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Mott MacDonald - Insurance Certificate (2019)Page 1 of 2 " CERTIFICATE OF LIABILITY INSURANCE A�06/22/22018 DATE(MM/ 018Y) 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 Willis of New Jersey, Inc. c/o 26 Century Blvd P.O. Box 305191 CONTACT NAME: PHONE 1- 877 - 945 -7378 FAX 1- 888 - 467 -2378 A/C No Ext : A/C No): E -MAIL certificates@willis.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC# Nashville, TN 372305191 USA INSURER A: Fireman's Fund Insurance Company 21873 INSURED Mott MacDonald LLC 111 Wood Avenue South INSURER B: Travelers Property Casualty Company of Amel 25674 INSURER C: American Automobile Insurance Company 21849 INSURER D: Underwriters at Lloyd's London 15792 Iselin, NJ 088304112 INSURER E : INSURER F: $ 1, 000, 000 COVERAGES CERTIFICATE NUMBER: W6562643 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR I TYPE OF INSURANCE ADDL IN SD SUBR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD/YYYY LIMITS X l COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE � OCCUR DAM AGE TO RENTED PREMISES Ea occurrence $ 1, 000, 000 MED EXP (Any one person) $ 10,000 A y y MZX80988373 06/30/2018 06/30/2019 PERSONAL & ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY I JEC FX I LOC PRODUCTS - COMP /OPAGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBIIJED SINGLE LIMIT Ea accident $ 2,000,000 X BODILY INJURY (Per person) $ ANY AUTO A OWNED SCHEDULED AUTOS ONLY AUTOS y MZX80988373 06/30/2018 06/30/2019 BODILY INJURY Per accident ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ B X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 10, 000, 000 AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE ZUP- 15591842 -18 -NF 06/30/2018 06/30/2019 DED l X I RETENTION $ 10, 000 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? No N/A y SCW0029061801 06/30/2018 06/30/2019 X STATUTE ORH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) Ifyes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 D Professional Liab. B080120388P18 06/30/2018 06/30/2019 Per Claim $1,000,000 Per Aggregate $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Mott MacDonald Project No. 380012, Welburn Ave Traffic Calming. City of Gilroy, its officers, officials and employees are named as Additional Insureds, per the attached endorsement. General Liability policy shall be Primary and Non - Contributory with any other insurance in force for or which may be CERTIFICATE HOLDER CANCELLATION 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 AUTHORIZED REPRESENTATIVE 7351 Rosanna Street Gilroy, CA 95020 of�,� 11:�.- ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 16345912 HATCH: 759531 AGENCY CUSTOMER ID: LOC #: AC")?" ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Willis of New Jersey, Inc. Mott MacDonald LLC 111 Wood Avenue South Iselin, NJ 088304112 POLICY NUMBER See Page 1 CARRIER NAIC CODE See Page 1 See Page 1 EFFECTIVE DATE: See Page 1 I_1 k THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance purchased by Additional Insureds as agreed to by written contract. Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability and Worker's Compensation as agreed to by written contract for all states as permitted by law ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 16345912 BATCH: 759531 CERT: W6562643 Additional Insured - Owners, Lessees or Contractors - Scheduled Person or Organization - CG 20 10 04 13 Policy Amendment(s) Commercial General Liability Insured: Mott MacDonald Group, Inc. Policy Number: MZX80988373 Producer: Willis of New Jersey, Inc. Effective Date: 06/30/2018 This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations City of Gilroy, its employees, officers, officials, All Projects and volunteers 7351 Rosanna Street Gilroy, CA 95020 Information required to complete this Schedule, if not shown above, will be shown in the Declarations A. Section H - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily injury, property damage or personal and advertising injury caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to bodily injury or property damage occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or This Form must be attached to Change Endorsement when issued after the policy is written. One of the Fireman's Fund Insurance Companies as named in the policy Secretary President CG2010 4 -13 + Insurance Services Office, Inc., 2012 Page 1 of 2 2. That portion of your work out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: CG2010 4 -13 + Insurance Services Office, Inc., 2012 If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 Additional Insured - Owners Lessees or Contractors - Completed Operations - CG 20 37 04 Y3 Policy Amendment(s) Commercial General Liability Insured: Mott MacDonald Group, Inc. Producer: Willis of New Jersey, Inc. Policy Number: MZX80988373 Effective Date: 06/30/2018 This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Products /Completed Operations Liability Coverage Part Schedule Name Of Additional Insured Person(s) Location And Description Of Or Organization(s) Completed Operations City of Gilroy, its employees, officers, officials, All Projects and volunteers 7351 Rosanna Street Gilroy, CA 95020 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for bodily injury or property damage caused, in whole or in part, by your work at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the products- completed operations hazard. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. This Form must be attached to Change Endorsement when issued after the policy is written. One of the Fireman's Fund Insurance Companies as named in the policy Secretary CG2037 4 -13 + Insurance Services Office, Inc., 2012 President Courtesy Notice of Cancellation for Other Than Nonpayment of Premium to Designated Entities - 145977 01 11 Policy Amendment Policy Number: Policy Number: MZX80988373 Effective Date: 06/30/2018; SCW0029061801 Effective Date: 06/30/2018 General Liability; Auto Liability, Workers Compensation Schedule Name and Address of Person(s) or Organizations Number of Days Notice if other than 10 days: On File with Carrier, as required by written contract Cancellation Number of Days Notice- 60 When we don't Renew (Non - Renewal)- 30 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. This policy is amended as follows: A. If We cancel this policy prior to expiration for any reason other than non payment of premium or at Your request, and we have been notified that You are required under a current contractual obligation to notify a certificate of insurance holder or holders when this policy is canceled, then We will endeavor to mail or deliver a copy of such written notice of cancellation to the certificate holder(s) shown in the Schedule above, as follows: 1. To the name and address corresponding to each certificate of insurance holder indicated in the Schedule above; and 2. At least 10 days prior to the effective date of the cancellation, as shown in our notice to the first Named Insured, or, if indicated, the longer number of days notice shown in the Schedule above. B. Notwithstanding the foregoing, such notice of cancellation is provided on an informational basis and solely to assist You in informing the certificate of insurance holder(s) in advance of pending cancellation in coverage to assist you in meeting Your contractual notice requirements to such parties. Our failure to provide such advance notification to the certificate of insurance holder(s) shown in the Schedule of this endorsement will not extend any policy cancellation date, negate any cancellation of the policy, or grant, alter or extend any rights or obligations under this policy and we shall have no liability for any failure to provide the notice(s) as provided herein. All other terms and conditions of this policy remain unchanged. 1459771 -11 2010 Fireman's Fund Insurance Company, Novato, CA. All rights reserved.