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Bureau Veritas - Insurance Certificate (2021)DATE(MM/DD/YYYY) ,a�oRo® CERTIFICATE OF LIABILITY INSURANCE 12/31/2019 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 / p y, policies may require an endorsement. A statement on w this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: -a Aon Risk Services Northeast, Inc. PHONE FAX N Aon Risk Services Northeast, Inc. (A/C.No. E:t): 866-283-7122 (A/C.No.): 800-363-0105 -o NY NY Office E-MAIL 2 one Liberty Plaza ADDRESS: 165 Broadway, Suite 3201 New York NY 10006 USA INSURER(S) AFFORDING COVERAGE NAIC# INSURED INSURERA: Alllanz Global Risks US insurance Co. 35300 Bureau Veritas North America, Inc. INSURERB: Hartford Fire Insurance Co. 19682 Promenade Circle, Suite 150 Sac Sacramento CA 95834 USA INSURER Hartford Underwriters Insurance Com an 30104 p Y INSURER D: Trumbull Insurance Company 27120 INSURERE: Hartford Ins Co of the Midwest 37478 INSURERF: Sentinel insurance Company, Ltd 11000 COVERAGES CERTIFICATE NUMBER: 570079936771 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 MAYBE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, Limits shown are as requested INSR ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY EFF POLICY EXP POLICY NUMBER (MM/DD/VYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY USLOO159320 01/01/202d 01/01/2021 EACH OCCURRENCE $2,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 MED EXP (Any one person) $10 , 000 PERSONAL & ADV INJURY $2 , 000 , 000 r GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2 , 000 , 006 POLICY J PRO LOC JECT PRODUCTS - COMP/OPAGG $2,000,000 r OTHER: o r B AUTOMOBILE LIABILITY 10 AB 541202 01/01/2020 01/01/2021 COMBINED SINGLE LIMIT $2 000 000 AOS (Ea accident) , , C ANY AUTO 10 AB S41203 01/01/2020 01/01/20211 BODILY INJURY( Per person) X C SCHEDULED OWNED HI BODILY INJURY (Per accident) Z AUTOS ONLY AUTOS DAMAGE 01PROPERTY M HIREDAUTOS NON -OWNED (Per accident) U ONLY AUTOS ONLY ;�_ 1= O1 UMBRELLA LIAB OCCUR EACH OCCURRENCE L) EXCESS LIAB CLAIMS -MADE H (AGGREGATE DED I (RETENTION D WORKERS COMPENSATION AND IOWNS41200 01/01/2020 01/01/2021 I PERSTATUTE ORTH- EMPLOYERS' LIABILITY Y / N X AOS E ANY / PARTNER ❑N N/A 10wNS41200 01/01/2020 01�O1�2Ni71 E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBTOR ER EXECUTIVE OFFICER/MEMBER EXECUTIVE (Mandatory in NH) AK ID NY E.L. DISEASE -EA EMPLOYEE $1,000,000 Dyes, describe under DESCRIPTION ow OPERATIONS bel E.L. DISEASE -POLICY LIMIT $1,000,000 A Archit&Enq Prof USF00248020 01/01/2020 01/01/2021 Each Claim $1,000,000 Claims Made Aggregate $1,000,000 =_ SIR applies per policy terms & conditions DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)` RE: Contract for 18-RFP-CDD-406 for on -Call Plan Review services. � City of Gilroy, its officers, officials and employees are included as Additional Insured in accordance with the policy provisions of the Business Auto Coverage & General Liability Coverage policy. N Y, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION J S DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. .y rYKr �S City of Gilroy , its officers, AUTHORIZED REPRESENTATIVE officials and employees 7351 Rosanna Street Gilroy CA 95020 USA �/f p ,(/p �i� r4w- eXXa9a J�iD1c cJ c/j� lxrr�i eJ i� ©1988-2015 ACORD CORPORATION. All rights reserved ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACO AGENCY CUSTOMER ID: 570000048582 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMEDINSURED Aon Risk Services Northeast, Inc. Bureau veritas North America, Inc. POLICY NUMBER See Certificate Numbe 570079936771 CARRIER NAIC CODE see Certificate Numbe 570079936771 I EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liabilitv Insurance INSURER(S) AFFORDING COVERAGE NAIC # (INSURER G: Property & Casualty Ins Co of Hartford 34690 (INSURER H Hartford Casualty Insurance Co 29424 (INSURER I Nutmeg Insurance Co 39608 (INSURER 3 Hartford Accident & Indemnity Company 22357 ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR ADDL SUBR POLICY NUMBER TYPE OF INSURANCE POLICY POLICY LIMITS EFFECTIVE EXPIRATION DATE LTR INSD WVD DATE (MM/DD/YYYY) WORKERS COMPENSATION 7 N/A 10WNs41200 01/01/2020 01/01/2021 AL GA KY MT NE TN VT C N/A 10WN541200 01/01/2020 01/01/2021 AZ HI MA MO NJ NC SD TX G N/A 10WN541200 01/01/2020 01/01/2021 CA CO DE LA ME MN MS SC I N/A 10WN541200 01/01/2020 01/01/2021 CT B N/A 10WN541200 01/01/2020 01/01/2021 FL MD NH ND OH OR PA WA F N/A 10WN541200 01/01/2020 01/01/2021 IA NV OK H N/A 1OWNS41200 01/01/2020 01/01/2021 IL B N/A 1OWBRS41201 01/01/2020 01/01/2021 WT ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD