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COI - Bay Area Community Health - Expires 2021-08-22ACCMEP CERTIFICATE OF LIABILITY INSURANCE DATE7/27! 021 1164.� 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 CONTACT (MP) Heffernan Insurance Brokers PHONE FAX • 650-842-5200 A/C No): 650-842-5201 1460E O'Brien Drive Menlo Park CA 94025 AD" RESS: INSURERS AFFORDING COVERAGE NAIC 11 INSURERA: Massachusetts Bay Insurance Company_22306 icense#: 0564249 INSURED TRI-HEA-05 INSURER B : Allmedca Financial Benefit Insurance Company 41840 Bay Area Community Health 40910 Fremont Blvd INSURER c :Hanover Insurance Company 22292 INSURER D: Care West Insurance Company 10520 Fremont CA 94538 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:722636350 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. INSR LTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER MM/I.DD EFF MM DCDY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE I-R-1 OCCUR Y ZDFH022186 01 8/22/2020 8/22/2021 EACH OCCURRENCE $ 1,000.000 DAMAGE TO-RE—NrIND— PREMISES Ea occurrence $1,000,000 MED EXP Any one person $15,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEML AGGREGATE LIMIT APPLIES PER: POLICY PRO � JECT LOC OTHER: GENERAL AGGREGATE $ 2.000,000 PRODUCTS - COMP/OP AGG $ 2.000,000 $ B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY AWFH02222501 8/22/2020 8/22/2021 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UHFH022187 01 8/22/2020 8/22/2021 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED I X RETENTION $ n $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECU I IVE Y❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If es, describe under DESCRIPTION OF OPERATIONS below NIA W12008001869 8/22/2020 8/22/2021 X STATUTE 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 I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Re: As Per Contract or Agreement on File with Insured. City of Gilroy, its Officers, Representatives, Agents and Employees is included as an additional insured on General Liability policy per the attached endorsement, if required. CERTIFICATE HOLDER CAIVCtLLA I IUNV 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 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ZDF H022186 01 5701046 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ THIS CAREFULLY. Effective Date: 07/19/2021 Added form CG 2026 should be read as follows: City of Gilroy its Officers, representatives, agents and employees 7351 Rosanna Street Gilroy CA 95020 Nothing herein contained shall be held to vary, alter, waive or extend any of the terms, conditions, agreements or limitations of the policy other than as above stated. (Completion of the following, including countersignature, is required to make this endorsement effective only when it is issued subsequent to preparation of the Policy.) Effective 08/22/2020 Issued to By Massachusetts Bay Insurance Company Date of Issue Countersigned by 221-0163 (4-90) this endorsement forms a part of Policy No. ZDF H022186 01 Authorized Representative of the Company ZDF H022186 01 5701046 POLICY NUMBER: 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): [Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section 11 — 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 applicable Limits of Declarations. shall not increase the Insurance shown in the CG 20 26 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1