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COI - Mott MacDonald, LLC - Expires 2022-06-30Page 1 of 1 , lb. R CERTIFICATE OF LIABILITY INSURANCE DATE(MM/2021 �� 06/23/2021 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 endorsements . PRODUCER CONTACT Willia Towera Watson Certificate Center Willis of New Jersey, inc. NAME: c/o 26 Century Blvd V. PHONE . 1-877-945-7378 AIC No: 1-888-467-2378 P.O. Box 305191 AD_DRESS: certificatea®villia.com _ Nashville TN 372305191 USA INSURER(S) AFFORDING COVERAGE NAIC It _ INSURER A: Fireman' s Fund Insurance Company 21873 INSURER B : American Automobile Insurance Company i — --- - 21849 — — INSURED Mott MacDonald, LLC ill Wood Avenue South INSURERC• Travelers Property Casualty Company of Ame� 25674- Iselin, NJ 088304112 INSURER D • National Surety Corporation 21881 INSURER E • Lloyd's Syndicate 2488 86155 INSURER F : COVERAGES CERTIFICATE NUMBER_ W21323436 RFVIi41AN NIIMRERr 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. LTR - ----- ---- -- - -- -- SUeRf-- - -- POLICY EFF POLICY EXP - -- INSR TYPE OF INSURANCE 1 ADDL POLICY NUMBER MMIDD/YYY MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY i I 2,000,000 EACH OCCURRENCE $ _--j--CLAIMS MADE %� OCCUR DAMAGE TO RENTED 1, 000, 000 'PREMISES (Ea occurrences-t'_$ A --_---� I --__ -- -- -_-. MED EXP (An one person) ` $ 10, 000 USCO16868210 06/30/2021 06/30/2022 � PERSONAL & ADV INJURY $ 2,000,000 G_ EN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 � r----- - POLICY L X JECTPRO• rX LOC •------,--�_..----------- PRODUCTS • COMPIOP AGG is 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT _$ 2,000,000 )('ANY AUTO BODILY INJURY (Per person) $ B OWNED SCHEDULED SCV010281-21-01 06/30/2021 AUTOS ONLY AUTOS 06/30/2022 BODILY INJURY (Per accident) $ HIRED NON-OWNEDAUTOS PROPERTY DAMAGE -- ONLY AUTOS ONLY iIs X X (Comp/Coll $ 1000 C X UMBR£LLALIAB , X OCCUR EACH OCCURRENCE is 10, 000, 000 $ 10,000,000 EXCESS LIAB CLAIMS -MADE �1 CUP-OS634559-21-NF 06/30/2021I06/30/20221AGGREGATE i DED F X RETENTION $ 10,000 $ WORKERS COMPENSATION x STATUTE 1 ER AND EMPLOYERS' LIABILITY Y / N r E.L. EACH ACCIDENT D ANYPROPRIETOR'PARTNERIEXECUTIVE $ 1,000,000 OFFICER/MEMBEREXCLUDED? No INIA SCW018893-21-01 06/30/2021 06/30/2022f (Mandatory In NH) I E.L. DISEASE • EA EMPLOYEE $ 1,0000000 If Yes, describe under 0 SCRIPTION OF OPERATIONS below E.L. DISEASE • POLICY LIMIT - - $ 1,000,000 E 'Profosaional Liab. B080120388P21 06/30/2021I06/30/2022 Par Claim $1,000,000 Per Aggregate i$1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Romarks Schedule, may be attached If more space is required) Re: Mott MacDonald Project No. 380012, Welburn Ave Traffic Calming. L;tH I IrIUA I It MUL.UtH IUANlL;LLLATIUN City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A.e.. .7 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 21246085 BATCH: 2140222 2of7 971 E Additional Insured - Owners, Lessees or Contractors - Scheduled Person or Organization - CG 20 10 04 13 Policy Amendment(s) Commercial General Liability Insured: Mott MacDonald Group, Inc. Producer: Willis of New Jersey, Inc. Policy Number: USCO16868210 Effective Date: 06/30/2021 This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations City of Gilroy, its employees, officers, officials, All Projects and volunteers 7351 Rosanna Street Gilroy, CA 95020 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: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behal f; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: I. 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 additional exclusions apply: This insurance does not apply to bodily injury or property damage occurring after: I. 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(~) at the location of the covered operations has been completed; or This Form must he attached to Change Endorsement when issued ,liter the policy is written. One of the Fireman's Fund Insurance Companies as named in the policy Secretary President C'G2010 4- 1.1 •+ Insunince Services Office. Inc.. 2012 Page I of 2 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. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: CG201 Q 4-13 1115UIJneC services Office. Inc.. 2012 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. Page 2 of 2 3 of 7 971 Additional Insured - Owners, Lessees or Contractors - Completed Oerations p- CG 20 37 04 13 icy Amendments) Commercial General Liability Insured: Mott MacDonald Group, Inc. Producer: Willis of New Jersey, Inc. Policy Number: USCO16868210 Effective Date: 06/30/2021 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) Location And Description Of Or Organization(s) Completed Operations City of Gilroy, its employees, officers, officials, All Projects and volunteers 7351 Rosanna Street Gilroy, CA 95020 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 shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. This Form must he attached to Change Endorsement when issued alter tic Policy is written. One ol' the Fireman's Fund Insurance Companies as named in the Policy Secretary CG2037 4-13 4 Instirince Services Office. Inc.. 2012 President Courtesy Notice of Cancellation for Other Than Nonpayment of Premium to Designated Entities - 145977 01 11 Policy Amendment Policy Number: USC01 686821 0;SCV01 0281-21 -01 Effective Date: 06/30/2021 General Liability; Auto Liability Schedule Name and Address of Person(s) or Organizations Number of Days Notice if other than 10 days: On File with Carrier, as required by written contract Cancellation Number of Days Notice- 90 When we don't Renew (Non -Renewal)- 30 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. This policy is amended as follows: A. If We cancel this policy prior to expiration for any reason other than non payment of premium or at Your request, and we have been notified that You are required under a current contractual obligation to notify a certificate of insurance holder or holders when this policy is canceled, then We will endeavor to mail or deliver a copy of such written notice of cancellation to the certificate holder(s) shown in the Schedule above, as follows: 1. To the name and address corresponding to each certificate of insurance holder indicated in the Schedule above; and 2. At least 10 days prior to the effective date of the cancellation, as shown in our notice to the first Named Insured, or, if indicated, the longer number of days notice shown in the Schedule above. B. Notwithstanding the foregoing, such notice of cancellation is provided on an informational basis and solely to assist You in informing the certificate of insurance holder(s) in advance of pending cancellation in coverage to assist you in meeting Your contractual notice requirements to such parties. Our failure to provide such advance notification to the certificate of insurance holder(s) shown in the Schedule of this endorsement will not extend any policy cancellation date, negate any cancellation of the policy, or grant, alter or extend any rights or obligations under this policy and we shall have no liability for any failure to provide the notice(s) as provided herein. All other terms and conditions of this policy remain unchanged. 1459771-11 � 2010 Fireman's Fund Insurance Company, Novato, CA. All rights reserved. 4 of 7 971 ,ac rl _ CERTIFICATE OF LIABILITY INSURANCE Page 1 of 1 DATE (MMlDD(YYYY) 06/23/2021 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 endorsements . PRODUCER CONTACT NAME: Willis Towers Watson Certificate Center _ Willis of New Jersey, Inc. PHONE 1-877-945-7378 1-888-467-2378 C/o 26 Century Blvd A/C No): P.O. Box 305191 E-MAIL certificates@willio.com ADDRESS: Nashville, TN 372305191 USA INSURER(S) AFFORDING COVERAGE — NAIC 1t _ INSURED INSURER A : Fireman' s Fund Insurance Company 21873 INSURER B - American Automobile Insurance Company 21849 Mott MacDonald, LLC --- - - -- - ------ -- lit wood Avenue South INSURER C - National Surety Corporation 21881 INSURER D : Lloyd's Syndicate 2488 B6155 Iaelin, NJ 088304112 COVERAGES CERTIFI(_ATF NIIIURFR- W21323435 ocvlclnN Al111RADcc. 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 - AOOC',SQI3Ri POi.ICY EFF POUCY€XP i LTR TYPE OF INSURANCE POLICY NUMBER MM'DD/YYYY MM/DD/YYYY LIMITS X ! COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED _PREMISES(Ea occurrence _ $ 1, 000, 000 CLAIMS MADE OCCUR _ A MED EXP (Any one person) $ 10, 000 USCO16868210 06/30/2021 06/30/2022I PERSONAL 8 ADV INJURY !$ 2,000,000 GENERAL AGGREGATE $ 2,000,000 GE_ N'L AGGREGATE LIMIT APPLIES PER: PRO - l C POLICY POLICY X � LOC ! PRODUCTS - COMP/OP AGG $ 2,000,000 ! OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT accident) $ 2,000,000 BODILY INJURY (Per person) X I ANY AUTO $ B OWNED SCHEDULED SCV010281-21-01 06/30/2021 AUTOS ONLY AUTOS 06/30/2022 BODILY INJURY ' $ JU(Per accident)f_ HIRED N NED AUTOS ONLY AUTOS ONLY _ PROPERTY DAMAGE er a (PccidentZ_ $ X �i, Comp/Coll �$ 1000 UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ _ V EXCESS UAB CLAIMS -MADE AGGREGATE $ i DED 7 RETENTION$ $ WORKERS COMPENSATION YI I OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE_ I ER E.L.ACHACCIDENT C ANYPROPRIETOR'PARTNERIEXECUTIVEN 'NIA 1,000,000 $o OFFICEWMEMBEREXCLUDED? SCW018893-21-01 06/30/2021 06/30/2022 4 (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 II yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 11000,000 D Professional Liab. B08012038BP21 106/30/2021 06/30/2022 Per Claim 41,000,000 ,Per Aggregate j$110001000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 1 D1, Additional Remarks Schedule, may be attached If more space is required) MM Project No. 372692 Gilroy AWSC Warrants 2016. %.r-n I rrMpm r r_ nvL4.Pt`n UAIVIaLLA 1 IVN City of Gilroy 7351 Rosanna Street 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 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR ID: 21246085 BATCH: 2140222 5 of 7 971 Additional Insured - Owners, Lessees or Contractors - Completed Overations - CG 20 37 04 13 icy Amendment(s) Commercial General Liability Insured: Mott MacDonald Group, Inc. Producer: Willis of New Jersey, Inc. Policy Number: USCO16868210 Effective Date: 06/30/2021 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) Location And Description Of Or Organization(s) Completed Operations City of Gilroy, its employees, officers, officials, All Projects and volunteers 7351 Rosanna Street Gilroy, CA 95020 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 wtuch 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. This Form nuisl he attached to Change Endorsement when issued alter the policy is written. One or the Fireman's Fund Insurance Companies as named in the policy Secretary CG2037 4-13 + Insurance Services Office. Inc.. 2012 President Additional Insured - Owners, Lessees or Contractors - Scheduled Person or Organization - CG 20 10 04 13 Policy Amendment(s) Commercial General Liability Insured: Mott MacDonald Group, Inc. Producer: Willis of New Jersey, Inc. Policy Number: USCO16868210 Effective Date: 06/30/2021 This endorsement modifies insurance provided under the following: Commercial General Liability Coverage Part Schedule Name Or Additional Insured Person(s) Or Organization(s) Locations) Of Covered Operations City of Gilroy, its employees, officers, officials, All Projects and volunteers 7351 Rosanna Street Gilroy, CA 95020 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 pant, 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 insureds) 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. 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 This Form must he attached to Change: Endorsement when issued alter the policy is written. One of the Fireman's Fund Insurance Companies as named in the policy Secretary CG2010 4-1.1 lnsunince Services Office. Inc.. 2012 President Page 1 of 2 6 of 7 971 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. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: CG2010 4-13 + Insurance Services office. Inc.. 2012 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 ?. 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. Page 2 of 2 "4& Courtesy Notice of Cancellation for Other Than Nonpayment of Premium to Designated Entities - 145977 01 11 Policy Amendment Policy Number: USC016868210;SCV010281-21-01 Effective Date: 06/30/2021 General Liability; Auto Liability Schedule Name and Address of Person(s) or Organizations Number of Days Notice if other than 10 days: On File with Carrier, as required by written contract Cancellation Number of Days Notice- 90 When we don't Renew (Non -Renewal)- 30 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. This policy is amended as follows: A. If We cancel this policy prior to expiration for any reason other than non payment of premium or at Your request, and we have been notified that You are required under a current contractual obligation to notify a certificate of insurance holder or holders when this policy is canceled, then We will endeavor to mail or deliver a copy of such written notice of cancellation to the certificate holder(s) shown in the Schedule above, as follows: 1. To the name and address corresponding to each certificate of insurance holder indicated in the Schedule above; and 2. At least 10 days prior to the effective date of the cancellation, as shown in our notice to the first Named Insured, or, if indicated, the longer number of days notice shown in the Schedule above. B. Notwithstanding the foregoing, such notice of cancellation is provided on an informational basis and solely to assist You in informing the certificate of insurance holder(s) in advance of pending cancellation in coverage to assist you in meeting Your contractual notice requirements to such parties. Our failure to provide such advance notification to the certificate of insurance holder(s) shown in the Schedule of this endorsement will not extend any policy cancellation date, negate any cancellation of the policy, or grant, alter or extend any rights or obligations under this policy and we shall have no liability for any failure to provide the notice(s) as provided herein. All other terms and conditions of this policy remain unchanged. 1459771-11 + 2010 Fireman's Fund Insurance Company. Novato. CA. All rights reserved. 7 of 7 971