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COI - Tait & Associates, Inc. - Expires 2021-09-01ACO ® CERTIFICATE OF LIABILITY DATE(MMIDDIYYYY) LITY INSURANCE 8/24/2020 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). CONTACT PRODUCER GMGS Risk Management & Insurance Services NAME: Jennifer Barton 6201 Oak Canyon, Suite 100 Irvine, CA 92618 (AIC No. Ext)=_- 949-559-3394 (A/C, Nol:_949-559-6703 E-MAIL ADDRESS: Jenniferb@gmgs.Com INSURER(S) AFFORDING COVERAGE I NAIC # www.gmgs.com OB84519 _ INSURER A: Travelers Property Casualty Co of America _ 25674 INSURED INSURER B : Tait & Associates, Inc. -- — --- - -- ---- - r --- - Tait Environmental Services, Inc. INSURER c_ _ 701 Parkcenter Dr. INSURER D : Santa Ana CA 92705 INSURERE:_ ------ ----- -- - --� -- - j C0VFRAr.FS rI=0TICIreT= AIIIIUlQCt - r INSURER F • e�rsie.�►■...■■.•.e 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 'ADDL SUBR, POLICY EFF POLICY EXP LTR i TYPE OF INSURANCE INSDWVoI POLICY NUMBER MMIDDIYYYY) (MMIDD/YYYY1 LIMITS — COMMERCIAL GENERAL LIABILITY i - EACH OCCURRENCE S CLAIMS -MADE �j OCCUR r DAMAGE TO RENTED — PREMISES (Ea occurrence) _ -- - — S - MED EXP An one (Any Person)- 5 - -- PERSONAL & ADV INJURY--, S GEN-L AGGREGATE LIMIT APPLIES PER POLICY E] PRO- JECT LOC GENERAL AGGREGATE - - PRODUCTS - COMP/OP AGG $ - -- - — -- S OTHER S A AUTOMOBILE LIABILITY 810-8P491962-20-43-G 9/1/2020 9/1/2021 COMBINED ISINGLE LIMIT 51,A00,000 ANY AUTO _✓_ __ � BODILY INJURY (Per person) S OWNED 'SCHEDULED - - AUTOS ONLY ; AUTOS BODILY INJURY (Per accident) S ` ✓ HIRED NON -OWNED p PROPERTY DAMAGE- — $ AUTOS ONLY ✓-; AUTOS ONLY $1,000 Com . Ded. (Per accident)_ $1,000 Coll. Ded. I S UMBRELLA LIAB OCCUR EACH OCCURRENCE $ I- - - - — EXCESS LIAB 1 CLAIMS•MADE, AGGREGATE I S DED 1 I RETENTION $ S A WORKERS COMPENSATION UB-4J588939-20-43-G 9/1/2020 9/1/2021 PER OTH- AND EMPLOYERS' LIABILITY ✓ Y / N _ STATUTE ER ANYPROPRIETORlPARTNER/EXECUTIVE E L EACH ACCIDENT $ 1,000:000 j OFFICER/MEMBER EXCLUDED? a NIA __ - - Mandatory in NH) IE L DISEASE - EA EMPLOYEE S 1.000.004 f yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE -POLICY LIMIT $1 fl00 060 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: 20-RFP-PW 441 As respects Automobile Liability coverage, The City of Gilroy, Its officials and employees are added as Additional Insured as per CAT3530215 attached. This certificate may be relied upon only if the certificate addendum referred to herein is attached hereto. This certificate of insurance amends and supersedes any previously issued certificate. CERTIFICATE HOLDER CANCFI I ATION City of Gilroy 7351 Rosanna St. Gilroy CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Michael Finn ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: _ LOC #: ACa ADDITIONAL REMARKS SCHEDU LE U LE Page of g AGENCY NAMEDINSURED GMGS Risk Management & Insurance Services Tait & Associates, Inc. Tait Environmental Services, Inc. POLICY NUMBER 701 Parkcenter Dr. Santa Ana CA 92705 CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (03/16) HOLDER: City of Gilroy ADDRESS: 7351 Rosanna St. Gilroy CA 95020 RE: 20-RFP-PW-441 As respects Automobile Liability coverage, The City of Gilroy, Its officials and employees are added as Additional Insured as per CAT3530215 attached. As respects Automobile Liability coverage, 30-day written notice of cancellation (10 days for non-payment of premium) applies per IT0010107 attached. As respects Workers' Compensation coverage, 30-day written notice of cancellation (10 days for non-payment of premium) applies per WC040601(A) attached. AL;UKU 1 Ul (ZUUt$/U9) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ADDENDUM 571884%6 1 U-:?1 A/w�_ i :ennifec 3jr-,on ?/_';/''J'U :�:3_:5, A:.1 IF.1'1 1 Fsge -, oI 3 Tait & Associates. Inc. 810-8P491962-20-431-G COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO EXTENSION ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BROAD FORM NAMED INSURED B. BLANKET ADDITIONAL INSURED C. EMPLOYEE HIRED AUTO D. EMPLOYEES AS INSURED E. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS F. HIRED AUTO — LIMITED WORLDWIDE COV- ERAGE — INDEMNITY BASIS G. WAIVER OF DEDUCTIBLE — GLASS PROVISIONS A. BROAD FORM NAMED INSURED The following is added to Paragraph A.1., Who is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any organization you newly acquire or form dur- ing the policy period over which you maintain 50°% or more ownership Interest and that is not separately insured for Business Auto Coverage. Coverage under this provision is afforded only un- til the 180th day after you acquire or form the or- ganization or the end of the policy period, which- ever is earlier. B. BLANKET ADDITIONAL INSURED The following is added to Paragraph c. in A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which H. HIRED AUTO PHYSICAL DAMAGE — LOSS OF USE — INCREASED LIMIT I. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT J. PERSONAL PROPERTY K. AIRBAGS L. NOTICE AND KNOWLEDGE OF ACCIDENT OR LOSS M. BLANKET WAIVER OF SUBROGATION N. UNINTENTIONAL ERRORS OR OMISSIONS this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section 11. C. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION If — COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating an "auto" hired or rented under a contract or agreement in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your CA T3 53 0215 ® 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 4 Includes copyrighted material of Insurance Services Office, Inc. with its permission. A Rom' EVIDENCE OF COMMERCIAL PROPERTY INSURANCE DATE(MM1DDNYYY) 7/2/2019 THIS EVIDENCE OF COMMERCIAL PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. PRODUCER NAME PHONE 949-252-4400 CONTACT PERSON AND ADDRESS A/C. No. Ext COMPANY NAME AND ADDRESS NAIC NO: 13604 Lockton Insurance Brokers LLC Starr Surplus Lines Insurance Company 19800 MacArthur Blvd., Suite 1250 CA License 4OF15767 Irvine 92612 IF MULTIPLE COMPANIES, COMPLETE SEPARATE FORM FOR EACH AIL (AIC. No): 949-252-4410 ADDRESS: CODE: SUB CODE: POLICY TYPE Property CUSTOMER TOER ID #: NAMED INSURED AND ADDRESS TRI Pointe Homes, Inc. LOAN NUMBER POLICY NUMBER 1111485 TRI Pointe Group, Inc. C 1927255 19540 Jamboree Road, Suite 300 EFFECTIVE DATE EXPIRATION DATE CONTINUED UNTIL Irvine CA 92612 7/7/2019 7/7/2020 TERMINATED IF CHECKED ADDITIONAL NAMED INSURED(S) THIS REPLACES PRIOR EVIDENCE DATED: rKvrr_K1 T 11vrumnr1ffi►1IUIv tm uKu iui mayoe anacnea IT more space Is requires) LU BUILDING OR LJ BU51NE55 PER50NAL PROPERTY LOCATIONIDESCRIPTION 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 EVIDENCE OF PROPERTY INSURANCE 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. rnV9=RA12F IN19=n0MATInA1 V .,.,�... COMMERCIAL PROPERTY COVERAGE AMOUNT OF INSURANCE: $ 30,000,000 DED: $10,000 YES NO NIA ® BUSINESS INCOME ❑ RENTAL VALUE X If YES, LIMIT: Included Actual Loss Sustained; #f of months: BLANKET COVERAGE X If YES, indicate value(s) reported on property identified above: $ TERRORISM COVERAGE X Attach Disclosure Notice 1 DEC IS THERE A TERRORISM -SPECIFIC EXCLUSION? X IS DOMESTIC TERRORISM EXCLUDED? X LIMITED FUNGUS COVERAGE X If YES, LIMIT: $100,000 DED: FUNGUS EXCLUSION (If "YES", specify organization's form used) X REPLACEMENT COST X AGREED VALUE X COINSURANCE X If YES, % EQUIPMENT BREAKDOWN (If Applicable) X If YES, LIMIT: Included DED: ORDINANCE OR LAW - Coverage for loss to undamaged portion of bldg X If YES, LIMIT: Included DED: $10,000 - Demolition Costs X If YES, LIMIT: Included DED: $10,000 - Incr. Cost of Construction X If YES, LIMIT: Included DED: $10,000 EARTH MOVEMENT (If Applicable) X If YES, LIMIT: See Attached DED: See Attached FLOOD (If Applicable) X If YES, LIMIT: See Attached DED: See Attached WIND 1 HAIL INCL X❑ YES NO Subject to Different Provisions: X If YES, LIMIT: Included DED: $50,000 NAMED STORM INCL XD YES ❑ NO Subject to Different Provisions: X If YES, LIMIT: $30,000,000 DED; See Attached PERMISSION TO WAIVE SUBROGATION IN FAVOR OF MORTGAGE HOLDER PRIOR TO LOSS X CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ADDITIONAL INTEREST fn5� 2 tRUI CONTRACT OF SALE MORTGAGEE LENDER'S LOSS PAYABLE X LOSS PAYEE LENDER SERVICING AGENT NAME AND ADDRESS NAME AND ADDRESS 597792 City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED PR TA E / C-#Uc ZyU3-LUIS AGUKU f;UK1-UKAIIUN. All rights reserves. ACORD 28 (2016103) The ACORD name and logo are registered marks of ACORD NCt UI- CUMMtKUTAL PKUPERTY INSURANCE REMARKS - Includina Snecial Conditions (use only if more space is required Builders Risk & Property: Catastrophe Limits: $30,000,000 any one occurrence; $15,000,000 any one building or structure. Soft Costs: $10,000,000 limit any one occurrence; 30 day limit. Transit - $10,000,000. Temporary Storage - $5,000,000. Real Property, Business Personal Property, EDP/Computer, Business Income/Extra Expense, Improvements & Betterments, Owned Property - $50,631,451. Rented and Leased Equipment: $100,000; Deductible: $1,000. Golf Carts: $150,000; Deductible: $1,000. Earth Movement Coverage Limits: $20,000,000 CA & Pacific NW: $30,000,000 (Other states), Deductible: 5% of values in place at time of loss/minimum of $100,000 (CA, AK, HI, PR); $50,000 (Other states). Flood: Limits: $20,000,000 (100 Year Flood Zones): $30,000,000 (All Other Zones), Deductible: $250,000 (100 year Flood Zones) $50,000 (All other zones). Named Storm: Limits: $30,000,000, Deductible: 3% of values in place at time of loss/minimum of $50,000. City of Gilroy is loss payee as per the attached endorsement or policy language. ACORD 28(2018103) Certificate Holder ID: 597792 C1927255 This endorsement changes "your" policy PLEASE READ THIS CAREFULLY LOSS PAYEE (The entries required to complete this endorsement will be shown below or on the "schedule of coverages".) Holders of certificates of insurance issued against this policy that are shown as loss payees are added to "your" policy as their interest may appear as respects the property listed on the certificate. Attachment Code: D523389 Certificate ID : 597792 r,. t Cl CW A021011 CERTIFICATE OF INSURANCE This certificate is issued for infomntional purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holier. Named Insured: CITY OF GILROY TWO BROTHERS CATHODIC SERVICE ITS OFFICERS, OFFICIALS AND 5361 HILLTOP RD EMPLOYEES AS ADDITIONAL INSURED GARDEN VALLEY CA 95633-9501 7351 ROSANNA ST GILROY, CA USA 950206141 Automobile Liability Insurer Name: Allstate Insurance Company Polic.rNumber048751653 1 -Any Auto 2 - Owned Autos Only 3 - Owned Priv. Pass. Autos Only 4 - Owned Autos Other Than Priv. Pass. Autos Only 5 - Owned Autos Subject to No Fault 6 - Owned Autos Subject to a Compulsory UM Law X 7 - Specifically Described Autos I X 18 - Hired Autos Only X 19 - Nonowned Autos Only Policy Effective Date : 11-16 -2 0 2 0 1 Policy Expiration Date: 11-16 -2 0 21 Limits of $2, 000, OOC Combined Single Limit (each accident) Insurance: BI Per Person BI Per Accident PD Per Accident Description of Operations/Locations/Vehicles/Endorsements/Special Provisions Interested Patty Type: Additional Insured - Murici alit THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer. CENTURY PARTNERS INSURANCE AGENCY Authorized Representative: Date: 09-C2-20 Cl CW A021011 Includes copyrighted material of Insurance Services Office, Inc., with its permission Allstate Insurance Company Insured Full Copy Page 1 of 1 �J • o � -i I QQ o �F o CL s rim CL POLICY NUMBER: 048751653 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR C OVER ED AUTOS LIABI LITY C OVERAG E This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: TWO BROTHERS CATHODIC SERVICE Endorsement Effective Date: 11-16 - 2 0 2 0 SCHEDULE Name Of Person(s) Or Organ¢ation(s): CITY OF GILROY ITS OFFICERS,OFFICIALS AND EMPLOYEES AS ADDITIONAL INSURED 7351 ROSANNA ST GILROY, CA USA 950206141 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an 'insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an 'insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA20481013 © Insurance Services Office, Inc., 2011 Page 1 of 1 Insured Full Copy A`a. "z�� EVIDENCE OF COMMERCIAL PROPERTY INSURANCE °02/04/2021 THIS EVIDENCE OF COMMERCIAL PROPERTY INSURANCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST NAMED BELOW. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS EVIDENCE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE ADDITIONAL INTEREST. PRODUCER NAM£, PHONE . 1-B77-945-7378 CONTACT CONTACT PERSON AND ADDRESS Ex COMPANY NAME AND ADDRESS NAIC NO: 16535 Willis Towers Watoon Midwest, Inc. Zurich American Insurance Company c/o 26 Century Blvd 1400 American Lane P.O. Box 305191 Schaumburg, IL 601961056 Nashville, TH 372305191 USA IF MULTIPLE COMPANIES, COMPLETE SEPARATE FORM FOR EACH FAX 1-888-467-2378 E-MAIL No: ADDRESS: certificates@willia.com CODE: SUB CODE: POLICY TYPE AGENCY Commercial Property NAMED INSURED AND ADDRESS UnitedHealth Group LOAN NUMBER POLICY NUMBER 9900 Bren Road East PPR00533299-02 Minnetonka, ter 55343 EFFECTIVE DATE ----TEXPIRATION DATE CONTINUED UNTIL 03/01/2020 � 03/01/2021 TERMINATED IF CHECKED ADDITIONAL NAMED INSURED(S) THIS REPLACES PRIOR EVIDENCE DATED: r-nvrr-n r T iNrymmm I Ivry tAt.ynu wi may De attacnea IT more space Is requirea) L&I IiUILU1NU UK MJ f3USIIVtSS F'tHSUNAL PHUF hH I Y LOCATION / DESCRIPTION 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 EVIDENCE OF PROPERTY INSURANCE 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. ciiv�QAi:r= IfUCA011AAT1AA1 ornu c u.Ich,nr- 7-7 on�wn Y COMMERCIAL PROPERTY COVERAGE AMOUNT OF INSURANCE: $ $50, 000, 000 DED: $250, 000 YES NO N/A ❑x BUSINESS INCOME ❑x RENTAL VALUE X If YES. LIMIT: Included X I Actual Loss Sustained: # of months: 12 BLANKET COVERAGE X II YES, indicate value(s) reported on property identified above: $ Included TERRORISM COVERAGE X Attach Disclosure Notice I DEC IS THERE A TERRORISM-SPECIF IC EXCLUSION? X IS DOMESTIC TERRORISM EXCLUDED? X LIMITED FUNGUS COVERAGE X If YES. LIMIT: Included DED: $250, 000 FUNGUS EXCLUSION (If 'YES", specify organization's form used) X REPLACEMENT COST X AGREED VALUE X COINSURANCE X If YES, % EQUIPMENT BREAKDOWN (If Applicable) X If YES. LIMIT: Included DED: $250, 000 ORDINANCE OR LAW - Coverage for loss to undamaged portion of bldg X If YES, LIMIT: Included DED: $250, 000 - Demolition Costs X If YES, LIMIT: Included DED: $250, 000 - Incr. Cost of Construction X If YES. LIMIT: Included DED: $250, 000 EARTH MOVEMENT (If Applicable) X If YES, LIMIT: $15, 000, 000 DED: 5% - $250, 000 MIN FLOOD (11 Applicable) X It YES, LIMIT. $25, 000, 000 DED: $250, 000 WIND / HAIL INCL ) YES ❑ NO Subject to Different Provisions: X If YES, LIMIT: $50, 000, 000 DED: 18 - $250, 000 MIN NAMED STORM INCL Q YES ❑ NO Subject to DiHerent Provisions: X If YES, LIMIT: $50, 000, 000 DED: 5% - $250, 000 MIN PERMISSION TO WAIVE SUBROGATION IN FAVOR OF MORTGAGE HOLDER PRIOR TO LOSS X CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CONTRACT OF SALE LENDER'S LOSS PAYABLE U LOSS PAYEE LENDER SERVICING AGENT NAME AND ADDRESS MORTGAGEE NAME AND ADDRESS City of Gilroy AUTHORIZED REPRESENTATIVE 7351 Rosanna Street Gilroy, CA 95020 if,'4• �r*� © 2003-2015 ACORD CORPORATION. All rights reserved. ACORD 28 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 20687540 BATCH: 1975848 CERT: W20044434 2 of 2 2288 AGENCY CUSTOMER ID: LOC #: ,00RV AGENCY Willis Towers Watson Midwest, Inc. POLICY NUMBER See Page 1 CARRIER See Page 1 ADDITIONAL REMARKS SCHEDULE NAMED INSURED UnitedHealth Group 9900 Bran Road East Minnetonka, MN 55343 NAIC CODE See Page 1 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 28 FORM TITLE: Evidence of Commercial Property Re: Address of location we need evidence for: 7351 Rosanna Street, Gilroy, CA 95020 (Named Insured Includes: Logistics Health, Inc. 328 Front Street South, La Crosse, WI Page 2 of 2 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 20687540 BATCH: 1975848 CERT: W20044434