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Applied Survey Research - Insurance Certificate (2019)loouft 112sail CG Policy No. 97 CJN707 0 2551—FC05 CMP-4791.1 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4791.1 ADDITIONAL INSURED — STATE OR POLITICAL SUBDIVISIONS (Permits) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 97 CJN707.0 Named Insured: APPLIED SURVEY -RESEARCH INC PO BOX 1927 WATSONVILLE CA 95077-1927 Name And Address Of Additional Insured Or Political Subdivision: CITY OF GILROY ITS OFFICERS EMPLOYEES & REPRESENTATIVES 7351 ROSANNA ST GILROY CA 95020 .6196 1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to include, as an additional insured, any state or political subdivision shown in the Schedule, but only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. 2. With respect to the insurance afforded the additional insured, this insurance does not apply to: a. "Bodily injury", "property damage", or "personal and advertising injury" arising out of operations performed for the state or municipality; or b.' "Bodily injury" or "property damage" included within the "products -completed operations hazard". 3. Any insurance provided to the additional insured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 4. Primary Insurance. This insurance is primary to and will not seek contribution from any other insur- ance available to an additional insured under your policy provided that the additional insured is a named insured under such other insurance. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. CMP-4791.1 1007034 148013 08-14-2014 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. ACOP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `,,,� I 06/18/2019 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 CONTACT NAME: Chelsea Rosato CoverWallet, Inc. A//CN o. EXt). (646) 844-9933 FAX No): 100 Ave. of the Americas, E-MAIL ADDRESS: customer.service@coverwallet.com Floor 16 INSURER(S) AFFORDING COVERAGE NAIC # New York, NY. 10013 INSURER A: Hiscox Insurance Company Inc. 10200 INSURED Applied Survey Research Inc INSURER B : 55 Penny Lane INSURER C : Watsonville, CA, 95076 INSURER D : 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 Ol� 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. ILTR TYPE OF INSURANCE ADDL SUBR INSD WVD POLICYNUMBER POLICY EFF POLICY EXP (MM/DDIYYYY) (MM/DDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED I CLAIMS -MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ POLICY PRO ❑ LOC I JECT PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY AUTOS ONLY AUTOS (Per accident) $ HIRED NON -OWNED PROPERTY DAMAGE $ - AUTOS ONLY AUTOS ONLY ! (Per accident) UMBRELLA LIAB OCCUR HCLAIMS-MADE EACH OCCURRENCE $ EXCESS LIAB AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION I SPER TATUTE I I AND EMPLOYERS' LIABILITY Y I N ERH ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) I E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Professional Liability UDC-1930565-EO-19 03/14/2019 03/14/2020 Liability (Each claim): $2,000,000 A Liability (Aggregate): $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Gilroy its officers, employees & representatives are included as additional insured with respect to the Professional Liability policy per the policy terms and conditions CERTIFICATE HOLDER CANCELLATION City of Gilroy its officers, employees & representatives SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 Rosanna St.. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Gilroy, CA, 95020 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD StateFarm STATE FARM GENERAL INSURANCE COMPANY n4w A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILL INOIS DECLARATIONS AMENDED MAY 7 2019 owl Richar dar son, 75085-3925 Policy Number 97-CJ-N707-0 AAA1 I A a *1 fin I "QUIV 0 WV VII " y D 1 10 . A C a n , 000251 3123 M-02-2551 -FC05 F U CITY OF GILROY ITS OFFICERS EMPLOYEES 0 & REPRESENTATIVES 7351 ROSANNA ST 1 GILROY CA 95020-6141 III III IIIIII Rill I 111111111] 11111111 111 1111111111111111 LE V iv OR U HOUR, vu ate CX IraTIOn Me 12 Months NOV 20 2018 NIM 20 2019 The policy period be ins 4nd ends at 12:01 am standard time atthe premises cat on. Named Insured APPLIED SURVEY RESEARCH INC PO BOX 1927 WATSONVILLE CA 95077-1927 Office Policy Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjeetto the premiums, rules and forms in effect for each succeeding policy period. If this policy is terminated, we will give you and the M ortga gee/l-ien holder written notice in compliance with the policy provisions or as required by law. Entity: Corporation Reason for Declarations: Your policy is amended'MAY 7 2019 ADDITIONAL INSURED ADDED PREMIUM ADJUSTMENT FORM CMP-4791.1 ADDED Endorsement Premium Increase Discounts Applied: Renewal Year Years in Business inclosed Building Protective Devices Qlaim Record Prepared MAY 29 2019 CMP-4000 001335 290 Al N 00 Copyright, State Farm Mutual Automobile Insurance Company, 2000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Continued on Reverse Side of Page Page 1 of 7 53U-686a.2 05-31-2011 folf3231c) I:na, CON -9" # I Location Location of Limit of Insurance* Limit of Insurance* Seasonal Number Described Increase" Premises Coverage A - Coverage B - Business Buildings Business Personal Personal Property Property 001 1871 THE ALAMEDA STE 180 No Coverage $ 22,600 25% SAN JOSE CA 95126-1752 002 55 PENNY LN STE 101 WATSONVILLE CA 95076-6017 No Coverage $ 52,900 25% As of the effective date of this policy, the Limit of Insurance as sh own includes any increase in the limit due to, Inflation Coverage. SECTION I -INFLATION COVERAGE INDEWES) Cov A - Inflation Coverage Index: N/A Cov B - Consumer Price Index: 252.0 SECTION I - DEDUCTIBLES Basic Deductible $500 Special Deductibles: Money and Securities $250 Employee Dishonesty $250 Prepared @ Copyright, State Farm Mutual Automobile Insurance Company, 2008 MAY 29 4000 2019 includes copyrighted material of Insurance Services Office, Inc., with its permission. CMP- 001335 Continued on Next Page Page 2 of 7 .390rtateFarm nN NO, DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Equipment Breakdown M Other deductibles may apply - refer to policy, x SEICTION I - EXTENSIONS OF COVERAG-E - LIMIT OF INSVRA,NCE - EACH DESCRIBED PREMISES (6 The coverages and corresponding limits shown below apply separately to each described premises shown in these Declarations, unless Indicated by."See Schedule." If a coverage does not have a corresponding limit shown below, but has "Included" indicated, please refer to that policy provision for an explanation of that coverage. LIMIT OF COVERAGE INSURANCE Accounts Receivable On Premises See Schedule Off Premises See Schedule Arson Reward $5,000 Back -Up Of Sewer Or Drain See Schedule Collapse Included Damage To Non -Owned Buildings From Theft, Burglary Or Robbery Coverage 6 Limit Debris Removal 25% of covered loss Equipment Breakdown Included Fire Department Service Charge $5,000 Fire Extinguisher Systems Recharge Expense $5,000 Forgery Or Alteration $10,000 Glass Expenses Included Increased Cost Of Construction And Demolition Costs (applies only when buildings are 10% insured on a replacement cost basis) Money And Securities (Off Premises) See Schedule Money And Securities (On Premises) See Schedule Money Orders And Counterfeit Money $1,000 Prepared MAY 29 2019 O Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission, 001336 290 Continued on Reverse Side of Page Page 3 of 7 N DECLARATIONS (CONTINUED) 10' Moorri Poll Newly Acquired Business Personal Property (applies only if this policy provides $100,000 Coverage B - Business Personal Property) Newly Acquired Or Constructed Buildings (applies only if this policy provides $250,000 Coverage A - Buildings) Ordinance Or Law - Equipment Coverage Included Outdoor Property See Schedule Personal Effects (applies only to those premises provided Coverage B - Business $5,000 Personal Property) Personal Property Off Premises $15,000 Pollutant Clean Up And Removal $10,000 Preservation Of Property 30 Days Property Of Others (applies only to those premises provided Coverage B - Business See Schedule Personal Property) Signs See Schedule Unauthorized Business Card Use $5,000 Valuable Papers And Records See Schedule On Premises Off Premises See Schedule Water Damage, Other Liquids, Powder Or Molten Material Damage Included SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANCE -�P0E1►qLE The coverages and corresponding limits shown below apply only to the described premises as shown. LIMIT OF LOCATION COVERAGE INSURANCE 0001 Signs Back -Up Of Sewer Or Drain Money And Securities (On Premises) Money And Securities (Off Premises) Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Accounts Receivable (On Premises) Accounts Receivable (Off Premises) Prepared @ Copyright, State Farm Mutual Automobile Insurance Company, 2008 MAY 24000 9 2019 Includes copyrighted material of Insurance Services Office, Inc,, with its permission, CMP- 001336 Continued on Next Page $2,500 $15,000 $10,000 $5,000 $2,500 $50,000 $15,000 StateFarm A@ DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 Outdoor Property Valuable Papers and Records (On Premises) Valuable Papers and Records (Off Premises) 0002 Accounts Receivable (On Premises) 8 Accounts Receivable (Off Premises) Back -Up Of Sewer Or Drain Money And Securities (Off Premises) Money And Securities (On Premises) Outdoor Property Property Of Others (applies only to those premises provided Coverage B - Business Personal Property) Signs Valuable Papers and Records (On Premises) Valuable Papers and Records (Off Premises) LEI $2,500 $50,000 $15,000 SECTION I - EXTENSIONS OF COVERAGE - LIMIT OF INSURANC4 -,PER POLICY The coverages and corresponding limits shown below are the most we will pay regardless of the number of described premises shown in these Declarations. Dependent Property - Loss Of Income Employee Dishonesty Utility Interruption - Loss Of Income Loss Of Income And Extra Expense PACTION 11 - LIABILITY COVERAGE Coverage L - Business Liability 0 11106,111,M6 -A $5,000 Actual Loss Sustained - 12 Months Prepared MAY 29 2019 0 Copyright State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001337 290 Continued on Reverse Side of Page N LIMIT OF INSURANCE Page 5 of 7 1901 4) Iq , 1 Coverage M - Medical Expenses (Any One Person) $5,000 Damage To Premises Rented To You $300,000 LIMIT OF AGGREGATE LIMITS INSURANCE Products/Completed Operations Aggregate $4,000,000 General Aggregate $4,000,000 Each paid claim for Liability Coverage reduces the amount of insurance we provide during the applicable annual period. Please refer to Section II - Liability in the Coverage Form and any attached endorsements. Your policy consists of these Declarations, the BUSINESSOWNERS COVERAGE FORM shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequent to the issuance of this policy. FORMS AO D ENbC►R ►EMENTS CMP-4101 Businessowners Coverage Form CMP-4791.1 *Addl Insd State Political Perm CMP-4819.1 Unauthorized Business Card Use FE-6999.2 'Terrorism Insurance Cov Notice CMP-4705.2 Loss of Income & Extra Expense CMP-4710 Employee Dishonesty CMP-4709 Money and Securities CMP-4698 Back -Up of Sewer or Drain CMP-4704.1 Dependent Prop Loss of Income CMP-4703.1 Utility Interruption Loss Incm CMP-4786.1 Addl Insd Owners Lessee Sched CMP-4788.1 Addl Insd Mgrs Lessor of Prem CMP-4860.1 Al Design Person Org CMP-4787 Waiver of Trans Rgt of Recov CMP-4793.1 Al State Political Perm Prem CMP-4260 Amendatory Endorsement FD-6007 Inland Marine Attach Dec * New Form Attached Prepared MAY re 2019 Copyright, State Farm Mutual Automobile Insurance Company, 2008 CMP-4000 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001337 Continued on Next Page Page 6 of 7 StateFarm DECLARATIONS (CONTINUED) Office Policy for CITY OF GILROY Policy Number 97-CJ-N707-0 This policy is issued by the State Farm General Insurance Company. 111 You are entitled to participate in a distribution of the earnings of the company as determined by our Board of Directors in accordance with the Company's Articles of Incorporation, as amended. In Witness Whereof, the State Farm General Insurance Company has caused this policy to be signed by its President and Secretary at Bloomington, Illinois. *"11 )11 Secretary President California low requires us to provide you with Information for -filing complaints with the state Insurance Department regarding the coverage and service provided under thip policy. Your agent's name and contact information are provided on the front of this document. Another option is to reach out by mail or phone directly to: Stale FarrnO Executive Customer Service PO Box 2320 Bloomington IL 61702 Phone # 1-800-STATEFARM (I -800-782-p32) Department of Insurance complaints should be filed only after you and State Farm or your agent or other company representative have iailed to reach a satisfactory agreement on a problem. California Department of Insurance Consumer Services Division 300 South Spring Street Los Angeles, CA 90013 Phone # 1-800-927�HELP (4357) or visit www.insurance.ca.aov/01 -consumers Prepared MAY 29 2019 CMP-4000 001338 290 N O Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 5511c7teFarm STATE FARM GENERAL INSURANCE COMPANY ois INLAND MARINE ATTACHING DECLARATIOW� A STOCK COMPANY WITH HOME OFFICES IN BLOOMINGTON, ILLIN Policy dumber 97-CJ-N707,-O 91'cgaorxds8o5n9f� 75085-3925 Named Insured Policy Period Effective Date, Ex 1ration Date M-02-2551 -FC05 F U 12 Months NOV 20 2018 20 2019 The pot, period be ins qnd ends at 12:01 am standard APPLIED SURVEY RESEARCH INC time at poll premises ocation. PO BOX 1927 WATSONVILLE CA 95077-1927 501 Automatic Renewal - If the policy period is shown as 12 months, this policy will be renewed automatically subjectto the premiums, rules and forms in effectfor each succeeding policy period. If this policy is terminated, we will give you and the Mortgagee/Lienholder written notice in compliance with the policy provisions or as required by law. Annual Policy Premium Included The, above Premium Amount is included in the Policy Premium shown on the Declarations. Your policy consists of these Declarations, the INLAND MARINE CONDITIONS shown below, and any other forms and endorsements that apply, including those shown below as well as those issued subsequentto the issuance of this policy. Forms, Options, and Endorsements FE-8739 Inland Marine Conditions FE-6271 Amendatory Endorsement FE-8745 Inland Marine Computer Prop See, Reverse for Schedule Page with Limits Prepared Ca State Form Mutual Automobile Insurance Company, 2008 MAY 29 2019 FD-6007 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 001$39 530-600a.2 05-31-2011 WP2320 11 ATTACHING INLAND MARINE ENDORSEMENT NUMBER COVERAGE FE-6745 Inland Marine Computer Prop Loss of Income and Extra Expense Prepared MAY 29 2019 FD-6007 001339 LIMIT OF INSURANCE 25,OOO 25 400 DEDUCTIBLE AMOUNT $ 500 OTHER LIMITS AND EXCLUSIONS MAY APPLY - REFER TO YOUR POLICY (D Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services office, Inc., with its permission. ANNUAL PREMIUM Included Included 536-666 al 65-31-2011 OU3233c) eA atd-LAtMarm 97-CJ-N707-0 001340 CMP-4791.1 F1 n4w Page 1 of 1 (aw, THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. CMP-4791.1 ADDITIONAL INSURED STATE OR POLITICAL SUBDIVISIONS (Permits) VA V This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 97.CJ.N707.0 Named Insured: 9QW I i .01, � I A. . Jug; I 10 11, imp V T r-KiTil"i 11111111111111 111110�11!i 1111111111 0., � 1. SECTION 11 — WHO IS AN INSURED of SECTION 11 — LIABILITY is amended to include, as an additional insured, any state or political subdivision shown in the Schedule, but only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. 2. With respect to the insurance afforded the additional insured, this insurance does not apply to: a. "Bodily injury", "property damage", or "personal and advertising injury" arising out of operations performed for the state or municipality; or b. "Bodily injury" or "property damage" included within the "prod ucts-completed operations hazard". 3. Any insurance provided to the additional insured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage, 4. Primary Insurance. This insurance is primary to and will not seek contribution from any other insur- ance available to an additional insured under your policy provided that the additional insured is a named insured under such other insurance. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. CMP-4791.1 0, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. StateFarm STATE FARMO owe PO Box 853922 Richardson, TX 75085-3922 29A AT1 02 A 000125 0093 CITY OF GILROY ITS OFFICERS, EMPLOYEES AND REPRESENTATIVES 7351 ROSANNA ST GILROY CA 95020-6196 O O O DATE OF NOTICE: MAY 30 2019 CODE: E211!11 . liRD��l U00 ............ ...........• ........... ................. ............ .......................... ................ .. .................. .. . ........ .. ......................... ......... .. . .......... .......... ........ ..... ... ... .... ... . ....... .APPIT-7-10 ...... IN ...... N NALA: ..... . ........... ..................... ........ .............. . ........ .... .......... State Farm mutual Automobile Insurance Company 2551-FC05-A NAMED INSURED: POLICY NO: 335 2611-1306-05M COVERAGE: CONNERY, SUSAN B & PETER & YR/MAKE/MODEL: NONOWNED AUTO BI AND PD LIABILITY le APPLIED SURVEY RESEARCH IN VINICAMPER: $1 MIL PO BOX 1927 AGENT NAME: JILL JUDD 9 WATSONVILLE CA 95077-1927 AGENT PHONE: (831)462-1666 ENDORSEMENT NO: 6028BU POLICY EFFECTIVE 6164DP 6165CS MAY 07 2019 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 3352611-05L. 00 0 The policy includes a loss payable clause protecting the additional insureds interest in the described car to the extent of the insurance provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is terminated. Until such notice is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of IR any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. FRT Sta-teFarm STATE FARM® -ft- (WOO PO Box 853922 Richardson, TX 75085-3922 38A AT1 02 000154 0093 CITY OF GILROY ITS OFFICERS., EMPLOYEES AND REPRESENTATIVES 7351 ROSANNA ST GILROY CA 95020-6196 DATE OF NOTICE: JUN 04 2019 CODE: F11 010 1 V *1=1 10 1 M :1 IT, Vill 0 State Farm Mutual Automobile Insurance Company 2551 -FC05-A NAMED INSURED: POLICY NO: 335 261 1-1306-05N COVERAGE: CONNERY, SUSAN B & PETER & YR/MAKE/MODEL: NONOWNED AUTO BI AND PD LIABILITY APPLIED SURVEY RESEARCH IN VIN/CAMPER: $1 MIL PO BOX 1927 AGENT NAME: JILL JUDD WATSONVILLE CA 95077-1927 AGENT PHONE: (831)462-1666 ENDORSEMENT NO: 6028BU POLICY EFFECTIVE 6164DP 6165CS JUN 03 2019 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 3352611-05M. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance o provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is terminated. Until such notice is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. FRT le cv 9 00 04 I- vS"t-teFarM STATE FARM@ ala -AL.. (wee PO Box 853922 Richardson, TX 75085-3922 26A AT1 02 000112 0093 CITY OF GILROY ITS OFFICERS, EMPLOYEES AND REPRESENTATIVES 7351 ROSANNA ST GILROY CA 95020-6196 DATE OF NOTICE: JUN 06 2019 CODE: NOTE: PLEASt NOTIFY STATE FARM AT THE ADDRESS LISTED AT THE TOP, LEFT CORNER OF THIS PAGE REGARDING ANY CHANGE OF ADDRESS INFORMATION. ........ � I ...... * , , , ........... ............... ....... ! ... I " 11 ...... .... .................. I ....... — ........ I ................. ...... I .......... — ..... .... I ............ ....... .... .. ........... .... ....... ............................... :::ADDITIONAL:::I::NSURE:D..'!OTICEDFC.O.. ....... N VERAOF .......... ........ ... .... ..................... ...................... .. ......... ............... ..................... ....... .......... ........... ....... ........... 1-1 ... :::: ...... ........ ...... ............... ....... ............. ............................. ......... ......... ...... State Farm Mutual Automobile Insurance Company 2551 -FC05-A NAMED INSURED: POLICY NO: 335 2611 -1306-05N COVERAGE: CONNERY, SUSAN B & PETER & YR/MAKE/MODEL: NONOWNED AUTO BI AND PD LIABILITY APPLIED SURVEY RESEARCH IN VIN/CAMPER: $1 MIL P0 BOX 1927 AGENT NAME: JILL JUDD WATSONVILLE CA 95077-1927 AGENT PHONE: (831)462-1666 ENDORSEMENT NO: 6028BU POLICY EFFECTIVE 6164DP 6165CS JUN 03 2019 UNTIL TERMINATED POLICY MESSAGES: This policy shown above supersedes policy# 3352611-05M. The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is terminated. Until such notice is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. FRT 1q? 9 CD StateFarM STATE FARM@ -ML owe PO Box 853922 Richardson, TX 75085-3922 25A AT1 02 000075 0093 CITY OF GILROY ITS OFFICERS, EMPLOYEES AND REPRESENTATIVES 7351 ROSANNA ST GILROY CA 95020-6196 DATE OF NOTICE: JUN 14 2019 CODE: 1 1 10, 10M I I , :%Cim 10 1201:1 J) VITA 0 1* i� ........... ....... ....... ... . ........ .... .................... IT OT:R�'*....... ................ ............. ::::'AD::D:l 110NALINSURED .. ........ .. .................... ........ ......................... ....... ........... ...... .... ... ... ...... .......................... ........ ..... . .............. ............... ...... ......... ............ .......... ............. ...... ................... . . . . . . . . . . . . . State Farm Mutual Automobile insurance Company 2551 -FC05-A NAMED INSURED: POLICY NO: 446 0758-C 16-05 COVERAGE: CONNERY, SUSAN B & PETER YR/MAKE/MODEL: 2001 CHEVROLET SPORT WG BI AND PD LIABILITY DIBA APPLIED SURVEY RESEARCH VIN/CAMPER: 3GNE016T71 G1 60093 $1 MIL PO BOX 1927 AGENT NAME: JILL JUDD $250 DED. COMP.$250 DED. COLL. WATSONVILLE CA 95077-1927 AGENT PHONE: (831)462-1666 ENDORSEMENT NO: 6028BU POLICY EFFECTIVE POLICY MESSAGES: This policy shown above supersedes policy# 2717307-05Z. JUN 03 2019 UNTIL TERMINATED The policy includes a loss payable clause protecting the additional insured's interest in the described car to the extent of the insurance provided and subject to all policy provisions. The additional insured will be given 20 days notice if the policy is terminated. Until such notice is provided, it shall be presumed that the required renewal premiums have been paid. The additional insured must notify us within 10 days of any change of interest or ownership coming to their attention. Failure to do so will render this policy null and void. FRT