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COI - Dewberry Engineers Inc. - Expires 2022-07-01ACORU® CERTIFICATE OF LIABILITY INSURANCE k-�. DATE (MMIDD/YYYY) 06128/2021 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 pollcy(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 MARSH USA, INC. 1050 CONNECTICUT AVENUE, SUITE 700 CONTACT Alex Gasta NAME: PHONE 202-263-7881 A/c No): 202-295-0909 ADDRESS: Alex.Gasta@marsh.com WASHINGTON, DC 20036.5386 INSURERS AFFORDING COVERAGE NAIC 9 INSURER A: Charter Oak Fire Insurance Company 125674 25615 CN102736896-711-1.1 a-21-22 GAWU INSURED EWBERRY ENGINEERS INC. INSURER B : Travelers Indemnity Co 25658 INSURER C : Travelers Property Casualty Co. Of America 1760 CREEKSIDE OAKS, SUITE 280 INSURER D : Beazley Insurance Company, Inc. 37540 SACRAMENTO, CA 95833 INSURER E : Travelers Casualty And Surety Company 19038 INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-006482907-06 REVISION NUMBER: 5 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 SUER POLICY NUMBER EFF MMIDD/YYYY MCY / POLICY EXP DIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 630-7792B312-COF-21 07101/2021 07/01/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE r_x1 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 X MED EXP (Any oneperson) $ 10,000 CONTRACTUAL INS. COV. (INSURED CONTRACTS) PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000.000 X POLICY PRO JECT LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY 810-1N7889742iA3-G 07/01/2021 07/01/2022 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMP / COLL DED: $ 1,000 X UMBRELLA UAB X OCCUR CUP-4J580377-21A3 07/01/2021 0710112022 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED I RETENTION $ $ E WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? �N (Mandatory in NH) N I A UB-6P972264-21-43-G 07101/2022 X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000.000 It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 D PROFESSIONAL LIABILITY V11B5E211201 07/0112021 07/01/2022 PER CLAIM/AGGREGATE 5,000,000 RETRO. DATE: FULL PRIOR ACTS SIR 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) RE: CITY OF GILROY RENOVATION. DEWBERRY PROJECT/JOBIPLN # 50118429. BU 8890. CITY OF GILROY PROJECT NO.19-RFP-PW-429. CITY OF GILROY, ITS OFFICERS, AND EMPLOYEES ARE INCLUDED AS ADDITIONAL INSURED WHERE REQUIRED BY WRITTEN CONTRACT WITH RESPECT TO THE GENERAL LIABILITY, AUTO LIABILITY, AND UMBRELLA POLICIES. THE GENERAL LIABILITY POLICY COMPLIES WITH THE PROVISIONS OF THE STANDARD ISO ENDORSEMENT FORMS FOR ONGOING AND COMPLETED OPERATIONS. CERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Attn:Julie Oates THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosnna Street ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhedee _roc ��.-.�►-� ..s s...�.c .....ate 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD V jL0 00 >N�� CD � 0 G OQ) CD O�y C . CERTIFICATE OF LIABILITY INSURANCE DAAT12(MMIDDIYYYY) 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 policy0es) 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 MARSH USA, INC. 1050 CONNECTICUT AVENUE, SUITE 700 WASHINGTON, DC 20036-5386 CONTACT AME CT Alex Gasta PHONE 202-263-7881 FAX No : 242-263-7700 E-MAIL ADDRESS: alex.gasta@marsh.com INSURERS AFFORDING COVERAGE NAIC # CN102736896-7l1-1.1CA-21-22 INSURER A: Travelers Property Casualty Co. Of America 25674 INSURED DEWBERRY ENGINEERS INC. INSURER B : N/A N/A INSURER C . Travelers IndemnitV Company 25658 DBA DEWBERRY I DRAKE HAGLAN 11060 WHITE ROCK ROAD, SUITE 200 RANCHO CORDOVA, CA 95670 INSURER D : Beazley Insurance Company, Inc. 37540 INSURER E : INSURER F %0VVCKA%JM0 CtF! iiPiCATE NIIMRFR• (:I G_nnRA1Q40'17_A1Z n=1Ln9_%1r%u .u.■.r%rm_ n 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. ILTR TYPE OF INSURANCE ADDL UBR POLICY NUMBER POLICY EFF MMIDDNYYY POLICY EXP MMID Y LIMITS A X COMMERCIAL GENERAL LIABILITY 630-7792B312-COF-21 07/01/2021 07/01/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE a OCCUR DAMAGE TO PREMISES ERRENTED occurrence)$ 1,444,404 X CONTRACTUAL INS. COV. MED EXP (Any one parson) $ 10,000 (INSURED CONTRACTS PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: - PROF-] GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2,004,000 POLICY JECT LOC $ OTHER: C AUTOMOBILE LIABILITY 810-1N788974-2143-G 07/01/2021 07/01/2022 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ COMP / COLL DER $ 1,000 X UMBRELLA LIAB X OCCUR CUP-4J584377-21-43 07/0112021 07/01/2022 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,044,040 EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION UB-6P972264-21.43-G 07/01/2022 X PER oTH- AND EMPLOYERS' LIABILITY YIN STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 ANYPROPRI ETOR/PARTNER/EXECUTI VE OFFICER/MEMBER EXCLUDED? Hl NIA E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yas, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below D PROFESSIONAL LIABILITY V11 B5E211201 07/01/2021 07/01/2022 PER CLAIMIAGGREGATE 5,000,000 RETRO. DATE: FULL PRIOR ACTS SIR 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Re: Lions Creek Trails Project Construction Services - Lions Creek Trails Project Construction Services: Kern to Wren; Wren to Farrell, Gilroy, CA City of Gilroy, its officers, elected or appointed officials, employees, agents and volunteers are included as additional insured where required by written contract with respect to general liability. /1CP9Tr'�A�Tr •�A• www City of Gilroy Attn: David Stubchaer 7351 Rosanna Street Gilroy, CA 95020 VM19LrGLLA 1 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 of Marsh USA Inc. Manashi Mukherjee U 1985-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD G}w>n rc moo n0c� aCf) ao N Cl) aa m) CD ACORU® CERTIFICATE OF LIABILITY INSURANCE f4o�. DATE (MMIDDIYYYY) 06/28/2021 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 endorsement(s). PRODUCER MARSH USA, INC. 1050 CONNECTICUT AVENUE, SUITE 700 CONTACT Alex Gasta NAME: PHONE 202-263-7881 A1C No): 202-263-7700 ADDRIESS: alex.gasta@marsh.com WASHINGTON, DC 20036-5386 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Travelers Property Casualty Co. Of America 25674 CN102736896-711-1.1CA-21-22 INSURED DEWBERRY ENGINEERS INC. INSURER B : NIA NIA INSURER C : Travelers Indemnity Company 25658 DBA DEWBERRY I DRAKE HAGLAN 11060 WHITE ROCK ROAD, SUITE 200 RANCHO CORDOVA, CA 95670 INSURER D . Beazley Insurance Company, Inc. 37540 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: CLE-006483938-05 REVISION NUMBER: 0 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 A B POLICY NUMBER POLICY EFF IMMIDDIYYYYI.MM/DD/YYYY POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX I OCCUR 630-7792B312-COF-21 07/01/2021 07/01/2022 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 1,000,000 X MED EXP (Any oneperson) $ 10,000 CONTRACTUAL INS. COV. (INSURED CONTRACTS) PERSONAL & ADV INJURY $ 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY JECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPIOP AGG $ 2,000,000 $ OTHER: C AUTOMOBILE LIABILITY 810-1N788974-2143-G 07/01/2021 07/01/2022 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ COMP / COLL DED: $ 1,000 X UMBRELLA UAB X OCCUR CUP-4J580377-2143 07/01/2021 07/01/2022 EACH OCCURRENCE $ 5,000.000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? �N (Mandatory in NH) N I A UB-6P972264-21.43-G 07101/2021 07/01/2022 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 PROFESSIONAL LIABILITY V11 B5E211201 07/0112021 07/01/2022 PER CLAIM/AGGREGATE 5,000,000 RETRO. DATE: FULL PRIOR ACTS SIR 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Addltional Remarks Schedule, may be attached if more space is required) Re: Ronan Channel and Lions Creek Trails Project in the City of Gilroy Proposal No.12-RFP-PW-356 City of Gilroy, its officers, representatives, agents and employees are included as additional insured where required by written contract with respect to general liability. %.CR I Irmom 1 tC IIVLUCR UANC:tLLA I IUN City of Gilroy: Purchasing Division Attn: Inga Alonzo 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 of Marsh USA Inc. Manashi Mukherf'ee VWC-4.u�b-'L ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD G)-4aC.) -� CA) .� o D�S�Y mo >o cn :3 o :5 0 SD m o'o a col m o s CD m co vV o' 0 AGENCY CUSTOMER ID: CN102736896 LOC #: Washington ACOREP ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY MARSH USA, INC. NAMED INSURED DEWBERRY ENGINEERS INC. 1760 CREEKSIDE OAKS, SUITE 280 SACRAMENTO, CA 9M33 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance AS RESPECTS THE GENERAL LIABILITY, AUTOMOBILE LIABILITY, UMBRELLA LIABILITY, AND WORKERS' COMPENSATION COVERAGES EVIDENCED ABOVE, NOTICE OF CANCELLATION WILL BE PROVIDED BY THE INSURER(S) TO THE CERTIFICATE HOLDER PER THE ATTACHED AS REQUIRED BY WRITTEN CONTRACT. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights i The ACORD name and logo are registered marks of ACORD 0257-01.00-0002572-0002-0007442 POLICY NUMBER: 810-1N788974-21-43-G COMMERCIAL AUTO ISSUE DATE: 06-09-21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. VfRGINIA BLANKET CANCELLATION AND NONRENEWAL NOTICE This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM In the event of cancellation or nonrenewal or material change that reduces or restricts the insurance afforded by this Coverage Part, we agree to mail prior written notice of cancellation or nonrenewal or material change to: SCHEDULE Any person or organization to whom you have agreed to under any contract or agreement that notice of cancellation or material limitation of this policy will be given, but only if- 1 . You send us a written request to provide such notice, including the name and address of such person or organization, after the first Named Insured receives notice from us of the cancellation or nonrenewal or material change of this policy; and 2. We receive such written request at least 14 days before the beginning of the applicable number of days shown in this endorsement. 3. Number of days advance notice: Cancellation for nonpayment of premium: Days Cancellation other than nonpayment of premium: 30 Days Nonrenewal: Days Material change: Days Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CA F2 36 0417 0 2017 The Travelers Indemnity Company. Al rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc. with its permission. I POLICYNUMBER: P-630-7792B312-COF-21 ISSUE DATE: 06-10-21 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: PERSON OR nor:AIUMATlnm- ANY PERSON OR ORGANIZATI-.4 (CONTINUED ON IL T8 06) Anna;:SS• SEE I] 78 0 6 FAIRFAX v ea 22031 30 PROVISIONS If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. IL T4 05 05 19 0257-01-00-0002572-0003-0007443 0 2019 The Travelers Indemnity Company. All rights reserved. Page 1 of oao a co cv W '•"adHC C4M" 6.3w WH►C 07.. W d O C+ n H 9H H M in U1 �dw b OwHu4= M o m H V] M0HwHt,�ffzi"a0 H W H O H C►� '2. H H O ;d O w Orn ti xwafoxOH1213 v tL-4 Its � C3. o ci t w O tarn t:f to c3 ED O DO 0 Fi rs 0co 0 ►ri H �7 yr mpg C0 C3 0 :33�:to to �' tt�" po �t � � 4�i xH xx�H'f@ �'O 0 co H n H btd �H�rhdRiHHH HCO± d E 0 E+IH►dHobi xM to t=i wH3 0 � yW � a w � En O mo w" to pm tM'{ t�-4 God 0 x� 0xpmO C 1-3 .. w 0-3 En M C tpd O mDO H�Q0 M ttA M02 �s v to x C x O HR�w CA x VH H 1-3 r4 oOR o n�x K H x DO. to N z 7d�� O8 00 b H HC cnho r C3 -4Hw PC o tore o �d w tm W tb N r :U x 0 .a x O O oPC H ry x 0 tv V. tR3 0 9 H H m M O HW 0 x H H H Ld x H 0 w x 014 to HPOO ►�f O to w 0 z r d to to x t'� K H � K � G03 � C7 M � ��''i Cif • H G1 K tbd .. 6.3 x r) .. a►,i 0 C3 x H H 93 z tod Q 0 tid H n H "a H H G] m m r c "a m m 0 ;o cn m K m z --i NOTICE: THESE POLICY FORMS AND THE APPLICABLE RATES ARE EXEMPT FROM THE FILING REQUIREMENTS OF THE NEW YORK STATE INSURANCE DEPARTMENT. HOWEVER, SUCH FORMS AND RATES MUST MEET THE MINIMUM STANDARDS OF THE NEW YORK INSURANCE LAW AND REGULATIONS. Effective date of this Endorsement: 01-Jul-2021 Thls Endorsement is attached to and formsa part of Policy Number: V11 BSE211201 Beazley Insurance Company, Inc. referred to in thisendorsement aseither the "Insurer" or the "Underwriters!' DEWBERRY NOTICE OF CANCELLATION TO CERTIFICATE HOLDER This endorsement modifies insurance proWed under the following: ARCHITECTS AND ENGINEERS PROFESSIONAL LIABILITY INSURANCE POLICY In considerationof the premium charged forthe Policy, it is hereby understood and agreed that in addition to the provisions of the Cancellation section of theConditions, if this policy is canceW by us, other than fornon-payrrat of premium, we will provide 30 days written notice to the following party(ies): As per list to be provided by the Famed Insured or its Broker of Record. All other terms and conditions of this Policy remain unchanged. EDB005NYFTZ 032011 ed. Class Code: 2-14180 Page 1 of 1 0257-01-00-0002572-0004-0007444 �► WORKERS COMPENSATION TRAVELERS J AND ONE TOWER SQUARE EMPLOYERS LIABILITY POLICY HARTFORD CT 06183 ENDORSEMENT WC 99 06 R4 (00) - 001 POLICY NUMBER: UB-6P972264-21-43-G NOTICE OF CANCELLATION OR NONRENEWAL TO DESIGNATED PERSONS OR ORGANIZATIONS The following is added to PART SIX — CONDITIONS: Notice Of Cancellation Or Nonrenewal To Designated Persons Or Organizations if we cancel or non -renew this policy for any reason other than non-payment of premium by you, we will provide notice of such cancellation or non -renewal to each person or organization designated in the Schedule below. We will mail or deliver such notice to each person or organization at its listed address at least the number of days shown for that person or organization before the cancellation or nonrenewal is to take effect. You are responsible for providing us with the information necessary to accurately complete the Schedule below. If we cannot mail or deliver a notice of cancellation or nonrenewal to a designated person or organization because the name or address of such designated person or organization provided to us is not accurate or complete, we have no responsibility to mail, deliver or otherwise notify such designated person or organization of the cancellation or nonrenewal. SCHEDULE Name and Address of Designated Persons or Organizations: Number of Days Notice: ANY PERSON OR ORGANIZATION WITH WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OR NON RENEWAL OF THIS POLIC 30 Y WILL BE GIVEN, BUT ONLY IF: 1. YOU SEE TO IT THAT WE RECEIVE A WRITTEN REQU EST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NA MED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR NON RENEWAL OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS ENDORSEMENT. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGA NIZATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. All other terms and conditions of this policy remain unchanged. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Insured Policy No. Endorsement No. Premium $ Insurance Company Countersigned by DATE OF ISSUE: 06-09-21 STASSIGN: © 2013 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 POLICY NUMBER: CUP-4J583077-21-43 ISSUE DATE: 06/11/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED PERSON OR ORGANIZATION - NOTICE OF CANCELLATION PROVIDED BY US This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY SCHEDULE CANCELLATION: Number of Days Notice: 30 PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZ- ATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation. IL T4 05 0519 02019 The Travelers Indemnity Company. All rights reserved. Page 1 of 1 0257-01-00-0002572-0005-0007445 Dear Certificate Holder: As many companies have moved to a rernote working environment, mailing Certificates of Insurance to a physical address can cause unnecessary delays in providing you proof of insurance. To streamline delivery and in an effort to support our firm`scommitment to sustainability, going forward, we would like to distribute your Certificates of Insurance electronically if possible. We are kindly requesting Certificate Holders provide us an email address where we can deliver your COI in the future. Please send your response to: USOperations.email@marsh.com and provide the following information so that we can expedite your COI delivery: • Certificate # (Shown below Insured Name —e.g.: ABC-123455789-01) s E-Mail for future delivery: For undeliverable email addresses, our system is configured to automatically redirect the Certificate for delivery via USPS. Lastly, if you no longer need this COI please respond to USOperations.emailttmarsh.com with the Certificate number and we will inactive the record in our system to avoid future automatic delivery. Thank you. US Operations, Marsh USA, Inc.