk Insurance Services West, Inc. American Zurich Insurance Company San Jose CA Office 177 Park Avenue, Suite 200 San Jose CA 95113 USA CODE: AO088220 I SUB CODE: I INSURED LOAN NUMBER POLICY NUMBER Monterey Peninsula Engineering I ER11782309 P.O. Box 400 EFFECTIVE DATE EXPIRATION DATE Marina, CA 93933 CONTINUED UNTIL 07116/2018 07/16/2019 n TERMINATED IF CHECKED THIS REPLACES PRIOR EVIDENCE DATED: LOCATION /DESCRIPTION First St (from Santa Teresa Blvd to Monterey St) Gilroy, CA 95020 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 EVIDENCE OF PROPERTY INSURANCE 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. CnVFRAr;F INFnRMATInN COVERAGE/ PERILS I FORMS AMOUNT OF INSURANCE DEDUCTIBLE Builders Risk Coverage Form ADDITIONAL INSURED $10,000 Total Completed Project Value $5,451,990 Property At A Temporary Storage Location $500,000 Property In Transit $500,000 I ki9 Ill rff\WLF7 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AnnITInNAI INTFRFRT NAME AND ADDRESS City of Gilroy 7351 Rosanna Street MORTGAGEE LOSS PAYEE K ADDITIONAL INSURED LOAN# Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE AGUKU Zr (ZUUUIIZ) V 1993 -2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD