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Alpha Analytical - Insurance Certificate (2019)ALPHANA-01 DFRANSEN ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11 /16/2018 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). CONTACT Danielle Fransen PRODUCER NAME: Team Insurance & Financial Services, Inc. PHONE PO Box 1472 (A/c, Ne, Ext): (707) 462-5901 jq//c, No):(707) 462-3763 Ukiah, CA 95482 E-MAIL danielle@teamins.net INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Arch Specialty Insurance 21199 INSURED INSURER B: Libertv Mutual Insurance 23043 Alpha Analytical Laboratories, Inc. INSURER C: Emplovers Comp Ins Co 11512 262 Rickenbacker Circle INSURER D : Livermore, CA 94551 INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY 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 'AID CLAIMS. INSR TYPE OF INSURANCE ADDL'SUBR' POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSD WVD - _ (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,0001 CLAIMS -MADE F_XJ OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑X PRO ❑ LOC JECT OTHER: B AU`OMOBILE LIABILITY X ANY AUTO X 12EMP7204106 OWNED SCHEDULED _ AUTOS ONLY AUTOS AUTOS ONLY AUOTOS ONLYY B UMBRELLA LIAB I X-1 OCCUR X EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE N / A OFFICER/MEMBER EXCLUDED? (Mandatoryin NH) If yes,, describe under i A Prof,RIP lION nal eP )RATIONS be!nw A Pollution Coverage BAA57280362 ESA57280362 EIG261089200 12EMP7204106 12EMP7204106 04/06/2018 04/06/2019 DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ COMBINED SINGLE LIMIT fEaaccident) $ 08/22/2018 08/22/2019 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident) $ omp/Collision $ EACH OCCURRENCE $ 08/22/2018 08/22/2019 AGGREGATE $ X I STATUTE EERH 05/01/2018 05/01/2019 I E.L. EACH ACCIDENT S E.L.DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ 04/06/2018 04/06/2019 JEa.Occ./Aggregate 04/06/2018 04/06/2019 lEa.Occ./Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: City of Gilroy Pretreatment Wastewater Processing City of Gilroy, its officers, officials and employees are named as an Additional Insured on the general liability. *30 Notice of Cancellation* 100,0001 5,0001 3,000,0001 3,000,0001 3,000,0001 1,000,0001 1,000 2,000,000 2,000,000 1 1,000,0001 1,000,0001 1,000,0001 3,000,000 3,000,000 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. 7351 Rosanna Street Gilroy, CA 95020 \ ' AUTHORIZED REPRESENTATIVE tff�.tAl ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATTrights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED/ PRIMARY COVERAGE INCLUDING COMPLETED OPERATIONS (COVERAGES A, B, D & F) This endorsement modifies insurance provided under the Environmental Multilane Policy It is agreed that Section III - WHO IS AN INSURED is amended to include the following: Under Coverages A,B,D and F the person or organization shown in the schedule below shall be an Additional Insured, but only to the extent liability arises out of YOUR WORK for that Additional Insured and not due to any actual or alleged independent liability of said Additional Insured. This Endorsement does not apply to BODILY INJURY or PROPERTY DAMAGE arising out of the sole negligence or willful conduct of, or for defects in design furnished by the Additional Insured. With respect to the coverage afforded to the Additional Insured, this insurance is primary and non- contributory, and our obligations are not affected by any other insurance carried by such Additional Insured whether primary, excess, contingent or on any other basis. This Endorsement does not increase the Company's limits of liability as specified in the Declarations of this policy. Additional Insured: ANY PERSON OR ORGANIZATION FOR WHOM YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US. THE WRITTEN CONTRACT MUST BE EFFECTIVE PRIOR TO THE DATE OF THE LOSS OCCURRENCE. All other terms and conditions of this Policy remain unchanged. Endorsement Number:13 Policy Number: 12 EMP 72041 06 Named Insured: ALPHA ANALYTICAL LABORATORIES, INC. This endorsement is effective on the inception date of this Policy unless otherwise stated herein: Endorsement Effective Date: 4/6/2018 00 EMP0101 00 01 14 1 of 1