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COI - MJR Electric Inc - Expires 2023-08-14PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 OWATONNA, MN 55060 INSURED MJR ELECTRIC INC PO BOX 668 MORGAN HILL, CA 95038-0668 AC R DATE (MM/OD/YYYYI CERTIFICATE OF LIABILITY INSURANCE 06/24/2022 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 riohts to the certificate holder in lieu of such enrosement(st. CONTACT NAME: CLIENT CONTACT CENTER PHONE (A/C. No, EMI: 888-333-4949 FAA./c, No,: 507-446-4664 ADDRESS: CLIENTCONTACTCENTER(a1FEDINS.COM INSURER(S) AFFORDING COVERAGE NAIC 1/ INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 315-542-1 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: 13935 COVERAGES CERTIFICATE NUMBER: 207 REVISION NUMBER: 0 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 4DDLSUBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER /MM/DD/YYYYI (MM/DD/YYYYI X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [ X OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY (PRO- JECT LOC JJII OTHER: AUTOMOBILE LIABILITY X ANY AUTO - SCHEDULED A OWNED AUTOS ONLY AUTOS N N - NON -OWNED HIRED AUTOS ONLY AUTOS ONLY Y N 9080246 08/14/2022 08/14/2023 EACH OCCURRENCE DAMAGE TO RENTED PREMISES IEa occurrence) MED EXP (Any one person) IPERSONAL & ADV INJURY I GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT IEa acdden0 BODILY INJURY (Per person) 9080246 08/14/2022 08/14/2023 BODILY INJURY (Per accident) PROPERTY DAMAGE )Per accident\ X UMBRELLA LIAB X OCCUR A ! EXCESSLIAB CLAIMS -MADE N N 9080247 08/14/2022 08/14/2023 DED I I RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) 11 yes, describe under DESCRIPTION OF OPERATIONS below YIN NIA EACH OCCURRENCE AGGREGATE PER STATUTE' E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) RE: 7851 CARMEL ST, GILROY CA 95020 CITY OF GILROY, ITS OFFICERS, OFFICIALS, AND EMPLOYEES ARE NAMED AS ADDITIONALLY INSURED CERTIFICATE HOLDER CANCELLATION 207 0 315-542-1 CITY OF GILROY 7351 ROSANNA ST GILROY, CA 95020-6141 OTH- ER $1,000,000 $100,000 EXCLUDED $1,000,000 $2,000,000 $2,000,000 $1,000,000 $5,000,000 $5,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ) 1G /V\/ O 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD JUL —6 2022 GILROY CITY CLERK'S OFFICE POLICY NUMBER:9080246 COMMERCIAL GENERAL LIABILITY CG20100413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations: City of Gilroy 7351 Rosanna St Gilroy, CA 95020 Location(s) Of Covered Operations Any Coverage Provided by This Endorsement Applies Only to Electrical Service Work at 7851 Carmel St, Gilroy CA 95020 of the Certholder. Additional Insureds Also Include: City of Gilroy, its Officers, Officials, and Employees Are Named As Additionally Insured. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section ii - Who is An insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 Policy Number:9080246 Transaction Effective Date: 08/14/2022 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or Insured: MJR Electric Inc PO Box 668 Morgan Hill, CA 95038-0668s 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 0 Insurance Services Office; Inc:, 2012- CG 20 10 04 13 Po]tWN ifitber:'9080246, Transaction Effective:Date •08/1'4/2022g" DocuSign Envelope ID: 6481B807-7E0D-416F-902E-A1D7E58D18D0 County of Santa Clara Office of the County Executive Office of Risk Management Liability/Property Insurance Division 2310 North First Street, Suite 203 San Jose, California 95131 Tel. No. (408) 441-4340 FAX (408) 441-4341 This is to Certify to: glEMIED JUL 11 2022 GILROY CITY CLERK'S OFFICE RE CERTIFICATE OF COVERAGE ISSUED BY COUNTY OF SANTA CLARA City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 Attn: Bryce Atkins Revised Ins. Cert. No. FY23-009 That the following described coverages are in force on this date as set forth below: Assured: County of Santa Clara 70 W. Heddinq Street San Jose, CA 95110 Insurer 1. Self -Funded Retention 2. PRISM Type of Coverage Expiration Continuous 07/01/2023 Limits 1. Workers' Compensation $4,000,000 Per Occurrence 2. Excess Workers' Compensation Statutory This certificate of coverage is provided by the County of Santa Clara to the above named certificate holder. The coverage specified herein will not be cancelled or reduced without thirty (30) days written notice from County of Santa Clara to the certificate holder. This certificate pertains to the agreement between the City of Gilroy and the Santa Clara County Library District for the Construction Work in Patio Area of Gilroy Library. This certificate is valid from July 1, 2022 to December 31, 2022. .-DocuSigned by: ERFIReDa 5Rrna Hank Ford Insurance Contracts & Claims Manager July 5, 2022 HF:td F Y 2 3-009 G i l ro y C i ty& S C C L i b ra ryD i s t Board of Supervisors: Mike Wasserman, Cindy Chavez, Otto Lee, Susan Ellenberg, S. Joseph Simitian County Executive: Jeffrey V. Smith