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COI - Western Truck Fabrication, Inc. - Expires 2022-10-01SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 1/19/2022 Woodruff-Sawyer &Co. 50 California Street,Floor 12 San Francisco CA 94111 Harriet Wong 415-402-6650 415-989-9923 hwong@woodruffsawyer.com Hartford Accident &Indemnity 22357 WESTTRU-01 GuideOne Mutual Insurance Company 15032WesternTruckFab,Inc. 1923 W.Winton Hayward CA 94545 Hartford Fire Insurance Company 19682 1377129604 C X 1,000,000 X 300,000 10,000 1,000,000 2,000,000 X Y 57UUNQ00253 10/1/2021 10/1/2022 2,000,000 A 1,000,000 X Y 57UENOL1540 10/1/2021 10/1/2022 B X01001204410/1/2021 10/1/2022 1,000,000 1,000,000 1,000,000 All California Operations.The City of Gilroy,its officers,employees,agents and volunteers are additional insured per the attached.Coverage is primary & non-contributory per the attached.Policies contain a 30 day notice of cancellation and a 10 day notice of cancellation for non-payment of premium. City of Gilroy 7351 Rosanna Street Gilroy CA 95020 DocuSign Envelope ID: D930F3AB-2005-4162-BE15-9B395C392034 ABCDEFGHI THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMMERCIAL AUTOMOBILE BROAD FORM ENDORSEMENT WITH VEHICLE WRAP EXTENSION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM To the extent that the provisions of this endorsement provide broader benefits to the "insured" than other provisions of the Coverage Form, the provisions of this endorsement apply. 1. BROAD FORM INSURED B. Employees as Insureds Paragraph A.1. - WHO IS AN INSURED - ofA. Subsidiaries and Newly Acquired or SECTION II - LIABILITY COVERAGE isFormed Organizations amended to add:The Named Insured shown in the Declarations d. Any "employee" of yours while using ais amended to include: covered "auto" you don't own, hire or(1) Any legal business entity other than a borrow in your business or your personalpartnership or joint venture, formed as a affairs.subsidiary in which you have an C. Lessors as Insuredsownership interest of more than 50% on the effective date of the Coverage Form.Paragraph A.1. - WHO IS AN INSURED - ofHowever, the Named Insured does not Section II - Liability Coverage is amended toinclude any subsidiary that is an "insured"add:under any other automobile policy or e. The lessor of a covered "auto" while thewould be an "insured" under such a policy "auto" is leased to you under a writtenbut for its termination or the exhaustion of agreement if:its Limit of Insurance. (1) The agreement requires you to(2) Any organization that is acquired or provide direct primary insurance forformed by you and over which you the lessor andmaintain majority ownership. However, (2) The "auto" is leased without a driver.the Named Insured does not include any newly formed or acquired organization:Such a leased "auto" will be considered a covered "auto" you own and not a covered(a) That is a partnership or joint venture, "auto" you hire.(b) That is an "insured" under any other D. Additional Insured if Required by Contractpolicy, (1) Paragraph A.1. - WHO IS AN INSURED -(c) That has exhausted its Limit of of Section II - Liability Coverage isInsurance under any other policy, or amended to add:(d) 180 days or more after its acquisition f. When you have agreed, in a writtenor formation by you, unless you have contract or written agreement, that agiven us notice of the acquisition or person or organization be added asformation. an additional insured on yourCoverage does not apply to "bodily injury"business auto policy, such person oror "property damage" that results from an organization is an "insured", but only"accident" that occurred before you to the extent such person orformed or acquired the organization.organization is liable for "bodily injury" or "property damage" caused Form HA 99 75 03 20 Page 1 of 5 © 2020, The Hartford (Includes copyrighted material of Insurance Services Office, Inc. with its permission.) Policy Number: 57UENOL1540DocuSign Envelope ID: D930F3AB-2005-4162-BE15-9B395C392034 DocuSign Envelope ID: D930F3AB-2005-4162-BE15-9B395C392034 DocuSign Envelope ID: D930F3AB-2005-4162-BE15-9B395C392034 DocuSign Envelope ID: D930F3AB-2005-4162-BE15-9B395C392034 cancellation at least 60 days before the effective to move the auto but does not include autos date of cancellation.powered solely by electricity or natural gas. b. A "hybrid" auto is defined as an auto with an18. HYBRID, ELECTRIC, OR NATURAL GAS internal combustion engine and one or moreVEHICLE PAYMENT COVERAGE electric motors; and that uses the internalIn the event of a total loss to a "non-hybrid" auto combustion engine and one or more electricfor which Comprehensive, Specified Causes of motors to move the auto, or the internalLoss, or Collision coverages are provided under combustion engine to charge one or morethis Coverage Form, then such Physical Damage electric motors, which move the auto.Coverages are amended as follows: 19. VEHICLE WRAP COVERAGEa. If the auto is replaced with a "hybrid" auto or In the event of a total loss to an "auto" for whichan auto powered solely by electricity or Comprehensive, Specified Causes of Loss, ornatural gas, we will pay an additional 10%, to Collision coverages are provided under thisa maximum of $2,500, of the "non-hybrid" Coverage Form, then such Physical Damageauto's actual cash value or replacement cost, Coverages are amended to add the following:whichever is less, In addition to the actual cash value of the "auto",b. The auto must be replaced and a copy of a we will pay up to $5,000 for vinyl vehicle wrapsbill of sale or new lease agreement received which are displayed on the covered "auto" at theby us within 60 calendar days of the date of time of total loss. Regardless of the number of"loss," autos deemed a total loss, the most we will payc. Regardless of the number of autos deemed a under this Vehicle Wrap Coverage provision fortotal loss, the most we will pay under this any one "loss" is $15,000. For purposes of thisHybrid, Electric, or Natural Gas Vehicle coverage provision, signs or other graphicsPayment Coverage provision for any one painted or magnetically affixed to the vehicle are"loss" is $10,000.not considered vehicle wraps.For the purposes of the coverage provision, a. A "non-hybrid" auto is defined as an auto that uses only an internal combustion engine. Form HA 99 75 03 20 Page 5 of 5 DocuSign Envelope ID: D930F3AB-2005-4162-BE15-9B395C392034 DocuSign Envelope ID: D930F3AB-2005-4162-BE15-9B395C392034 DocuSign Envelope ID: D930F3AB-2005-4162-BE15-9B395C392034 DocuSign Envelope ID: D930F3AB-2005-4162-BE15-9B395C392034 DocuSign Envelope ID: D930F3AB-2005-4162-BE15-9B395C392034 DocuSign Envelope ID: D930F3AB-2005-4162-BE15-9B395C392034 DocuSign Envelope ID: D930F3AB-2005-4162-BE15-9B395C392034 DocuSign Envelope ID: D930F3AB-2005-4162-BE15-9B395C392034