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American Pipeline Services - Insurance Certificate (2020)CERTHOLDER COPY SC P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04-20-2019 CITY OF GILROY SC 7351 ROSANNA ST GILROY CA 95020-6141 GROUP: POLICY NUMBER: 9157252-2019 CERTIFICATE ID: 25 CERTIFICATE EXPIRES: 04-20-2020 04-20-2019/04-20-2020 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. EMPLOYER AMERICAN PIPELINE SERVICES SC PO BOX 1931 MONROV I A CA 91017 M0408 (REV.7-2014) PRINTED : 03-18-2019 ADVICE INS AGY INC 1230 HUNTINGTON DR #2 DUARTE, CA 91010 THE CITY OF GILROY 7351 ROSANNA ST GILROY, CA 95020 Additional insured endorsement Name of Person or Organization THE CITY OF GILROY 7351 ROSANNA ST GILROY, CA 95020 P OEsf�i,�1.f/1/,E COMMERCIAL Policy number: 06530401-1 Underwritten by: United Financial Cas Co " Insured: AMERICAN PIPELINE March 8, 2019 Policy Period: Feb 23, 2019 - Feb 23, 2020 Mailing Address United Financial Cas Co PO Box 94739 Cleveland, OH 44101 1-800-444-4487 For customer service, 24 hours a day, 7 days a week The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. Limit of Liability (Bodily Injury Not applicable Property Damage Not applicable Combined Liability $1,000,000 each accident All other terms, limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number: 06530401-1 Issued to (Name of Insured): AMERICAN PIPELINE SERVICES Effective date of endorsement: 02/23/2019 form 1198 (01/04) Policy expiration date: 02/23/2020 ADVICE INS AGY INC PR®,�,�,1�1f1Y 1230 HUNTINGTON DR #2 COMMERCIAL DUARTE, CA 91010 Policy number: 06530401-1 Underwritten by: United Financial Cas Co Insured: THE CITY OF GILROY AMERICAN PIPELINE 7351 ROSANNA ST February 2, 2019 GILROY, CA 95020 Policy Period: Feb 23, 2019 - Feb 23, 2020 Mailing Address United Financial Cas Co PO Box 94739 Additional insured endorsement Cleveland, OH44101 1-800-444-4487 Name of Person or organization For customer service, 24 hours a day, THE CITY OF GILROY 7 days a week 7351 ROSANNA ST GILROY, CA 9502.0 The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page, Limit of Liability Bodily Injury Not applicable Property Damage Not applicable Combined Liability $1,000,000 each accident All other terms, limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number: 06530401-1 Issued to (Name of Insured): AMERICAN PIPELINE SERVICES Effective date of endorsement: 02/23/2019 Policy expiration date: 02/23/2020 Form 1198 (01/04)