COI - Bess Testlab Inc - Expires 2022-08-14A`. C o® CERTIFICATE OF LIABILITY INSURANCE
TE MID
D 11�s/2o )
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 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
Leavitt Pacific Insurance Brokers, Inc.
#OD79674
1570 The Alameda, Suite 101
San Jose CA 95126
NAME: Sandy Brown
PHONED Ext: (408)288-6262 FANo: (408)298-7635
INC, NCLicense
E-MAIL ADDRESS: sandy-brown@leavitt.com
INSURERS AFFORDING COVERAGE
NAIC #
INSURERA: Hartford Fire Insurance Company
19682
INSURED
Bess TESTLAB INC
2463 Tripaldi Way
Hayward CA 94545
INSURER B: Hartford Casualty Insurance Company
A29424
INSURER C : Hartford Accident & Indemnity Company
22357
INSURERD:Mount Hawley Insurance Company
37974
INSURER E : Columbia Casualty Company
31127
INSURER F :
COVERAGES CERTIFICATE NUMBER:21-22 WC All Lines 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 CONTRACTOR 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.
INTR
I
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
MMIDDPOLICYIYYYY
MM DDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$ 1,000,000
A
CLAIMS -MADE OCCUR
DAMAGE TO RENTED
PREMISES Ea occurrence)$
300,000
X
MED EXP (Any one person)
$ 10,000
Ded $5000 applies to PD
X
57UENOLS244
8/14/2021
8/14/2022
only
PERSONAL & ADV INJURY
$ 1,000,000
GEN'LAGGREGATE LIMIT APPLIESPER:
GENERAL AGGREGATE
$ 2,000,000
POLICY LEI JET LOC
PRODUCTS -COMP/OP AGG
$ 2,000,000
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident
$ 1,000,000
BODILY INJURY (Per person)
$
A
X ANY AUTO
X ALL OWNED x SCHEDULED
AUTOS AUTOS
S7UENOLS24S
8/14/2021
8/14/2022
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident)$
NON -OWNED
X HIRED AUTOS X AUTOS
$
x Comp DedS1000 X Colli Ded $1000
X
UMBRELLA LIAB
X
OCCUR
EACH OCCURRENCE
$ 9,000,000
AGGREGATE
$ 9,000,000.
B
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
$
57XHUOL5246
8/14/2021
8/14/2022
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED? El (Mandatory in NH)
NIA
57wEOL6H9G
11/21/2021
11/21/2022
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
D
Pollution Liability
EGL008794
8/14/2021
8/14/2022
Each Pollution Incident limit 5,000,000
E
Prof/Errors6 Omissions
CE05091869087
12/27/2020
12/27/2021
Each claim/Aggregate5,000.000 Ded $10,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached If more space Is required)
City of Gilroy, its Officers, Officials, Representatives, Agents, Employees, and Volunteers are named as
additional insured per endorsements attached.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Gilroy
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
7351 Rosanna St
ACCORDANCE WITH THE POLICY PROVISIONS.
Gilroy, CA 95020
AUTHORIZED REPRESENTATIVE
-
Fred Stafford/YVVALD"'�"t�i0
ACORD 25 (2014/01)
INS025 (201401)
01988-2014 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD