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COI - Bureau Veritas North America, Inc. - Expires 2022-01-01ACL7R0 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD2YYYY) 12/22/2020 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. Aon Risk Services Northeast, Inc. NY NY Office One Liberty Plaza 165YokdwYy, Suite 3201 Neww York NY 10006 USA CONTACT NAME: (aC N . Ext): 866-283-7122 (a . No.): 800-363-0105 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Bureau Veritas North America, Inc. 180 Promenade Circle, Suite 150 Sacramento CA 95834 USA ' INSURER A: Hartford Fire Insurance Co. 19682 INSURERB: Hartford underwriters Insurance Company 30104 INSURER C: Allianz Global Risks US Insurance Co. 35300 INSURER D: Trumbull Insurance Company 27120 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570085339583 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 INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF CMM/DD/YYYY!! POLICY EXP iMM/DD/YYY LIMITS C X COMMERCIAL GENERAL LIABILITY USL00159321 01/01/202101M/202T EACH OCCURRENCE $2,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 MED EXP (Any one person) $10, 000 PERSONAL & ADV INJURY $2,000,000 GENII AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2,000,000 POLICY X PRO-X JECT LOC PRODUCTS - COMP/OP AGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY 10 AB S41202 AOS 01/01/2021 01/01/2022 COMBINED SINGLE LIMIT (Ea accident) $2,000,000 B _ X ANY AUTO 10 AB S41203 01/01/2021 01/01/2022 BODILY INJURY ( Per person) OWNED SCHEDULED AUTOS HI BODILY INJURY (Per accident) - AUTOS ONLY HIRED AUTOS ONLY - NON -OWNED AUTOS ONLY PROPERTY DAMAGE (Per accident) - UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 10wNS41200 01/01/2021 O1/01/2022 x PER STATUTE OTH- ER ANY PROPRIETOR / PARTNER I EXECUTIVE OFFICER/MEMBER EXCLUDED? Y / N N N / A See State Policy Addendum E.L. EACH ACCIDENT S1,000,000 (Mandatory in NH) If describe E.L. DISEASE -EA EMPLOYEE $1,000,000 yes, under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 C Archit&Eng Prof USF00248021 Claims Made SIR applies per policy terns 01/01/2021 & conditions 01/01/2022 Each claim Aggregate $1,000,000 $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be 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. CERTIFICATE HOLDER CANCELLATION City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy CA 95020 USA 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 tsz4. Holder Identifier : * * 000000 02 02 002866 005829 P ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000048582 LOC #: ACO OR ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Northeast, Inc. NAMED INSURED Bureau Veritas North America, Inc. POLICY NUMBER See Certificate Number: 570085339583 CARRIER See Certificate Number: 570085339583 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 Workers Compensation/Employers Liability 10wNS41200 01/01/21-01/01/22 Trumbull Insurance AR,DC,IN,LA,RI,UT 10wNS41200 01/01/21-01/01/22 Twin City Fire Insurance Company FL,ND,OH,WA,WY 10wNS41200 01/01/21-01/01/22 Hartford Insurance Company of the Midwest AK,ID 1OWNS41200 01/01/21-01/01/22 Hartford Casualty Insurance Company MO,TX 10wNS41200 01/01/21-01/01/22 Nutmeg Insurance Company CT,IL 1OWNS41200 01/01/21-01/01/22 Hartford Fire Insurance Company NH,OR,PA 10wNS41200 01/01/21-01/01/22 Hartford Accident and Indemnity Company AL,GA,KY,ME,MI,MT,NE,NY,TN,VT 1OWNS41200 01/01/21-01/01/22 Property /Casualty Insurance Company of Hartford CA,CO,DE,MN,MS,SC 1OWNS41200 01/01/21-01/01/22 Hartford Insurance Company of Illinois WV 1OWNS41200 01/01/21-01/01/22 Hartford Insurance Company of the Southeast KS,MD 1OWNS41200 01/01/21-01/01/22 Hartford underwriters Insurance Company AZ,HI,MA,NC,NJ,SD,VA 1OWNS41200 01/01/21-01/01/22 Sentinel Insurance Company, Limited IA,NM,NV,OK 10WBRS41201 01/01/21-01/01/22 Twin City Fire Insurance Company WI 10WBRS41201 01/01/21-01/01/22 Hartford Fire Insurance Company PR ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD ® 2008 ACORD CORPORATION. All rights reserved.