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COI - DeSilva Gates Construction LLC - Expires 2024-04-01DATE (MM/DDfYYYY) ir. 470 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). NAME: Chris Kelley M GIN U) 6) O Li) E-MAILI DSS: ckelley@woodruffsawyer.com u Q Z N N N •cY 7 N INSURER(S) AFFORDING COVERAGE INSURER A: Greenwich Insurance Company INSURER B : XL Insurance America Inc. INSURER C: INSURER D : INSURER F : Z THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIF CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDE BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSUI REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. U ?a CV U) Ca N O Y Lo d' Ti w o re zZ oti' x ---.N ?+i cew z PRODUCER Woodruff -Sawyer & Co. 50 California Street, Floor 12 San Francisco CA 94111 License#: 0329598 INSURED DESIGAT-01 DeSilva Gates Construction LLC 11555 Dublin Boulevard Dublin, CA 94568 Cf/FRAr:IC VIJIUN NUIVIbtK: IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD ATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS IFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, JSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. N O do- 0 O 03 0 0 C. CO O O C+ 19 0 O 0 O fA 1 S2,000,000 $ 2,000,000 ---1 O 0 CD C) O V) 0) fA M V) 0 O 0 O (9 CD 00 O O o f/) 69 CD 0 C. f9 O C 0 C 0 C O C f9 (f. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Excess Limits apply to the General Liability, Auto and Workers Compensation coverages. RE: ADK Permits City of Gilroy, its officers, agents and employees are included as Additional Insured where required by written contract but only with respect to liability arising out of the Named Insured's operations. Project or Job #: 1-613974206 Policies contain a 30 day notice of cancellation and a 10 day notice of cancellation for non-payment of premium. r.FRTIFICATG uni r- EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person)A PERSONALS ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE X STATUTE IERH E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT POLICY EFF POLICY EXP _ (MM/DD/YYYYI (MM/DD/YYYY) 4/1/2023 4/1/2024 N 0 V 0 NI 4/1/2023 4/1/2024 4/1/2023 4/1/2024 POLICY NUMBER CGD740946607 CAS740946707 N J v to 0 0 o O ~O co m 71- m o cr 0 0 cc > n > Y y ?_ > Y Q z TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS -MADE rk-1 OCCUR 'It AGGREGATE LIMIT APPLIES PER: POLICY LXJI jE 17 LOC OTHER: SCHEDULED AUTOS NON -OWNED AUTOS ONLY OCCUR CLAIMS -MADE DED I RETENTION S INUKAERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRI ETOR/PARTNERrEXECUTIV E OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below xI r X UMBRELLA LIAB EXCESS LIAB rOMOBILE LIABILIT ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY WU-U 0 =Z X�-_(� I C9l I x i W U V-rem 2J Q ¢ m m IllZ V CC _ 0 W CI W In W - co J W COW 0 U C U paQ W J CO J 0 CO U W I- OP.Z 0 a. ci Z N ill —ix U oice wa IX 0 11.1 ~o a IY O 0a- W c U m.' W w > 0.H Q N w W co o ~ZF w a)) ui u. 0 OO W w cC ccQ ZXZ LU QFQ z ) a W -J W IXN 2 . , < =N--G d QL 2 m nn� LJ GILROY CITY CLERK'S OFFICE 0 rn 0 f6 U E c 0 0 N ACORD 25 (2016/03) POLICY NUMBER: CAS740946707 XIC 411 1013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTOMATIC ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM AUTO DEALERS COVERAGE FORM A. COVERED AUTOS LIABILITY COVERAGE, Who Is An Insured, is amended to include as an "insured" any person or organization you are required in a written contract to name as an additional insured, but only for "bodily injury" or "property damage" otherwise covered under this policy caused, in whole or in part, by the negligent acts or omissions of: 1. You, while using a covered "auto"; or 2. Any other person, except the additional insured or any employee or agent of the additional insured, operating a covered "auto" with your permission; Provided that: a. The written contract is in effect during the policy period of this policy; b. The written contract was signed by you and executed prior to the "accident" causing "bodily injury" or "property damage" for which liability coverage is sought; and c. Such person or organization is an "insured" solely to the extent required by the contract, but in no event if such person or organization is solely negligent. B. The Limits of Insurance provided for the Additional Insured shall not be greater than those required by contract and, in no event shall the Limits of Insurance set forth in this policy be increased by the contract. C. General Conditions, Other Insurance is amended as follows: Any coverage provided hereunder shall be excess over any other valid and collectible insurance available to the additional insured whether such insurance is primary, excess, contingent or on any other basis unless the contract specifically requires that this policy be primary. All terms, conditions, exclusions and limitations of this policy shall apply to the liability coverage provided to any additional insured, and in no event shall such coverage be enlarged or expanded by reason of the contract. All other terms and conditions of this policy remain unchanged. XIC 411 1013 © 2013 X.L. America, Inc. All Rights Reserved. May not be copied without permission. Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 1 POLICY NUMBER: CAS740946707 a) C m m m 2 O .0 O U a C .-E u)ED � J }; L J a) O_ Q) C d' a >` C LL (0 `L "O 'C C O O CO L a) C 0 3 0 W Q N N N >O O c D m 'C o C LL L +' Q O C N N 2 v W �� O C U_ o C p N re O Oou v_a« C U) mU� OI 0 m -C O.Q U -O C)`� `o> U L. 8 oa)° Una) E .�o fy Z m a> U) �ic •- c c > �p.o ui N•co Z-o U a o U N Ego .0 a)C 0� O > L. C C m re �—la �m 2wa)=c'oa�i-o�CD �oc W =� � Q a O a =0 U 0) - 4•O C a) -0 U •5 a) m 'O L (/� co CI 0 � m �CCCo �o occ < �..Z N CCN LmcO�a UU >om =. W o 3 C a) > CD _ c .c E Z'o a3) �0 �o�oQ, co . a)m L o gl v2. ,(42)c1LE- s2 ov)•CC2 L oca U>Eoo cno >-macs_ Z W c a a) f— U U) I— U o o >, cNi -I0V m 0 V Z ...: IL Z a) a) W 0� L a)EUoo z,-. o Lo .c Z N Co V L II) .0 a) U o .Q O U 1- C o caw c� coo -o N a� U () 4- cn W ...CI CO O C = a)WU.5 J..., cv �� c cop) > O:- • N.o C 0 0 C.5 ZartZ v N 2coa oc�° 0 .0 Z 2 La)ao 5 a 2 W-0 a 62O>�2c Q.§°ia N CD Vc I ��/ pw +•Um m c� Ecom U W C.) U W -0 O0E2u) �-Omo c m"'c4 I— & c cn O U O L- N W .� § w w n" o N °' U° co L§ c o a t o W > o a v y Z c— c c LU 0 0 >p0 &E o•N c C cn E Z•o o m c ' .D = IX o°mom aimo. Lcao Ups W fomE �-E o oc"E oc �.L} •�. o c 'v c cn > o -r vmi pw� ��, 0O0�o,�'oa°��E �EC`O� L Q) (� = o 0Zp a- o 2as2c0cLa_aU o� ��'E>,u�) ~ aci DD0 2 0 o c-oN > o w > t_� cn o >-m aal�E .� .coc oo :Eo U4 Qm2 L-0 i-U m =Uw E-0 U m N H. E Q © Insurance Services Office, Inc., 2016 CA 04 49 11 16 POLICY NUMBER: CAS740946707 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. � a Z a' co ,,___ 15 - LL.O : .cn W l' >Qcii 00 Li. cii 0 0) C W a) `° Ln a)U) o c Lim o 0 o N� o� I .N o 0 W -- ' c' °- -0 �Um a o a) C o �0 o ..: a 0 E •c a) E a) W0 I o Wm. -. . -0 a) a) v, 0 °' Z O w N Q V♦ 0. Omoo .0 134- Ure Et o W.a m W�0 v Q I. W ai QctW O N U. E �wW 2 0 o' �0oo � 0)E �N0) CO 0 W~ t re c)cn Z EQ�° E�Q a) W V .r OW cc oZp LL-0 O �� 2 N C Q0 I - E I=— .0 CO N 0 T a. Endorsement Effective Date: 1 SCHEDULE a W X w co 0 cL a. w o I- w z w w W Q O U U) H o O c1 ° N z •C W J to IS O`>.w (MI l- c am" W u)� W N3a 0 0 Z __ ea he Declarations. be shown in is Schedule, if not shown above, wil a) 0 0 0 0 nformation required tad 2aiO-5 c +. L •3 • -0 0- a) U d� al L'Qa)30 C.) 0 -- CCD 0) C C y0 iii (C V) 0 0) '�- a) -Cu) o OO2�= a o U) :P..- ( o .Coa= o q)= Or a):.5. C O .r 4-* N '4- ON_ C C 4; 0 O Cx_ 0) N 2-)O C O L=0a)a),_ 1.6 L t p o U) 0 O O C NCH^O 0 O L w O 0 w Q -0 ♦' a) 0 ca I- 0 o..o 0 s © Insurance Services Office, Inc., 2011 CA04441013 POLICY NUMBER: CGD740946607 COMMERCIAL GENERAL LIABILITY CG20101219 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 Organization(s) ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE PERFORMING OPERATIONS WHEN YOU AND SUCH PERSON OR ORGANIZATION HAVE AGREED IN WRITING IN A CONTRACT OR AGREEMENT THAT SUCH PERSON OR ORGANIZATION BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY, PROVIDED THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS SUBSEQUENT TO THE EXECUTION OF THE WRITTEN CONTRACT OR WRITTEN AGREEMENT. Location(s) Of Covered Operations VARIOUS AS REQUIRED PER WRITTEN CONTRACT. Information required to complete this Schedule, if not sho 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. wn above, will be shown in the Declarations. 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. CG20101219 © Insurance Services Office, Inc., 2018 Page 1 of 2 O cn E a) .0 L a) 0 C whichever is less. a)O U — .a o CU O (j) 0) .. a3 •c V U O N N O 3 L N N a) C .c C_ _ 4.. • a) N N a) U) J 5.0 I a)— a. — = as 2 o 0 a) r a) U) cv 0 U C 00a) a) • .U) • 0 c E .2 ,- 2L 0 a. Q) cu 10 E C O O 2 73 a) L t0 RS O o2 N (2O .> C To O U .0 aa3Jo N U C 2.3 1. Required by the contract or agreement; or CG20101219 © Insurance Services Office, Inc., 2018 POLICY NUMBER: CGD740946607 COMMERCIAL GENERAL LIABILITY CG20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE PERFORMING OPERATIONS WHEN YOU AND SUCH PERSON OR ORGANIZATION HAVE AGREED IN WRITING IN A CONTRACT OR AGREEMENT THAT SUCH PERSON OR ORGANIZATION BE ADDED AS AN ADDITIONAL INSURED ON YOUR POLICY, PROVIDED THE "BODILY INJURY" OR "PROPERTY DAMAGE" OCCURS SUBSEQUENT TO THE EXECUTION OF THE WRITTEN CONTRACT OR WRITTEN AGREEMENT. Location And Description Of Completed Operations VARIOUS AS REQUIRED PER WRITTEN CONTRACT. 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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 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 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG20371219 © Insurance Services Office, Inc., 2018 Page 1 I- T _ N C T 4.4 Q J N J g0 z J U w 2 0 POLICY NUMBER: CGD740946607 T CAREFULLY. J W a �. Zoa WI—N W — O 00 O 0. _ 0a W Z ix 1-20 I 6 2 Q C4 WCI)a cn 0 Z Z>-o aZC/) Z W 0 ° C1 —Qm 0 CO 0) 0 0 a) a) C 0 a▪ ) V 2 0 a) U C C U) a) a O E C a) aai U) O a) U) I- COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 0 U W z WO z cc [NI 0O 0'— ccQ O W en 1- 0 N=w c0 Q v= Uw o=� a5u) oo- 0(f) LL NC3 I .� W Z 0 ri Z O 0 woo v2� C Q Z Q W U ~ J LL 4�d LZO O o<0_ 0 cc7) W O05 N Q U) O 5 TO (Di- - U whichever is less. N Lit o °O UC O 03 (Lp C.c -0 0 0 .. 0vU N D 0 -C .CN E U 0 O) • — = =NC L0_ C"0 C- NUCUQ L. a) N >, N .� .0 C () a LO _c _c oicc �O o'p>: L ON ''J (o `e a) .0 U) p 0 O O (U-0a L �oE.> �'�oo�° O >,>� N O . C C S a) > ° 0 •0 .,.. a) a - N N ,p 0) U) U) a) 7 L O L - C D �> •L (1) L N E (1) = N 0_ 0- a) a) L O co p CO O-- 0 L N O C a) `t U) 0- O C >, a) C >. U L i9..-'0 �v_).�'- a) N a L O= 0 O co (II a) (a O N tU,...o(a wa >aEo�m- v)OCc.QO L N� 02a) ›O)N L I— o ° ai a. 2 rojct .o • coa) cc a U C 0 C © Insurance Services Office, Inc., 2018 CG20121219 ENDORSEMENT #012 O t N a t) U E 0 M N O N 0. Q E ca 0 a) > o a) C a) E a) L O v a) co 1--- Policy No. CGD740946607 by Greenwich Insurance Company THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY INSURANCE CLAUSE ENDORSEMENT co :C >. U C •O O a U cna L a)g U C N 3 N ▪ a▪ ) = IL N L C U a a) C U o C c 0 &) c Q ,c o CC >, >, p a c c CL - W_ a`) a < 0 0 O • L. c m • O > 0 O ca a W U >o > (I) a) 0 C.) c.)0. 0U 0 M o; a) - m . C U c.)F- .0 co L J C N In_a�c0 s cn < W m a� X 75 CL W a) cp a o W E W a a-o C 0 2 o aL a) a) 0 0 5 m Q U °i cn • (n _c r a na • W o co aa)) • 0 01 m ate) cn g O m L L E 0 Q . N cEn U) F- U a = •c c -d a) D) C co L U C C .Ca E .a_ Cl) .0 4- 0 U C C 0 0 .10 CU Co E 45 hi .c O Q XIL 424 0605 ©, 2005, XL America, Inc. POLICY NUMBER: CGD740946607 T CAREFULLY. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ ill'N • 0 LL WI-' > a o " 0o WW Ce m b coV�co " I -cc o w< _� WW Y 0 W 1- Q a goo• "— 3 N0W o W wm ~ pU z:i o -0 Q a ww a ▪ M< 0 W = S ww p� Jw5- • w U) ▪ O v 0cc Q z0J °>W O} aZ w0Q QV♦ CL F-0Qwa) JwOI i i c QI—(�CCWaml— H W N--�o-�-� �.I - ; Q j U-1 w j� O I.0 w ,, a o w< awcn C�ar_mmM~0 W 0 <J OOZ c QUmJJV�p 2Qzzcn°-o Q • Z a) wOJ000o0 >ocKu) wWw»dCw D J J O O Q a) OJ0OOc<Z u, O w J d a d tY p 1E I - SCHEDULE a w X w 0 J 0 O a 0 w W Z w W w 0 0 U Nz G O wQ RS�m v)Lp O w O m - Now caw O5a ow0 z O w w E w w z U) 0 U a) 0 a) L a) F. C 0 a) 0 L a) C 0 U) 0 9- ai a) cn U U) .0 a) a) a 0 U 0 C- a) 0 E C "'p NNa)�Nu)8 O `.> cL _CL O C o co ,�. , L N w� CnU�C0) �I- o a)'�u)0 �12•N a) > o N 0 00 i.. �c U I- a) °L°L•= ccoo•aa) m0 �Lp,N(N =�O ::: o C IU Q�LCOL ci.E > .c o •( .�.o >, u) CU EQ-u,m-a) O a U C a_ N C .c .2 Q= N 0 3 v) 'O @ O C N �'O_ "--c u) > 2'cn c ->= �Ncs��o°)3 'a Lea) mOc c� 1�oa.c u)VO L�Ea)N mN a) C �, > �V >,oa)•�� i N c� I m 7 2-�.c c0c oQ> o.co�2N�o C .>_moca a)zza) 5 I O cli Ens c) c a` .M .C++ Ow LOC 1a)ov) .C,-a) `CDmDc I-XC> o-0a CO a) o © Insurance Services Office, Inc., 2018 CG 24 0412 19 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 0 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT—CALIFORNIA (Ed. 04-8i We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description WHERE REQUIRED BY WRITTEN AGREEMENT SIGNED PRIOR TO LOSS. ALL CALIFORNIA OPERATIONS. 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 April 1, 2023 WC 04 03 06 (Ed. 04-84) GAYE 04/17/2017 Policy No. C\VD740946507 Endorsement No. Insurance Company XL Insurance America Inc. Aik �G Countersigned by Copyright 1984 Workers' Compensation Insurance Rating Bureau of California. All Rights Reserved. Page 1 of 1