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American Pipeline Services - Insurance Certificate (2019)AMERPIP-01 KBAISERI CERTIFICATE OF LIABILITY INSURANCE DATE 10111/20/8 ) .......... .... 10/11/2018 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 License # OC88587 CRNTACT Kelsey Baiseri CDS Insurance Services PHONE FAX 2001 E. Financial Way, Suite 200 (A/C, No, Ext): (A/c, No): Glendora, CA 91741 E-MAIL kelse b cdsinsurance.com I ADDREss: Y INSURER(S) AFFORDING_COVERAGE__ _ _ NAIC # INSURERA:Allied World Surplus Ins C_o124319 INSURED INSURER B: Acceptance Casualty_ Insurance Co110349 American Pipeline Services INSURERC: P.O. Box 1931 Monrovia, CA 91017 �_INSURER_p_:_ INSURER E INSURERF: 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 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' ADDL SUBR' POLICY EFF FPOLICY EXP -- LTR TYPE OF INSURANCE - INSD WVD I POLICY NUMBER (MMIDD/YYYY),i (MM/DD/YYYY) LIMITS A X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE FX i OCCUR X X I5057-2365 04/06/2018 04/06/2019 DAMAGE TO RENTED 50,000 PREMISES -(Ea occurrence) I S MED EXP (Anyone per G. $ __ 5,000 I _ PERSONAL & ADV INJURY I $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER j GENERAL AGGREGATE $ 2,000,000 OTHER: ;_PRODUCTS - COMP/OP AGG S 2,000,000 PRO- (-- - X l POLICY JECT I� LOC I I II AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT ANY AUTO OWNED SCHEDULED AUTOS ONLY _ AUTOS __.._ AUTOS ONLY �' A�TOS ONELYY G UMBRELLA LIAR ��, OCCUR X EXCESS LIAB CLAIMS -MADE r DED ( RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE -- Mandatory (n NH) EXCLUDED? J If yes, describe under DESCRIPTION OF OPERATIONS below N/A I XL00015597 (Ea accident, S LBOILYINJURY (Perpersonl $ BODILY INJURY (Per accident) I'' $ PROPERTY DAMAGE (Per accident) $ � i I S EACH OCCURRENCE — S 3,000,000 10/05/2018 04/06/2019 AGGREGATE $ PER II STATUTE i i ORH- E.L. EACH ACCIDENT g I I,__E_L DISEASE - EA EMPLOYEE, S E.L. DISEASE - POLICY LIMIT $ �I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Large Meter Replacement Project No. 18-PW-251 Wrap Exclusion applies per form CSGL 00012 00 08 16 The City, its officers, officials, employees, and volunteers are named as additional insured per attached endorsement form CG 20 10 04 13. Primary & Non -Contributory Wording applies per form CSGL 00233 00 08 16. Waiver of subrogation applies to the general liability per endorsement form CG 24 04 05 09, All Endorsements apply As Per Written Contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: Risk Management 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD This endorsement, effective: 04/06/2018 (at 12:01 A.M. standard time at the address of the Named forms a part of Policy No: 5057-2365 Issued to: American Pipeline Services By: Allied World Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. Insured as showing in the Declarations) PLEASE READ IT CAREFULLY. WRAP-UP EXCLUSION It is agreed that this policy is amended as follows: The following exclusion is added to Paragraph 2., Exclusions of SECTION I — COVERAGES, COVERAGE A — BODILY INJURY AND PROPERTY DAMAGE LIABILITY, Paragraph 2., Exclusions of SECTION I — COVERAGES, COVERAGE B — PERSONAL AND ADVERTISING INJURY LIABILITY, Paragraph 2., Exclusions of SECTION I — COVERAGES, COVERAGE C — MEDICAL PAYMENTS and any OTHER COVERAGE PARTS provided under this policy: This insurance does not apply to any liability, loss, injury, damage, cost or expense, and this insurance shall have no obligation to defend or indemnify any claim or "suit", arising out of either your ongoing operations or operations included within the "products -completed operations hazard" which are performed by you or on your behalf and insured under a consolidated (wrap-up) insurance program. 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; (3) Remains in effect; or (4) Covers a claim or "suit" or the consolidated (wrap-up) insurer is unable or unwilling to pay or for any other reason. A consolidated (wrap-up) insurance program as referred to herein includes any prime contractor, project manager or owner controlled insurance policy (OCIP) or similar insurance policy or program which insures most or all contractors and subcontractors involved in a project. All other terms, conditions and exclusions under the policy are applicable to this endorsement and remain unchanged CSGL 00012 00 08 16 Page 1 of 1 POLICY NUMBER: 5057-2365 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Any person or organization to whom the Named Insured has agreed by a fully executed written contract that such person or organization be added as an Additional Insured, but only with respect to operations performed by or on behalf of the Named Insured and only with respect to occurrences subsequent to the making of such fully executed written contract otherwise covered by this insurance. Location(s) Of Covered Operations Where specified by fully executed written contract. 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", "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 CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 POLICY NUMBER: 5057-2365 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: 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. CG 20 10 04 13 O Insurance Services Office, Inc., 2012 Page 2 of 2 This endorsement, effective: 04/06/2018 (at 12:01/\.M.standard time 8tthe address Ofthe Named Insured GSshowing iOthe [}eCl8[8tiOOs\ � forms 8p8OfPolicy ��O: 5057-2365 � Issued to: American Pipeline SBFViC8G By: Allied World Surplus Lines Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY / NON-CONTRIBUTORY INSURANCE ENDORSEMENT (BLANKET) � Name ofPerson orOrganization � Any person or organization to whom the Named Insured has agreed by a written contract that was fully executed prior hoan"occunenne''that such person ororganization be added as on additional insured under this policy on a primary and noncontributory booia, but only with respect to operations performed bynronbehalf ofthe Named Insured and only with respect to "occurrences" subsequent huthe making of such fully executed written contract otherwise covered by this policy. Effective Date: 04/06/2018 It is agreed that this policy iaamended aofollows: � Name nfPro��t. Where specified byfully executed written contract that was fully executed prior to an "occurrence". Notwithstanding any other provision of this policy to the controry, the insurance afforded to the person or organization named in the above Schedule ehoU be primary to, and non-contributory with, any other insurance available to such person or organization, but only as respects liability resulting from "your work" performed by the Named Insured at the project designated in the Schedule above for the person or organization named in the Schedule above. This endorsement applies only to "bodily injury" or "property damage" caused by an "occurrence" under Coverage A and not otherwise excluded in the policy. All other terms, conditions and exclusions under the policy are applicable to this endorsement and remain unchanged. CSGLOO233OOO81G Includes copyrightedmaterial of Page of Insurance Services 0ffioeo. Inc., used with its permission POLICY NUMBER: 5O57-2365 COMMERCIAL GENERAL LIABILITY CG24U4O5OB 111"AUPT,"ER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization against whom you have agreed to waive your right of recovery in a written contract or written eQmement, provided such contract oragreement was executed prior to the date of loss, injury or damage. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added toParagraph 8.Transfer Of Rights Of Recovery Against Others To Us of Section|V—Conditione: VVewaive any right ofrecovery vvemay have against the person or organization shmwn in the Schedule above because ofpayments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 @ Insurance Services Office, Inc., 2008 Page I of 1 0 PRoWREMME' Policy number: 065304010 Underwritten by: United Financial Casualty CO. 10/05/2018 Certificate of Insurance Certificate Holder Additional Insured The City of Gilroy 7351 Rosanna St Gilroy, CA 95020 Insured American Pipeline Services Advice Ins Agency Inc PO Box 1931 1230 Huntington Dr #2 Monrovia, CA 91017 Duarte, CA 91010 This document certifies that insurance policies identified below have been issued by the designated insurer to the insured named above for the period(s) indicated. This certificate is issued for information purposes only. It confers no rights upon the certificate holder and does not change, alter, modify, or extend the coverages afforded by the policies listed below. The coverages afforded by the policies listed below are subject to all the terms, exclusions, limitations, endorsements, and conditions of these policies. I 1 1. ­ ".. I I .... . ............ ........ ........... Policy Effective Date: 02/23/2018 Insurance coveraue(s) Bodily Injury/Property Darnage Uninsured/Underinsured Motorist Employers Non -Owned Auto BIPD Hired Auto Bodily Injury/Property Damage Broad Form ...... I., ... .1, ..... ............... ............ Policy Expiration Date: 02/23/2019 Limits............................. $2,000,000 Combined Single Limit $300,000 Combined Single Limit $2,000,000 Combined Single Limit $2,000,000 Combined Single Limit Matching Limits All Coverages Description ofLooadonA/ehiuieoGpauia|Itema Scheduled autos only 201SChevrolet Ei|"omdoOu5O0 I8OoxVEGsFZ55Su87 20o8Ford F55OSuper Duty 1FDAF50R*8EB87002 2017For F5501BNF5HI"2HEE14710 Certificate number Medical Payments $5,000 0oe0vnVNo/$500Deductible Rental Reimbursement $40 Per Day (S1.200 Max) Roadside Assistance Selected Medical Payments $s.Oo0 Comprehensive/Collision $5O0Dedvctiblel*5UODeductible Rental Reimbursement $4VPet, Day ($1.oOVMax) Medical Payments $a.oO0 Comprehensive/Collision $50VDndoo|Wke/*5OVDeductible Rental Reimbursement $4VPer Day ($/.2O8Max) The city, it's officers, n(hc|alo and ernployees are included aoadditional insured inregards mthis commercial auto policy, The City of Gilroy is a primary and non-contributory additional insured regardless of whelher Holder is a named insured of any other policy. We will endeavor to provide 30 days notice of cancellation to the certificate holder, but failure to do so shalt impose no obligation or liability of any kind upon the insurer, its agents or representatives. Please hwadvised that additional insureds and UonhoWermwill benotified iothe event of mid-term cancellation. POLICYHOLDER COPY Sc P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10-08-2018 CITY OF GILROY Sc 7351 ROSANNA ST GILROY CA 95020-6141 GROUP: POLICY NUMBER: 9157252-2018 CERTIFICATE ID: 25 CERTIFICATE EXPIRES: 04-20-2019 04-20-2018/04-20-2019 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2018-10-08 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF GILROY ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-20-2018 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2572 ENTITLED BLANKET WAIVER OF SUBROGATION EFFECTIVE 2018-04-20 IS ATTACHED TO AND FORMS A PART OF THIS POLICY ENDORSEMENT #1850 - RICHARD CRAIG P,S,T - EXCLUDED. EMPLOYER AMERICAN PIPELINE SERVICES SC PO BOX 1931 MONROVIA CA 91017 [P1Z,HOj (REV.7-2014) PRINTED : 10-08-2018 CERTHOLDER COPY Sc P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 10-08-2018 CITY OF GILROY SC 7351 ROSANNA ST GILROY CA 95020-6141 GROUP: POLICY NUMBER: 9157252-2018 CERTIFICATE ID: 25 CERTIFICATE EXPIRES: 04-20-2019 04-20-2018/04-20-2019 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2018-10-08 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF GILROY ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 04-20-2018 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2572 ENTITLED BLANKET WAIVER OF SUBROGATION EFFECTIVE 2018-04-20 IS ATTACHED TO AND FORMS A PART OF THIS POLICY ENDORSEMENT #1650 - RICHARD CRAIG P,S,T - EXCLUDED. EMPLOYER AMERICAN PIPELINE SERVICES Sc PO BOX 1931 MONROVIA CA 91017 M0408 IRE V.7' 2014) PRINTED : 10-09-2018