ConXion to Community - Insurance Certificate (2019)CENTFOR 04 DMARTIN,
`�1 = ''�► D YV)CERTIFI ATE OF LIABILITY INSURANCE I 101101201$ THIS CERTIFICATE IS iSSUEE) 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(les) must have ADDITIONAL INSURED provisions or be endorsed.
If SUBROGA71ON IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement.. Astatement on
this certificate floes not confer rights to the certificate holder in lieu of such endorsernent(s).
PRODUCER COAITACT
Micheletti Insurance Services PHONE 111 N. Market Street, Suite 705 (Add No, �): (408) 292-4900 ( fFAxarc. nto1:(4,,) 297-49419
San Jose, CA 95113 irDA&s: iEnsure@.michelettinsurance.com
INSUPER(S) AFFORDING COVERAGE � NAIC X
INSURERA: Great American Insurance Companv 16691
INSURED (dba) ConXion to Community (ConXion) INsuRERs: State Compensation Fund 35076
Center for Training and Careers, Inc. INSURER C :
749 Story Road, Suite 10 INSURER D :
San Jose, CA 9S122
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,NOTIIVITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECTTO 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.
t� tSR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP -- _- -
iR fN$D VJVD POLICY NUMBER tAmt55NyY1C'iti tmAli)DIYYYYf uMns
A X commmcmGENERAL uABiuTy EACH CCURRENCE S 1,000,000
CLAIMS -MADE I..A I OCCUR PAC220717101 0912912018 0912912019 R RENTED 1,000,000DAMAGEng ,al g
MED EXP (Anv One person} g 6,006
PERSONAL&ADvINJURY 5 1,000,000
EN'LAGGREGATE LEMIT'APPL.IES PER: GENERALAG�GGR5C--,ATE S 2,000,000
POLICY E] T&- � Lac pRopucTs-CaMPIOPAGG s 2,000,000
OTHER, ABUSE MOLESTATI s 3,000,000
A AUTOMOBILE LIABILITY ICF +MBINEO SINGLE LIMIT �
-.� 1Fa a "'IRntl $ ,000,000
ANYAUTO PAC220717101 0912912018 091'1'2,912019 BODILY INJURY (Per emsnL s
OWNED SCHEDULED BflDILYINJLIRYSPeratadent) $
A�Ti'O$ ONLY AUTOS
x Ms ONLY � AUTC)&ONLY (PeraExi ngAMAOE S
S
A X UMBRELLA LIA1B I i+ I OCCUR EACH OCCURRENCE S 1,000,000
EXCESSLIAB 1rl CLAIMS -MADE UMB220717201 0912912"S 0912912019 AGGREGATE s
DEo I I RETENT ION s
WORKERS COMPENSAT10N S�A�rt r� �F
TH-
AND EMPLOYERS, LIABILITY YIN V I
OR
ANY PROPRIETORMARTNERtEXECUTINE I-L. EAONACCIDENT S $1,000,000
FFiCate hIBEREXCLUISEti? N!A 9036273-18
Mandatory gNHl 09ro1CIl201S 09ro11Zt}19 E.L. DISEASE-EAEMPLpYI:E S $1,000.000
Ifytrs. describe under
DESCRIPTION OF OPERATIONS below P F.L. DISEASE- POLICY LIMIT S $IZOW.000
A Errors & Omissions PAC220717101 0912912018 0912912019 Per Occurence 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddMonal Remarks Schedule, may be attached If more space Is required)
Name the City of Gilroy, its officers and employees as addional insured. Also name the City
of Gilroy representatives as additional insured.
CERTIFICATE HOLDER CANCELLATION
City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
7351 Rosanna Street THE EXPIRATION DATE THERF-OF.a policy lapse or a material change
Gilroy, California in policy terms, written notice will be provided within 30 days.
AUTHOR17-ED REPRESENTATIVE
I
ACORD 25 (2016103) @ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
POLICY'NUMBER: V'PAC2207171 01
LIABILIVIV
COVENIERCIAL GENERAL
CG 20 37 07 04
TMS ENDORSEMENT CHANGESS THE POLICY.- PLEASE READ CAREFULTLY.
IN
1:11kVil 121ll W
II �
COM—PLETFID OPERATION
Ibis endorsement modifies insumice provided under ft following7
COMMERCIAL GENERAL LIABILITY COVERAGE PAIrl
0&*
Name ofAdditional Insured Person(s) Or Orearziza;nn(sl Location(_4) of Covered Onomflom
gaTE- R FOR TMTNING AND CAREERS
749 STORY ROAD SUITE 10
SAN DOSE. CA- 93122
City of Gilroy, its officers, employees and
representatives as additonal insured.
Infonnaflon required to Complete this scheduh,- -1f not shown above, will be shown in the Declarations.
A. Section H—WHO IS AN UMURED t5ar*lended to include
As anadditibnal Insured ft persen(s) or arganixaftnisi
Shmvn In the SehWule, but cntywhh respect to liall4lity for
"bodily injurr. or 'plropeM den. age caused, In whcle or In
Par% by 0your woW at the locaUlan designated and
Dwcr1W In the sdmdula of this endorsement performed
ft that addiflonal Insured and included Ira the "pmduces-
Completed operl hazaW
IT IS AGREED THAT THIS INUSRMCE 15 PRIMARY AND ANYOTHER INSURAWCE MAINTAINW BY
THE ADDMOML INSURED SMALL BE EXCESS ONLY AND NON- C17MMIDUrING WrM THLS 15
INSURANCL
SWIPLE ADDITIONAL INSURED ENDORSEMENT
FOR PRODUCTS & COMPLETED OPERATIONS
Note — The Additiorittl Insured Endorsement Mustt
1) Be on ISO Form CG 20 37 07 04., or its, equivatent to specifically include
Products & Completed Operations. This form must be used in
Conjunction With 60 Form CG 2010 07 04, a,r its equivalent.
2) List ail of the required parties as additional insureds.
3) State thatthis insurance is primary.