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CSG Consultants - Insurance Certificate (2019)SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 12/4/2018 Arthur J.Gallagher &Co. Insurance Brokers of CA,Inc.LIC #0726293 1255 Battery Street,Suite 450 San Francisco CA 94111 415-536-8617 415-536-8627 certrequests@ajg.com American Fire and Casualty Company 24066 CSGCONS-01 Arch Insurance Company 11150CSGConsultants,Inc. 550 Pilgrim Drive Foster City,CA 94404 West American Insurance Company 44393 Berkshire Hathaway Homestate Insurance Company 20044 1304931378 C X 1,000,000 X 500,000 5,000 1,000,000 2,000,000 X Y BKW57695795 12/4/2018 12/4/2019 2,000,000 No Ded A 1,000,000 X Y BAA57695795 12/4/2018 12/4/2019 No Ded A X X 5,000,000USA5769579512/4/2018 12/4/2019 5,000,000 X 0 D X N Y CSWC929198 12/4/2018 12/4/2019 No Ded 1,000,000 1,000,000 1,000,000 B Professional Liability retro date:1/1/1991 PAAEP0008803 12/4/2018 12/4/2019 Each Claim Aggregate Deductible: $5,000,000 $5,000,000 $50,000 re:all operations.The City of Gilroy,its employees,officers,officials and volunteers are named as additional insureds on GL with 30 Day Notice of Cancellation and included as additional insured on Auto per attached endorsements.Waiver of Subrogation on WC per attached endorsement.30 Day Notice of Cancellation per attached endorsement.Sixty (60)Months Optional Extended Claims Reporting Period on Professional.30 Day Notice of Cancellation on WC is not available. City of Gilroy 7351 Rosanna Street Gilroy CA 95202 USA THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE BKW(18)57695795BKW57695795 44 46ofCOMMERCIAL GENERAL LIABILITY CG 89 70 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASEREAD IT CAREFULLY. AMENDMENT OF CANCELLATION PROVISIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 2013Liberty Mutual Insurance CG 89 70 04 13 Page 1 of 1Includes copyrighted material of Insurance Services Office, Inc.,with its permission. Any term or provision of the Cancellation Conditions of the policy or any endorsement amending or replac- ing such Conditions is amended by the following: If you have agreed in a written contract or written agreement to provide a person or organization notice of cancellation we agree to the following: Provide 30 days prior written cancellation notice to such person or organization for reasons other than nonpayment of premium, but only if we are provided with a schedule of persons or organizations with whom you have agreed to provide notification more than 30 days before the cancellation is to take effect. For purposes of this endorsement, knowledge of the agent as to the persons or organizations requesting notice of cancellation is insufficient to invoke our duty to provide notice of cancellation unless the identity of the persons or organizations is provided directly to us in accordance with the terms of this endorsement. Failure to provide notice to a person or organization in accordance with the terms of this endorsement shall not extend the effective date of the cancellation or otherwise affect cancellation of the policy as to any insured. Policy #: BKW(18)57695795BKW57695795 BAA(18)57695795BAA57695795 BAA(18)57695795 12/4/2017 BAA57695795 12/4/2018 BAA(18)57695795BAA57695795 BAA(18)57695795BAA57695795 Berkshire Hathaway Homestate Ins Co CSWC92919812/4/2018 PAAEP0008802PAAEP0008803 78of57695795001424270City of Gilroy,its officers, officials,employees and volunteers 7351 Rosanna St GILROY,CA 95020 Where required by contract POLICY NUMBER:COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY.PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS,LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CG 20 10 04 13 88ofCG 20 10 04 13