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Carnes & Associates - Insurance Certificate (2020)
L_ � R 09/252019 L DATE(M CERTIFICATE OF LIABILITY INSURANCE I /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 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 I CONTACT Jasminne Del Viilar PETE PETERSON- LIC #OE95583 1688 NORTH PERRIS BLVD., SUITE H6 DPERRIS CA 92571-4709 INSURED CARNES, GARY D DBA CARNES & ASSOCIATES 9505 SUGAR BABE DR GILROY CA 95020-9176 NAME. PHONE /A �. Ext1. 951-657-1905 ADDRESS: jasminne.delvillar.ub6j@statefarm.com ADDRESS:I J@ PRODUCER RID#: INSURER(S) AFFORDING COVERAGE [INSURER A: State Farm Fire and Casualty Company INSURER B : State Farm Fire and Casualty Company INSURER C : State Farm Fire and Casualty Company INSURER D : INSURER E : FA X. Nol: 951-657-1910 NAIC # 25143 25143 25143 I 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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP/YLIMITS LTR INSR WVD POLICY NUMBER (MMIDDYYY) (MMIDDIYYYY) A GENERAL LIABILITY 92-EU-X202-8 07/01/2019 07/01/2020 1 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE �X OCCUR FYI Eyl GEN'L AGGREGATE LIMIT APPLIES PER: POLICY n JE� n LOC AUTOMOBILE LIABILITY ANY AUTO ❑ ❑ ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAB HOCCUR EXCESS LIAB CLAIMS -MADE m _ DEDUCTIBLE I�I RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? ElNIA (Mandatory in NH) If yes, describe under CPFr.IAI PRovis1r1NC halm El 1-1 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG 2,000,000 I $ COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ N/A BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ IEACH OCCURRENCE $ N/A I AGGREGATE Is I I$ Is I WC TORY LIMITS ITS I N/A I E.L. EACH ACCIDENT I OER I Is E.L. DISEASE - EA EMPLOYEp $ E.L. DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 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 Project Address: 7310 & 7320 Monterey Rd., Gilroy, CA 95020 CERTIFICATE HOLDER CANCELLATION City of Gilroy, its Officers, officials and employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE 7351 Rosanna St. POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE PETE PETERSON © 1988- 2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 1001486 132849.4 02-11-2010 CG Policy NO. 92 EUX202 8 3261—FA71 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CMP-4786.1 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 EUX202 8 Named Insured: CARNES, GARY D DBA CARNES & ASSOCIATES 9505 SUGAR BABE DR GILROY CA 95020-9176 Name And Address Of Additional Insured Person Or Organization: CITY OF GILROY ITS OFFICERS, OFFICIALS AND EMPLOYEES 7351 ROSANNA ST GILROY CA 95020 6196 SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily injury", "property damage", or "personal and advertis- ing injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or b. Products — Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". However, Paragraph 1. above is subject to the following: a. The insurance afforded to the additional insured only applies to the extent permit- ted by law; CMP-4786.1 Page 1 of 2 b. If coverage provided to the additional in- sured is required by a contract or agree- ment, the insurance provided to the additional insured will not be broader than that which you are required by the contract or agreement to provide for such addition- al insured; and c. If the contract or agreement between you and the additional insured is governed by California Civil Code Section 2782 or 2782.05, the insurance provided to. the additional insured is the lesser of that which: (1) Is allowed for the satisfaction of a de- fense or indemnity obligation by Cali- fornia Civil Code Section 2782 or 2782.05 for your sole liability; or (2) You are required by contract or agreement to provide for such addi- tional insured. We have no duty to defend or indemnify the additional insured under this endorsement un- til a claim or "suit' is tendered to us. ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CONTINUED 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. With respect to the insurance afforded to the additional insured, the following is added to SECTION II — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by contract or agreement, the most we will pay on behalf of the additional insured will be the lesser of the amount of insurance: a. Required by the contract or agreement; or b. Available under the applicable Limits Of Insurance shown in the Declarations. This endorsement shall not increase the ap- plicable Limits Of Insurance shown in the Declarations. 4. With respect to the insurance afforded to the additional insured, the following is added to Paragraph 3. Duties In The Event Of Occur- rence, Offense, Claim Or Suit of SECTION II — GENERAL CONDITIONS: The additional insured must: a. See to it that we are notified as soon as practicable of an "occurrence" or an of- fense which may result in a claim. To the extent possible, notice should include: (1) How, when and where the "occur- rence" or offense took place; (2) The names and addresses of any in- jured persons and witnesses; and C M P-4786.1 Page 2 of 2 (3) The nature and location of any injury or damage arising out of the "occur- rence" or offense; b. Tender the defense and indemnity of any claim or "suit" to us and to all other insur- ers who may have insurance potentially available to the additional insured; and c. Agree to make available any other insur- ance the additional insured has for de- fense or damages for which we would provide coverage under SECTION II — LIABILITY. 5. With respect to the insurance afforded the ad- ditional insured, the following replaces SEC- TION II —LIABILITY of Paragraph 7. Other Insurance of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: a. This insurance is primary to and will not seek contribution from any other insurance available to the additional insured, provided that the additional insured is a named in- sured under such other insurance. b. Regardless of- any agreement between you and the additional insured, this insur- ance is excess over any other insurance whether primary, excess, contingent or on any other basis for which the additional in- sured has been added as an additional in- sured on other policies. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. CMP-4786.1 1007033 148011 08-21-2014 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. CG Policy No. 92 EUX202 8 3261—FA71 Page 14of1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 92 EUX202 8 Named Insured: CARNES, GARY D DBA CARNES & ASSOCIATES 9505 SUGAR BABE DR GILROY CA 95020-9176 Name And Address Of Person Or Organization: CITY OF GILROY ITS OFFICERS, OFFICIALS AND EMPLOYEES 7351 ROSANNA ST GILROY CA 95020 6196 The following is added to Paragraph 10.b. of SECTION I AND SECTION II — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 1006225 137715.1 11-19-2013 Includes copyrighted material of Insurance Services Office, Inc., with its permission. AC40R" `6- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) . 06/04/2018 THIS CERTIFICATE IS ISSUED ASA 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: Stefanie Plnhelr0 Albert Pinheiro(9660359) PHONE JI FAX 190 1 St St (A/C, NO, EXT): 408-842-4619 (A/C, NO): 408-842-3587 E-MAIL Gilroy CA 95020-5129 ADDRESS: apinheiro@farmersagent.com JI INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURERA: Truck Insurance Exchange 21709 I I INSURER B: Farmers Insurance Exchange 21652 CARNES & ASSOCIATES I INSURERC: Mid Century Insurance Company 21687 GARY CARNES I INSURER D: I 9505 SUGAR BABE DR I INSURERE: GILROY CA 95020 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAMEABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDTL SUBR POLICYNUMBER POLICYEFF POLICY EXP LIMITS LTR INSD WVD (MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY EACH OCCURREN CE $ CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea Occurrence) $ MED EXP (Anyone person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER: I GENERALAGGREGATE $ POLICY ❑ PROJECT ❑ LOC I PRODUCTS - COMP/OPAGG $ OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANYAUTO BODILY INJURY (Per person) Is OWNEDAUTOS SCHEDULED A ONLY X AUTOS Y 606271496 BODILY INJURY (Per accident) $ 03/30/2018 03/30/2019 HIREDAUTOS X NON -OWNED X PROPERTY DAMAGE $ ONLY AUTOSONLY (Per accident) Is I UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE I AGGREGATE $ DED I I RETENTION $ I Is WORKERS COMPENSATION PER OTHER $ AND EMPLOYERS' LIABILITY STATUTE ANY PROPRIETOR/PARTNER/ Y/N I E.L. EACH ACCIDENT Is EXECUTIVEOFFICERF Rory N/A E.L. DISEASE - EA EMPLOYEE EXCLUDED? (Mandatoryin NH) Ifyes, describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE- POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project location: 7310/7320 Monterey Rd. Gilroy, CA 95020 CERTIFICATE HOLDER CANCELLATION GI I Y Ui- GILKUY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DEPARTMENT OF PUBLIC WORKS DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 ROSANNA ST AUTHORIZED REPRESENTATIVE Albert Pinheiro ral Rnv rA g5n?n ACORD 25 (2016/03) @1988-2015 ACORD CORPORATION. All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD AC4DR CERTIFICATE OF LIABILITY INSURANCE °A09/25/2019YYY' 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: Stefanie Pinheiro Stefanie Pinheiro(966026A) PHONE FAX 190 1st St (A/C, NO, EXT): 408-842-4619 (A/C, No): 408-842-3587 E-MAI L Gilroy CA 95020-5129 ADDRESS: spinheiro@farmersagent.com INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURERA: Truck Insurance Exchange 21709 CARNES &ASSOCIATES INSURER B: Farmers Insurance Exchange 21652 GARY CARNES INSURERC: Mid Century Insurance Company 21687 9505 SUGAR BABE DR I INSURER D: GILROY CA 95020 I INSURERE: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS ISTO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO THE INSURED NAME ABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OFANY CONTRACT OR OTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALLTHETERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDTL SUBR POLICYEFF POLICY EXP LTR TYPEOFINSURANCE INSD VD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS W COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TO RENTED $ 11 CLAIMS -MADE OCCUR PREMISES (Ea Occurrence) MED EXP (Anyone person) $ PERSONAL & ADV INJURY $ GENT AGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ POLICY ❑ PROJECT ❑ LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ANY AUTO I BODILY INJURY (Per person) $ OWNEDAUTOS SCHEDULED p X BODILY INJURY (Per accident) $ ONLY AUTOS Y 606271496 03/30/2019 03/30/2020 X HIREDAUTOS X NON -OWNED PROPERTY DAMAGE $ ONLY AUTOSONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE I AGGREGATE $ DED I I RETENTION $ WORKERS COMPENSATION PER OTHER $ AND EMPLOYERS' LIABILITY STATUTE ANY PROPRIETOR/PARTNER/ Y/N E.L. EACH ACCIDENT EXECUTIVE OFFICER/MEMBER N/A C E.L. DISEASE - EA EMPLOYEE EXCLUDED? (Mandatory in NH) Ifyes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Project Location: 7310/7320 Monterey Rd. Gilroy, CA 95020 CERTIFICATE HOLDER CANCELLATION CITY OF- GI LROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DEPARTMENT OF PUBLIC WORKS DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 ROSANNA ST AUTHORIZED REPRESENTATIVE STEFANIEPINHEIRO rll RnV rA QFn9n ACORD 25 (2016/03) @1988-2015 ACORD CORPORATION. All Rights Reserved 31-1769 11-15 The ACORD name and logo are registered marks of ACORD Policy Number: Date Entered: 06/04/2018 '4� " CERTIFICATE OF LIABILITY INSURANCE I 6/4DATE (/2018YYY) 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 AL PINHEIRO INSURANCE AGENCY NAME: Stefanie Pinheiro 190 First St PHONE Extt. (408) 842-4619 a(408) 842-3587 E-M�'IL al@pinheiroinsurance . com Gilroy, CA 95020 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # IINSURER A:Darwin Select Insurance Campany INSURED Carnes & Associates INSURER B Gary Carnes I INSURER C : 9505 Sugar Babe Drive I INSURERD: Gilroy, CA 95020 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 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. 1NSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS DOCCUR DAMAGE TO RENTED -MADE PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO ❑ LOC JECT PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO I BODILY INJURY (Per person) $ OWNEDOSONLY AUTOS SCHEDULED AUT I BODILY INJURY (Per accident) $ HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Is UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ I I $ WORKERS COMPENSATION PER - O I I I PER' AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y� STATUTE I I E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A E&O 0310-2902 09/10/2017 09/10/2018 PL Liability $1, 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project Site: 7310/7320 Monterey Road, Gilroy CERTIFICATE HOLDER CANCELLATION Department of Public Works City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 Rosanna Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FormsBoss.com: Impressive Publishing 800-208-1977 Policy Number: Date Entered: 9/25/2019 ACID " CERTIFICATE OF LIABILITY INSURANCE ATE MM2019Y) 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 NAME: r NStefanie Pinheiro AL PINHEIRO INSURANCE AGENCY NAME: 190 First St IPHONE .E,,: (408) 842-4619 (A/C ,1: (408) 842-3587 -MAIL al@pinheiroinsurance.com Gilroy, CA 95020 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Darwin Select Insurance Campany INSURED Carnes & Associates INSURER B: Gary Carnes INSURER C : 9505 Sugar Babe Drive INSURER D: Gilroy, CA 95020 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 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE RENTED CLAIMS -MADE FOCCUR PREM SESO(Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ I GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO ❑ LOC JECT I PRODUCTS -COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) _ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTYDAMAGE $ AUTOS ONLY AUTOS ONLY (Per accidentl $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION PER TH I STATUTE I I FOR AND EMPLOYERS' LIABILITY Y /❑N E.L. EACH ACCIDENT ANY PROPRIETOR/PARTNER/EXECUTIVE N / A $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A E&O 0310-2902 09/10/2018 09/10/2019 PL Liability $1, 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project Site: 7310/7320 Monterey Road, Gilroy CERTIFICATE HOLDER CANCELLATION Department of Public Works City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 Rosanna Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Produced usinq Forms Boss Plus software. www.FormsBoss.com; Impressive Publishinq, LLC 800-208-1977 Policy Number: Date Entered: 9/25/2019 ACORO® I DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 9/25/2019 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 I NAME: CONTACT Stefanie Pinheiro AL PINHEIRO INSURANCE AGENCY 190 First St I ((AH,�c(°`NN .E,rtl. (408) 842-4619 FAX No). (408) 842-3587 E-MAIL al inheiroinsurance . com Gilroy, CA 95020 I ADDRESS: @P INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Darwin Select Insurance Campany INSURED Carnes & Associates I INSURERB: Gary Carnes I INSURER C : 9505 Sugar Babe Drive I INSURER D: Gilroy, CA 95020 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 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE DAMAGETO RENTED CLAIMS -MADE OCCUR PREMISES S( (Ea occurrence) MED EXP (Any one person) _ PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE PRO ❑ LOC I POLICY JECT PRODUCTS - COMP/OP AGG OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) ANY AUTO BODILY INJURY (Per person) OWNED SCHEDULED I BODILY INJURY ALLTOS ONLY AUTOS (Per accident) HIRED NON -OWNED PROPERTYDAMAGE AUTOS ONLY AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR HCLAIMS-MADE EACH OCCURRENCE EXCESS LAB AGGREGATE DED I I RETENTION $ WORKERS COMPENSATION I PER 1OTH- AND EMPLOYERS' LIABILITY Y/N STATUTE I ER ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N / A E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ It yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $ A E&O 0310-2902 09/10/2019 09/10/2020 PL Liability $1, 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project Site: 7310/7320 Monterey Road, Gilroy CERTIFICATE HOLDER CANCELLATION Department of Public Works City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 Rosanna Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Produced using Farms Boss Plus software. www.FormsBoss.com; Impressive Publishinq, LLC 800-208-1977 CERTHOLDER COPY NA P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09-25-2019 CITY OF GILROY NA 7351 ROSANNA ST GILROY CA 95020-6141 GROUP: POLICY NUMBER: 1779731-2019 CERTIFICATE ID: 31 CERTIFICATE EXPIRES: 06-01-2020 06-01-2019/06-01-2020 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 10 days advance written notice to the employer. We will also give you 10 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 UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-09-25 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF GILROY EMPLOYER CARNES, GARY AND CARNES, SUE DBA: CARNES & ASSOCIATES 9505 SUGAR BABE DR GILROY CA 95020 [JSZ,CNI (REV.7-2014) PRINTED : 09-25-2019 POLICYHOLDER COPY NA P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 09-25-2019 CITY OF GILROY NA 7351 ROSANNA ST GILROY CA 95020-6141 GROUP: POLICY NUMBER: 1779731-2019 CERTIFICATE ID: 31 CERTIFICATE EXPIRES: 06-01-2020 06-01-2019/06-01-2020 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 10 days advance written notice to the employer. We will also give you 10 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 UNLESS INDICATED OTHERWISE BY ENDORSEMENT, COVERAGE UNDER THIS POLICY EXCLUDES THE FOLLOWING: THOSE NAMED IN THE POLICY DECLARATIONS AS AN INDIVIDUAL EMPLOYER OR A HUSBAND AND WIFE EMPLOYER; EMPLOYEES COVERED ON A COMPREHENSIVE PERSONAL LIABILITY INSURANCE POLICY ALSO AFFORDING CALIFORNIA WORKERS' COMPENSATION BENEFITS; EMPLOYEES EXCLUDED UNDER CALIFORNIA WORKERS' COMPENSATION LAW. EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-09-25 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF GILROY EMPLOYER CARNES, GARY AND CARNES, SUE DBA: CARNES & ASSOCIATES 9505 SUGAR BABE DR GILROY CA 95020 [JSZ,CN] (REV.7-2014) PRINTED : 09-25-2019