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COI - Harris & Associates, Inc. - Expires 2022-08-01P5260028002 )® CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/YYYY) 08/02/2021 ~ 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 Tl-IE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE1WEEN 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 LIC #0757776 800-877-4560 CONTACT NAME: HOB International Insurance Services Inc. rtig\e.,~~,, 925 609-6500 I f,ifc Nol: 925 609-6550 E-MAIL P.O. Box 4047 ADDRESS, INSURER/Sl AFFORDING COVERAGE NAIC# Concord, CA 94524 USA INSURER A: VALLEY FORGE lNS CO 20508 INSURED INSURER B : CONTINENTAL CAS CO 20443 Harris & Associates Inc. INSURER C : qONTINENTAL INS CO 35289 Attn: SUsan Mandilag 1401 Willow Pass Road, Suite 500 INSURER D: TRAVELERS PROP CAS CO OF AMER 25674 INSURERE: Concord, CA 94520 USA INSURER Ii: COVERAGES CERTIFICATE NUMBER: 535105349 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 Tl-IE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN RE;OUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICYEFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER fMMIDD/YYYYl [MM/DDIYYYYl A X COMMERCIAL GENERAL LIABILITY 6072176739 08/01/21 08/01/22 EACH OCCURRENCE $ 1,000,000 -~ CLAIMS-MADE ~ OCCUR DAMAGE TO RENTED -PREMISES /Ea occurrence\ $ 1,000,000 X Ded: 0 MED EXP {Any one person} $ 15;000 -PERSONAL & NJV INJURY $1,000,000 -GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 =i POLICY ~ f~r ~LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY BUA 6076590520 Q8/Ql/21 08/01/22 COMBINED SINGLE LIMIT $ 1,000,000 [Ea accident) -X ANY AUTO BODILY INJURY (Per person} $ -OWNED -SCHEDULED BODILY INJURY {Per accident} $: -AUTOS ONLY -AUTOS HIRED NON-OWNED hROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accidentl --X Ded: 0 $ C UMBRELLA LIAB MOCCUR COE 6076590551 08/Ql/21 08/01/22 EACH OCCURRENCE $ 10,000,000 -X EXCESS LIAS CLAIMS-MADE AGGREGATE $10,000,000 DED IX I RETENTION$ lO,OOO $ WORKERS COMPENSATION UB-8K458448-21-43-G * 08/01/21 08/01/22 x I ~\J-ruTE I I OTH-D ER AND EMPLOYERS' LIABILITY Y/N AIIIYPROPRIETOR/PARTNER/EXECUTIVE ~ E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? N 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 B PROFESSIONAL LIABILITY AE:H591891588 08/01/21 08/01/22 10,000,000/claim; 10,000,000Ag Claims-Made Aggregate 10,000,000 Ded. Each Claim 150,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) * Workers COI11pensation policy excludes monopolistic states ND, OR, WA, WY. General Liability and Auto Liability Additional Insured status granted, if required by written contract/agreement, per attac..~ed forms CNA75079XX 1016 and CNA63359XX 0412 (pg. l, I.A.3). City, its officers & employees are additional insureds under General Liability and Auto Liability, if required by a written contract. RE: On-call Agreement for Surveyor/Map review services (HA *1500412) CERTIFICATE HOLDER 150-0412 (2023) City of Gilroy Maria Angeles, PE, CFM Develop.~ent Engineer 7351 Rosanna Street Gilroy, CA 95020 I ACORD 25 (2016/03) bbogart 535105349 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE l::XPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE USA -© 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ~jJI ~ u.. '-0 f$ N 0 c-oo a, N > ~ ■ ---- • -■ P5260028002 --...._ TRAVELERSJ · ONE TOWER SQUARE HARTFORD CT 06183 WORKERS COMPENSATION AND EMPLOYERS LIABILITY POLICY ENDORSEMENT WC 99 03 76 ( A) -001 POLICY NUMBER: UB-8K458448-21-43-G WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA (BLANKET WAIVER) We have the right to recover our payments from anyone liable for an injury covered by this polity. We will not enforce our right against the person or organization named in the Schedule. The additional premium for this endorsement shall be 2. oo % of the California workers' compensation pre-mium. Person or Organization ·ANY PERSON OR ORGANIZATION FOR WHICH THE INSURED HAS AGREED BY WRITTEN CONTRACT EXECUTED PRIOR TO LOSS TO FURNISH THIS WAIVER. Schedule Job Description This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Insurance Company Policy No. Endorsement No. Premium Countersigned by ____________ _ Page 1 of 1 co '° µ., 0 '° 0 r--00 °' N ~ U-l l P5260028002 HUB International Insurance Services Inc. P.O. Box4047 Concord, CA 94524 Electronic Service Requested ALL FOR AADC 950 29870 1-1752 AB 0-416 l1111•11111•'1•1'1'•l111l111111ll1l111111ll1l111lllfll11lll1l1ll1 City of Gilroy 7351 ROSANNA ST DEVELOPMENT ENGINEER GILROY, CA 95020-6141 391 202108043304 This document was brought to you by CertificatesNow. -EBIX BPO If you have questions regarding the content of this document, please contact -the Producer/Agent listed on the certificate of insurance or the Insured listed -on the notice of cancellation/reinstatement.-To find out how you can send and receive all of your certificates of insurance-either by email, high speed fax or standard mail, -email custom.ercare@confi:nnnet.com, or visit our website at -www.confi:nnnet.com-cc: The data included in this notice and in the attached document is confidential to Ebix BPO and the party responsible for bringing you this information. ~JI ~ i:i. '-0 6 0 r---00 °' N ~ i::i.1 ---''