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COI - Benchmark Environmental Enginnering - Expires 2024-10-01~ I CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) Acct#: 2795428 10/01/2023 ~ 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 NAME: Lockton Companies, LLC f i(18NJ0 Ext): 888-828-8365 I FAX 3657 Briarpark Dr., Suite 700 /A/C Nol: E-MAIL Houston, TX 77042 ADDRESS: INSPERITYCERTS®LOCKTONAFFINITY.COM INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Indemnity Insurance Co. of North America 43575 INSURED INSURER B: BENCHMARK ENVIRONMENTAL ENGINEERING, A CALIFORNIA CORPORATION INSURER C: 3732 CHARTER PARK DR STE A INSURER D: SAN JOSE, CA 95136-1355 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YYYYl (MM/DD/YYYYl LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ -~ CLAIMS-MADE □ OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence\ $ MED EXP (Any one person) $ -PERSONAL & ADV INJURY $ -GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ Fl □PRO-DLoc PRODUCTS -COMP/OP AGG $ POLICY JECT OTHER: $ AUTOMOBILE LIABILITY YE~~~b~~~llNGLE LIMIT $ ~ ANY AUTO BODILY INJURY (Per person) $ f-----ALL OWNED -SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ ~ -NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident\ $ f------$ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ f-----EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED I I RETENTION$ $ WORKERS COMPENSATION I PER I I OTH-AND EMPLOYERS' LIABILITY X STATUTE ER Y/N A ANY PROPRIETOR/PARTNER/EXECUTIVE □ N/A X C55953582 10/01/2023 10/01/2024 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE -EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Project: Ranch Site Building and Trailer Demolition WAIVER OF SUBROGATION IN FAVOR OF City of Gilroy, its officers, officials and employees WHEN REQUIRED BY WRITTEN CONTRACT. CERTIFICATE HOLDER CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES 7351 ROSANNA STREET GILROY, CA 95020 CANCELLATION 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 ~-~~ © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Policy Named Insured Endorsement Number BENCHMARK ENVIRONMENTAL ENGINEERING, A CALIFORNIA CORPORATION Policy Number 3732 CHARTER PARK DR STE A SAN JOSE, CA 95136-1355 Symbol: RWC Number: C55953582 Policy Period Effective Date of Endorsement 10/01/2023 TO 10/01/2024 10/01/2023 Issued By (Name of Insurance Company) Indemnity Insurance Co. of North America 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: Project: Ranch Site Building and Trailer Demolition WAIVER OF SUBROGATION IN FAVOR OF City of Gilroy, its officers, officials and employees WHEN REQUIRED BY WRITTEN CONTRACT. 3. Premium: The premium charge for this endorsement shall be INCLUDED 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: INCLUDED ~~P. ~ Authorized Agent WC 90 03 75 (05/18)