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COI - Verizon Wireless, LLC - Expires 2021-06-30CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) 06/09/2020 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. New York NY Office CONTACT NAME: (A/CNN . Ext): (866) 283-7122 FAX No (800) 363-0105 One Liberty Plaza 165 Broadway, Suite 3201 E-MAIL ADDRESS: New York NY 10006 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: National Union Fire Ins CO Of Pittsburgh 19445 verizon wireless, LLC 1095 Avenue of the Americas New York NY 10036 USA INSURERB: AIU Insurance Company 19399 INSURERC: American Home Assurance Co. 19380 INSURER D: New Hampshire Insurance Company 23841 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570082120383 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DDiY MM/DD/V LIMITS X COMMERCIAL GENERAL LIABILITY GL EACH OCCURRENCE $4 , 000 , 000 CLAIMS -MADE Xa OCCUR DAMAGE TO 1`11719TEU­ PREMISES Ea occurrence $4 , 000 , 000 X MED EXP (Any one person) $10, 000 XCU Coverage is Included PERSONAL 8 ADV INJURY $4 , 000 , 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4 , 000 , 000 X POLICY E] PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $4 , 000 , 000 OTHER: A AUTOMOBILE LIABILITY CA 4594298 AOS 06/30/2020 06/30/2021 COMBINED SINGLE LIMIT Ea accident)$1, 000, 000 BODILY INJURY ( Per person) A X ANYAUTO CA 4594299 06/30/2020 06/30/2021 A OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY MA CA 4594300 VA 06/30/2020 06/30/2021 BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident A See Next Page 06/30/2020 06/30/2021 UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE AGGREGATE DED RETENTION B C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NM Ii yes. describe under DESCRIPTION OF OPERATIONS below N / A wc045886576 AOS WC045886575 CA 06 30 T2020 06/30/2020 06 30 2021 06/30/2021 X PER STATUTE I 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 i 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 d NOPP ii E. ti- M SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WiLL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Gilroy AUTHORIZED REPRESENTATIVE Attn: City Administrator ,(%' �i Gilroy r Rosanna Street ` sG> ,O c/l�C/L Gilroy CA 95020 USA 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CANCELLATION AGENCY CUSTOMER ID: 570000027366 LOC #: ACORl7® �--- ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services Northeast, Inc. NAMED INSURED verizon Wireless, LLC POLICY NUMBER see Certificate Number: 570082120383 CARRIER See Certificate Number: 570082120383 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 # INSURER INSURER INSURER 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 TYPF, OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE (MNUDD/YYYY) POLICY EXPIRATION DATE (MNUDD/YYYY) LIMITS AUTOMOBILE LIABILITY A CA 4594301 NH - Primary 06/30/2020 06/30/2021 A CA 4594302 NH - Excess 06/30/2020 06/30/2021 WORKERS COMPENSATION B N/A WC045886579 NY 06/30/2020 06/30/2021 B N/A WC045886577 FL 06/30/2020 06/30/2021 D N/A WC045886578 MA,ND,OH,WI,WY 06/30/2020 06/30/2021 B N/A WC045886574 NJ,TX,VA 06/30/2020 06/30/2021 ACORD 101 (2008/01) m 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL 172-88-90 COMMERCIAL GENERAL LIABILITY CG 20 26 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED 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 whom you become obligated to include as an additional insured as a result of any contract or agreement you have entered into. 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 your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 26 04 13 0 Insurance Services Office, Inc., 2012 Page 1 of 1 0 s r ENDORSEMENT This endorsement, effective 12:01 A.M. 06/30/2020 forms a part of Policy No. CA 459-42-98 issued to VERIZON COMMUNICATIONS INC _ by NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - WHERE REQUIRED UNDER CONTRACT OR AGREEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SCHEDULE ADDITIONAL INSURED: ANY PERSON OR ORGANIZATION FOR WHOM YOU ARE CONTRACTUALLY BOUND TO PROVIDE ADDITIONAL INSURED STATUS BUT ONLY TO THE EXTENT OF SUCH PERSON'S OR ORGANIZATION'S LIABILITY ARISING OUT OF THE USE OF A COVERED "AUTO"_ I. SECTION II -COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. -Who Is Insured, is amended to add: d. Any person or organization, shown in the schedule above, to whom you become obligated to include as an additional insured under this policy, as a result of any contract or agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said contract or agreement. 1 r- t AUTHORIZED REPRESENTATIVE 87950 (9/14) Includes copyrighted information of Insurance Services Office, Inc., Page 1 of 1 with its permission.