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COI - HHS Construction, LLC - Expires 2023-10-01ACORO� CERTIFICATE OF LIABILITY INSURANCE AccW: 279538E DATE(MM/DD/YYYY) 10/0112022 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 Lockton Companies, LLC 3657 Briarpark Dr., Suite 700 Houston, TX 77042 CONTACT PHONE FAX . 888-828-8365 ac Ne: E-MAIL ADDRESS: INSPERITYCERTS LOCKTONAFFINITY.COM INSURERS) AFFORDING COVERAGE NAIL If INSURER A: Ace American Insurance Co. 22667 INSURED HHS CONSTRUCTION, LLC INSURER e: INSURER C: 2042 S GROVE AVE INSURER D ONTARIO, CA 91761-5617 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: 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 LTA rypE OF AODL SUB POLICY NUMBER POOCV EFF MM/DO/YYYY POLICY EXP MMIOD/YVV LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR T_ EACH OCCURRENCE $ O ETO flE D PREEMIMI SES Maaccunence $ MED EXP (Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY EC- JCT LOC OTHER: GENERAL AGGREGATE $ PRODUCTS. COMPIOP AGO $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION .$ IS A WORKERS COMPENSATION ANDEMPLOYERS'LIABILITY Y/N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) 11 yes, describe under DESCRIPTION OF OPERATIONS below N/A X C5161396A 10/01/2022 10/01/2023 X I PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POUCY LIMIT $ 1 000OW I DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more apace Is required) WAIVER OF SUBROGATION IN FAVOR OF City of Gilroy, its officers, officials and employees WHEN REQUIRED BY WRITTEN CONTRACT. G'3C�C�CE�M�D c=n nrwA l M nvLUCM I - - - ---- I IAW%LrMLLA I IVIV GILROY CITY CLERK'S CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES 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 AUUHU Zb (ZUIUIUJ) I ne AGUHU name and logo are regisierea marKS Or AL:VHU Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number HHS CONSTRUCTION, LLC 2042 S GROVE AVE Policy Number ONTARIO, CA 91761-5617 Symbol: RWC Number: C5161396A Policy Period Effective Date of Endorsement 10/01 /2022 TO 10/01 /2023 10/01 /2022 Issued By (Name of Insurance Company) ACE AMERICAN INSURANCE COMPANY Insert the policy number. The remainder of the information is to be completed only when this endorsement is issued subsequent to the preparation of the policy. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. CALIFORNIA WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule, where you are required by a written contract to obtain this waiver from us. You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. Schedule 1. ( X ) Specific Waiver Name of person or organization: City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy, CA 95020 () Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium: The premium charge for this endorsement shall be 1.0 percent of the California premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium: $0 Authorized Agent WC 90 03 75 (05/18)