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Cummins - Insurance Certificate (2019)® DATE (MM/DD/YYYY) ACOIRn CERTIFICATE OF LIABILITY INSURANCE I �/ 3/18/2019 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 Aon Risk Services Central Inc. NAME: Shelly Pence 200 E Randol h St., Suite 0900 PHONE FAX, No): 317-841-6006 (A/C, No. Ext): 317-841-6004 Chicago, IL 6 601 E-MAIL ADDRESS: Sheliv(c7✓/ aikinginsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Old Republic Insurance Company 24147 INSURED INSURER B : Allianz Global Risks US Insurance Co 35300 Cummins Inc. INSURERC: Ace American Insurance Company 22667 500 Jackson Street Mail Code 60805 INSURER D : Columbus IN 47201-6258 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 47558000 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 POLICY EXP TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER WM/DD/YYYYI (MM/DD/YYYYI LIMITS A ✓ COMMERCIAL GENERAL LIABILITY ✓ MWZY 302202-18 12/1 /2018 12/1 /2019 EACH OCCURRENCE $1,000,000 CLAIMS -MADE ❑✓ OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ✓ POLICY PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY MWTB 314312 12/1/2018 12/1/2019 COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 ✓ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY (Per accident) Phy Damaqe $ Self Insured B ✓ UMBRELLA LIAB / OCCUR USL 00126118 12/l /2018 12/1 /2019 EACH OCCURRENCE $10,000,000 EXCESS LIAB �—i CLAIMS -MADE AGGREGATE $10,000,000 DED I I RETENTION $ $ A WORKERS COMPENSATION MWC 314311 00 12/1/2018 12/1/2019 v/ I STATUTE EER R H AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $1.000.000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 C Property FAZD384845027 8/1/2018 8/1/2019 Limit: $10,000,000 Special Form including Earthquake & Flood Leased/Rented Equipment FAZD384845027 8/1/2018 8/1/2019 Limit: $25,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Service Agreement City of Gilroy, its officers, officials and employees are named as an additional insured, per the attached endorsement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy, its officers, officials and THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN employees ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy CA 95020 AUTHORIZED REPRESENTATIVE Richard Trakimas ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 47558000 1 18/19 GL AU UMB WC 18/19 PROP (Custom -Merged) I Shelly Pence 13/19/2019 1:10:49 PM (EDT) I Page 1 of 2 POLICY NUMBER: MwzY 302202-18 Cummins Inc. 12/01/2018 to 12/01/2019 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): All persons or organizations as required by contract or agreement 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned .by or rented to you. 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 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 applicable Limits of Declarations. shall not increase the Insurance shown in the CG 20 26 0413 O Insurance Services Office, Inc., 2012 47558000 1 18/19 GL AU UMB WC 18/19 PROP (CustcN Ye36k02e1&' Penc Cbrh�"h�pjhdl:10:49 f1Q(fPA1$ 2aMIMV019 Page 1 of 1