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COI - Verizon Wireless, LLC - Expires 2023-06-30.ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) osn s/zozz ' 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 Aon Risk Services Northeast, Inc. New York NY Office One Liberty Plaza 165 Broadway, Suite 3201 New York NY 10006 USA CONTACT PHON: (A/CC..NNo. Ext): (866) 283-7122 FAX No.): (800) 363-0105 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Verizon Wireless, LLC 1095 Avenue of the Americas New York NY 10036 USA INSURER A: Liberty Mutual Fire Ins Co 23035 INSURER B: LM Insurance Corporation 33600 INSURER C: Liberty Insurance Corporation 42404 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570093645660 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. Limits shown are as requested INER LTR TYPE OF INSURANCE ADDI; INSD SUER WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY TB2691550588142 06/30/2022 06/30/2023 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $2,000,000 f CLAIMS -MADE I X I OCCUR X XCU Coverage is Included MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GEN'LAGGREGATE X POLICY OTHER: LIMIT APPLIES PRO-LOC PER: GENERALAGGREGATE $2,000,000 PRODUCTS - COMP/OPAGG $2,000,000 A A A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS S SCHEDULED AUTOS NON -OWNED AS2-691-550588-122 AOS AS2-691-550588-132 NH — Primary TL2-691-550588-182 NH — Excess 06/30/2022 06/30/2022 06/30/2022 06/30/2023 06/30/2023 06/30/2023 COMBINED SINGLE LIMIT (Ea accident) $2,000,000 BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED RETENTION 'B B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) II yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N/A WA569D550588092 AOS WC5691550588082 WI , MN 06/30/2022 06/30/2022 06/30/2023 06/30/2023 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Named Insured includes: GTE Mobilnet of California Limited Partnership dba verizon Wireless. The City of Gilroy and its elected and appointed council members, board members, commissioners, officers and officials are included as Additional Insured with respect to the General Liability and Automobile Liability policies. The General Liability policy shall apply as Primary Insurance to each Additional Insured listed herein. CERTIFICATE HOLDER City of Gilroy Attn: City Administrator 7351 Rosanna Street Gilroy CA 95020 USA CgLgUVLgm JUL 18 2022 GILROY CITY CLERK'S OFFICE NCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. HORIZED REPRESENTATIVE Holder Identifier : 570093645660 Certificate No 000000 03 03 012275 039480 P ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000027366 LOC #: ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Northeast, Inc. NAMED INSURED Verizon Wireless, LLC POLICY NUMBER See Certificate Number: 570093645660 CARRIER See Certificate Number: 570093645660 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # R E@IflWGDD INSURER INSURER JULL JU18 I022 INSURER GILRO'i CI ' CLERK'S OFFICE INSURER 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 LTR TYPE OF INSURANCE ADDL 1NSD SLIER WYD POLICY NUMBER POLICY EFFECTIVE DATE (MEI/DD/YYYY I POLICY EXPIRATION DATE (MM/DD/YYYY) LIMITS WORKERS COMPENSATION C N/A WA769D550588072 MA 06/30/2022 06/30/2023 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD MSC#17755 Aon Risk Services PO Box 1447 Lincolnshire, IL 60069 MDG2022 00012275 01 111"1111111111111111111111111111111111d1111111111111111111 City of Gilroy Attn: City Administrator 7351 Rosanna Street Gilroy CA 95020 000000 01 03 012275 039478 P Certificate No: 570093645660 City of Gilroy Attn: City Administrator 7351 Rosanna Street Gilroy CA 95020 USA Saturday, June 25, 2022 To whom it may concern: Following a concentrated effort to reduce our environmental footprint and provide timely certificate delivery, Aon will begin delivering our Certificates of Insurance electronically in PDF format. Please utilize one of the following methods to ensure you will receive the electronic copy of your Certificate (Certificate No: 570093645660) for future renewals: - Visit aon.com/e-cert; or - Utilize the QR Code below to enter/validate your information. If your email address has changed or will be changing in the future, or you no longer require this certificate, please let us know using one of the methods above. Thank you for your cooperation and willingness to help us reduce our impact to the environment. MSC# 17755 I Aon P.O. Box 1447 Lincolnshire, IL 60069 000000 02 03 012275 039479 P 0 Esdvt Ti,trne Colas rya to FT F+ Del Sahzerou, General Counsel 300 North Rif Suite 2060 El Segundo, CA 90245 I)Sabzerou(a evolvetreatment.coni (818) 521-7127 January 22, 2020 Via US Certified Mail to: Gilroy City Hall 7351 Rosanna Street Gilroy, CA 95020 County of Santa Clara Board of Supervisors 70 West Hedding St, loth Floor San Jose, CA 95110 Re: Notice of Extension of Temporary Furlough To Whom It May Concern: Although we do not believe federal or California WARN regulations apply to our organization, we are providing you notice of our extension to a temporary in case and asking for your assistance with contacting chief elected officials in our community. This is a notice of an extension to temporary furlough by Evolve Growth Initiative ("Evolve"). The entire facility located at 2560 Butch Dr. in Gilroy California. 95020 was temporarily closed effective January 4, 2021. Our intent was to reopen by February 1, 2021, but are now pushing our reopening date to March 29, 2021 due to the effects COVID-19 is having our facility in Gilroy. The action is planned to be temporary.The number of affected employees by furlough is: 22. You may contact me for additional information at DSabzerou@evolvetreatment.com or 818-521-7127. Sincerely, /s/ Del Sabzerou General Counsel Evolve Growth Initiative dsabzerou@evolvetreatment.com