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COI - AmeriNational Community Services, LLC - Expires 2024-06-01INSR ADDL SUBR LTR INSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person)$ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS AUTOS ONLY HIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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 any rights to the certificate holder in lieu of such endorsement(s). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE Great Northern Insurance Company Federal Insurance Company Bankers Standard Insurance Co. Argonaut Insurance Company Certain Underwriters at Lloyds of Londo 6/02/2023 USI Insurance Services, LLC 8000 Norman Center Drive, Suite 400 Bloomington, MN 55437 Tami Hesthaven 800 735-3008 610-537-1954 Tami.Hesthaven@usi.com AmeriNational Community Services, LLC dba AmeriNat 5050 France Avenue South Minneapolis, MN 55410 20303 20281 18279 19801 15642N A X X Y Y 36031757 06/01/2023 06/01/2024 1,000,000 1,000,000 10,000 1,000,000 2,000,000 2,000,000 A X X Y Y 73627594 06/01/2023 06/01/2024 1,000,000 B X X 79898650 06/01/2023 06/01/2024 5,000,000 5,000,000 C N Y 77171555 06/01/2023 06/01/2024 X 1,000,000 1,000,000 1,000,000 D E Professional Liab Employee Theft ML42637251 MBBA2200389 06/01/2023 06/01/2023 06/01/2024 06/01/2024 $5,000,000 $1,000,000 Following Endorsements Apply To The Names/Projects/Events Listed Below Only If Required By Written Contract Or Agreement: General Liability: Additional Insured, Primary and Noncontributory per Form 80-02-2367; Waiver of Subrogation included in General Liability policy form. Automobile Liability: Additional Insured and Waiver of Subrogation per Form 16-02-0292. Workers Compensation: Waiver of Subrogation per Form WC000313. Umbrella Liability follows form. The additional insured and waiver of subrogation coverages (See Attached Descriptions) City of Gilroy its Employees, Officers Officials and Volunteers 7351 Rosanna Street Gilroy, CA 95020-6141 1 of 2 #S40271761/M40266883 OSPLLCClient#: 1951452 PDNZP 1 of 2 #S40271761/M40266883 SAGITTA 25.3 (2016/03) DESCRIPTIONS (Continued from Page 1) indicated by the box(es) checked above are provided by the forms listed that only extend coverage if required of the insured by a written contract or agreement. 2 of 2 #S40271761/M40266883