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HomeMy WebLinkAboutGaleb Paving, Inc. - Insurance Certificate A C 2/29/220,D CERTIFICATE OF LIABILITY INSURANCE DATE`MM/ Y) 010 0 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 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 Construction&Real Estate Practice NAME: PHONE FAX Wells Fargo Insurance Services USA,Inc.-CA Lic#:OD08408 E-PA Ext: (A/C.No): (650)413-4497 ADDRESS: CertRequests @wellsfargo.com 959 Skyway Rd.,2nd Fl PRODUCER GALEBPAVII CUSTOMER ID#: San Carlos,CA 94070 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Arch Specialty Insurance Group 11150 Galeb Paving Inc. Philadelphia Insurance Company 18058 INSURER B: P P Y 12340 Saratoga-Sunnyvale Rd INSURER C: RSUI Indemnity Company 22314 INSURER D: State Compensation Insurance Fund 35076 Saratoga CA 95070 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 2208888 REVISION NUMBER: See below 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 INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A GENERAL LIABILITY DPC0040520 9/15/2010 9/15/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 50,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X Ter- LOC $ B AUTOMOBILE LIABILITY PHPK623439 9/15/2010 9/15/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ _ C UMBRELLA LIAB X OCCUR NHA226684 09/15/10 09/15/11 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 5,000,000 DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC X TORY LIMITS OT H- D AND EMPLOYERS'LIABILITY Y/N 496455210 01/01/11 01/01/12 ANY PROPRIETOR/PARTNER/EXECUTIVE N/A 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 I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Re: Camino Arroyo Bridge Project-Phase 1. City of Gilroy is named as additional insured as respects general liability per endorsement attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy,CA 95020 AUTHORIZED REPRESENTATIVE 9« 1.— ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF-INSURED RETENTION COVERAGE FORM SECTION II —WHO IS AN INSURED is amended to include as an additional insured those persons or organizations who are required under a written contract with you to be named as an additional insured, but only with respect to liability for"bodily injury", "property damage", or"personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of your subcontractors: A. In the performance of your ongoing operations or"your work", including "your work"that has been completed;or B. In connection with your premises owned by or rented to you. As used in this endorsement,the words"you"and"your"refer to the Named Insured. All other terms and conditions of this Policy remain unchanged. Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: DPC0040520 Named Insured: Galeb Paving Inc. Endorsement Effective Date: 9/15/2010 00 CGL0006 00 05 07 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM COMMERCIAL GENERAL LIABILITY SELF - INSURED RETENTION COVERAGE FORM SECTION II — WHO IS AN INSURED is amended to include as an additional insured those persons or organizations who are required under a written contract with you to be named as an additional insured, but only with respect to liability for "bodily injury", "property damage ", or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of your subcontractors: A. In the performance of your ongoing operations or "your work ", including "your work" that has been completed; or B. In connection with your premises owned by or rented to you. As used in this endorsement, the words "you" and "your" refer to the Named Insured. All other terms and conditions of this Policy remain unchanged. Endorsement Number: This endorsement is effective on the inception date of this policy unless otherwise stated herein. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Policy Number: DP00040520 Named Insured: Galeb Paving Inc. Endorsement Effective Date: 9/15/2010 00 CGL0006 00 05 07 Page 1 of 1 _ _ 1 AcoR" CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 9/14/2010 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 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 Construction & Real Estate Services F 650 839 -6964 Wells Fargo Insurance Services USA, Inc. - CA Lic#: OD08408 305 Walnut Street Redwood City, CA 94063 CONTACT NAME: Cathy Etheridge ena • (415) 374 -2034 ac No : (415) 374 -2030 ADDRESS: Cathy. Etheridge @wellsfargo.com PRODUCER GALEBPAVII CUSTOMER ID #: INSURER (S) AFFORDING COVERAGE NAIC # INSURED Galeb Paving Inc. 12340 Saratoga - Sunnyvale Rd Saratoga CA 95070 INSURER A: Arch Specialty Insurance Group 11150 INSURER 6: Philadelphia Insurance Company 18058 INSURERC: RSUI Indemnity Company 22314 INSURER D: State Compensation Insurance Fund 35076 INSURER E: DAMAGE TO RENTED PREMISES Ea occurrence INSURER F: MED EXP (Any one person) rnVGaer_FC rFRTIFICATF NIIMBFR- 1 / (bbJV REVISION NUMBER: See below 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 SUBR POLICY NUMBER POLICY EFF MM /DD POLICY EXP MM/DD LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY DPCO040520 9/15/2010 9/15/2011 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence _ $ 50,000 MED EXP (Any one person) $ 5,000 CLAIMS -MADE OCCUR PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 $ POLICY X PRO- 7 LOC JECT B AUTOMOBILE LIABILITY PHPK623439 9/15/2010 9/15/2011 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED AUTOS BODILY INJURY (Per accident) $ X SCHEDULED AUTOS HIRED AUTOS PROPERTY DAMAGE (Per accident) $ X NON -OWNED AUTOS C UMBRELLA LIAB X OCCUR NHA226684 09/15/10 09/15/11 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ RETENTION $ D WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? F_N] (Mandatory in NH) NIA 496455209 01/01/10 01/01/11 X WC STATU- OTH- I ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEq $ 1,000,000 E.L. DISEASE - POLICY LIMIT I $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Camino Arroyo Bridge Project - Phase 1. City of Gilroy is named as additional insured as respects general liability per endorsement attached. 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 © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD GALEBPAVI1 ACORDTM CERTIFICATE OF LIABILITY INSURAI k' DATE(MM/DD/YYYY) (� 12/14/2009 PRODUCER THIS CERTIFICATE IS ISSUED AS A MA 6F INFORMATION Construction&Real Estate Services F 650 839-6964 ONLY AND CONFERS NO ZIGHTS UPON THE CERTIFICATE /ells Fargo of California Insurance Services,Inc. HOLDER.THIS CERTIFICq(p�E76DEf� T AMEND,EXTEND OR 305 Walnut Street ALTER THE COVERAGE A//F+�FdRDEDOYJ H(FOLICIES BELOW. Redwood City,CA 94063 INSURERS AFFORDI NDV PR ING NAIL# INSURED Caleb Paving Inc. INSURER A: Navigators Insurance Company,,jj t 42307 12340 Saratoga-Sunnyvale Rd INSURER B: Philadelphia Indemnity Insurance Company 18058 INSURER c: RSUI Indemnity Company 22314 INSURER o: State Compensation Insurance Fund 35076 Saratoga CA 95070 INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TNSR DD'L POLICY EFFECTIVE POLICY EXPIRATION LTR NSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY SF07CGL00950502 9/15/2009 9/15/2010 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000 PREMISES fEa_occurrencel CLAIMS MADE © OCCUR MED EXP(Any one person) $ 5900 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 nPOLICY n je& n LOC B AUTOMOBILE LIABILITY PHPK465298 9/15/2009 9/15/2010 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY _ SCHEDULED AUTOS (Per person) $ X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ C EXCESS/UMBRELLA LIABILITY NHA224522 09/15/09 09/15/10 EACH OCCURRENCE $ 5,000,000 EOCCUR n CLAIMS MADE AGGREGATE $ 5,000,000 DEDUCTIBLE _ $ RETENTION $ - $ D WORKERS COMPENSATION AND 496455209 01/01/10 01/01/11 _X I ` Y ATU-I IOTH- EMPLOYERS'LIABILITY TORY IMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 OTHER DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: Camino Arroyo Bridge Project-Phase 1. City of Gilroy is named as additional insured as respects general liability per endorsement attached. • CERTIFICATE HOLDER CANCELLATION Ten Day Notice for Non-Payment SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL&AMXtreN>IYXMAIL 30 DAYS WRITTEN City of Gilroy NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BICIXAMORIEMOLICSCKSIKAKK 7351 Rosanna Street IM1006Dm1B OeB• ,•,, ;,,,•:,,,'...: ... ,,.,,.1. I ,> , ;XILXAGENIBdARXX Gilroy,CA 95020 ROPOIMMIPMESX AUTHORIZED REPRESENTATIVE ACORD 25(2001/08)1 of 2 1023575 0 ACORD CORPORATION 1988 (This certificate replaces certificate#788352 issued on 9/9/2009) IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). 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). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s), authorized representative or producer,and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25-S(2001/08) 2 of 2 #S9152601M915043 .mac 2 �lp n 3 i ? p 1 r G bP. nay � 0 s + 6 1 5 .d b I9 0 , a m RI 1 Pii . Z.g W $ • Ecis t.�' Is g a il i .fie . ¢� O E O a� O O co to 19 ite st z .9- g t 12 hD f 9 II . il f r§ ni t' 5''' C° D l i O R fi 4 C� 1 $ 'I f c lig ill . dd 'g r S .El tug x '° M g Fps -Et t . 3 al Et 1 wt- Mg'i �1 IRig a io .G EFt 92 ag, 1 g:.4...9 .12 let- ti 3 f36 i >. - 0 — g q g cl to g i 0 1 o;, 3 1 i 0 c 1 al=9 /1 Jam . 8 to N d ogz 07/26/2007 09:30 4082534753 GALEB PAVING INC PAGE 02/05 From:Brian Raymond At SUhr Risk Services FaxID:650 343 5941 To:Jimmie OP ID BIy DATE(MMIDD/YrM ACORD. CERTIFICATE OF LIABILITY INSURANCE OPID a„xO PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 3uhr Risk services- Burlingame ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Burlingame Branch HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 1338 Bayshore Highway Burlingame CA 94010 NAIL# Phone:650-342-9535 Fax:650-343-5941 INSURERS AFFORDING COVERAGE 'INSURED INSURER A: State Compensation Fund INSURER B: INSURER G: Galeb Paving, Inc- 12340 Saratoga gga-Sunnyvale Rd INSURER D. INSURER E: COVERAGES _ TI-E POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE INSURED NAMED ABOVE FCR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REOLIIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OAR DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAT 5E ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY TIE.POLICIES DESCRIBED HEREIN 13 8USJECT TO ALL THE TERMS.EXCLUSIONS AND CONDITIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS • 3WR MDV f POU. I-EOTWr POUCY Fx?IRA rtON” UMRS LTR XJBRD TYPE OF INSURANCE _ POLICY NUMBER DATE(NMJDDM I DAIS(MMfD1SlYY) GENERAL LL4BILTTY EACH OCCURRENCE S p,,y(,N2t 1 V TEN it() COMMERCIAL GENERAL LIABILrI V PREMISES(Es ocarenoo) $ y CLAIMS MADE OCCUR •MED EXP(Any one person) F PERSONAL A ADV INJURY $ GENERAL AGGREGATE F GENT,AGGREGATE UMrrTpT..APPLIES PER' PRODUCTS-CCMP/OP AGG $ 7 POLICY n 7g. n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Es accident) _ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (rer pa rlor)SCHEDULED AUTOS —HIRED AUTOS GOI)ILY INJURY $ (Per eco owl) —NON-OWNED AUTOS PROPERTY DAMAGE $ IPA,eccIdentl — GARAGE LIABILITY AUTD ONLY_EA ACCIDENT $ • EA ACC $ A Nr AUTO _AUTO ONLY: AGG 5 EXCESS/UMBRELLA LIABLITY EACH OCCURRENCE 5 Occur E CLAIMS MADE AGGREGATE 6. $ DEDUCTIBLE $ RETENTION $ S 1I-- W(:SIAIU- U fT- WORKERa COMPENSATION AND UTORY LtA1TS r ER A II,IPLOYER9 LU161LTrY 161171906 01/01/07 01/01/08 E.L.EACH ACCIDENT 6 1000000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICEP/MEMBEREXCLUDED7 E.L.DISEASE-EAEMPLOYEG 81000000 U yes.dgeenbe under F I. DISEASE-POLICY LIMIT $1000000 speCIAL PROVl6i0N6 below oTHE2 • -DESCRIPTION OF OPERATIONS I LOCATION$I vEHICLES I EXCLUSIONS ADDED SY ENDORSEMENT!SPECIAL PROviSIONS Camino Arroyo Bridge Project, Phase 1. Project: 07-CCD-141 *10 days notice of cancellation for nonpayment of premium. CERTIFICATE HOLDER CANCELLATION GILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL City of Gilroy IMPOSE NO OBLIGATION OR LIABILITY Or ANY KIND UPON THE INSURER,ft AGENTS OR 7351 Rosanna Street REPRE9ENTAlIVEB. Gilroy, CA 95020 AUPRE AI Vv. ACORD 25(2001108) ID ACORD CORPORATION 1988 _ 07/26/2007 09: 30 4082534753 GALEB PAVING INC PAGE 03105 o ABOIns. - Construction 07/26/2007 08:b9 FAX 630 39 8964 pqL BPA CI -nt$: 351158 DATE(µMA]D1YYY f) D. CERTIFICATE OF LIABILITY INSURANCE MATTER /47 A C�R r/ THIS CERTIFICA PRODUCER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Construction Unit FAX 650.839-8864 HOLDER-THIS CERTIFICATE DOSS NOT AMEND,EXTEND OR ADD Insurance&Financial Serrleea ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 305 Walnut Strout INSURERS AFFORDING COVERACCOVERAGE Redwgod City,CA 94063 INsuRERA: I.AndmarkAmerlcan neurance Co •a Caleb INSURER INSURERS_ RSUI Indemnity Compan 12340 Paving Inc. 12 Saratn9a"5unnyvala Rd. INSUa2RC- Llnl®ard Insurance Company Saratoga,CA 95070 INSURER 0: COVERAGES BELOW HAVE I ESN ISSUED TO THE INSURED NAMED AEOVE FOR THE POLICY PERIOD INQICATEp.NOTWMTNSTANDINC, THE POLICLE.9 OF INSURANCE LISTED Y CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERT11 ICAT6 MAY BE ISSUED OR ANY RERTAIN THE II SUR OR CONDITION OF MAY PERTAIN.THE INSURANCE SHOWND�HHAV@ m)LICIEs >BY PAID HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF POLICIES.ACGR '3 .. �,r ON TYPE OF INSURANCE OLICY NUMER • 1=1 4„ •td 1W'^"�" }• � �C„�GURRENCE s1 Q 0 000 " LHA130487 09/1g/06 Q9/15107 oAM ccu a Ten ►50 000 A G�}IERAL L1AnILITr •�xat�U^�-n5� Y COMM6HCIAL GENbRAL LIABILRY rvtED F�(P(Am one pme^7 5 ,000 J GLAl1as MADE X 14GCUR PERSONAL&ADV INJURY 51,D0Q 400 ■� J'� QENERAL AGGREGATE S2,000,900 I_ PRODCTS-COMP/DP AGG 62 OOO OOD GEN'L AQ6REGATS LIMIT APPLIES r[It: --1 ---I roucY Xl jL ,-_ Lac 091 i b1OT PX808$71 09/15/06 COMBINED SINGLEUMIT X1,000,090 C AUT ANY ALE LIARIUTY (CA soclaans) ANY AUYO ryODILY INJURY r ALL OWNED AUTOS iii (Per persoA) $ SCFIEOVLt•D AUTOS BODILY INJURY E HIRED AUTOQ (Pay actlABnl) © NON-0WNED AUTOS - PROPERTY v PROPDAMAGE $ (Per PERT acddonl) AUTO ONLY<EA ACCIDENT S GARAGE LIABILITY I EA ACC 6 HER l ANY AUTO UTO ONLY:THAN AGO $ _� 09,15/06 09116107 EACH OCCURReNCE x5,000,000 B EXceserumSRELLAUABILRY NHA217240 AGr.REQATE 55,000,000 MI �GUR r4 CLAIMS MADE S • S DEDUCnOLH 1 PK;W ICN s I _ RYiIM s 1 1 rt EMP1.O E DOMPENSATI4N AND E,L,ggGH ACCIDENT $ AMpLpYERS'LIARILITY pNY CROP b8 urtr+1PAR'rNEwBXECUTI/E aL.DISEASE EA EMPLOYCE_$ OrFIC6fl ENB R EJ(CLUDED7 R s AL O I3!D I E.L.DISEASE-POpCV LILIIT E OTErAl paovrarDN tew L OTHER ' macaw-nom bF OPERATION!!I LOCATION 1 VEHICLES I CL SIGN of Gilroy OR n mod®s CIAL PROVIMON9 Re:Camino Arroyo Bridge ProJec>:- additional insured as respects general liability per endorsement attached. CANCELLATION -1 11 r, • . • L •1 - : n•^.1 •,J ' u n CERTIFICATE HOLDER SHOULD ANY CIF THE ABOVE DESCRIBED POLICIES BE CANCELLED WORE THE E7(PIrtP.T10N DATE THEREOF,THE ISSUING INSURER MULL EreaxsottoorsuL 3n DAYS WRITTEN City of Gilroy 7351 Rosanna Street NO'110ET0'irttCLR'TIFlCATG HOLDER NAMfiL1ZbTHeLEFT,H Gilroy, CA 95020 1 _ H IUD Rrrvt ACORD 25(20011061 1 of 2 IT/51g12520/M092443 GALEBPAVI1 `G LKI A ACORD CORPORATION 1988 07/26/2007 09: 30 4082534753 GALES PAVING INC PAGE 04/05 07/26/2007 08.59 FAX 650 839 6964 RBDIns. - Construction Z003/004 IMPORTANT If the certificate holder is an ADDITIONAL INSURED.the policy(ies)must be endorsed. A Statement on this certificate does not K onfer rights to-the certlfic to holder in lieu of such endorsement(s). If SUBROGATION IS WAIVD, subject to the terms and conditions of the policy, certain policies may require an endorsement. A se statement on this certificate does not confer rights to the certificate holder In lieu of such endo ment(s). DISCLAIMER The certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing Insurer(s), aufhn'ized representative or producer.sand the Certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. • ACORD 23•S(2001!08) 2 of 2 #910J12S20/MB32443 07/26/2007 09: 30 4082534753 GALEB PAVING INC PAGE 05/05 07/26/2007 08.59 FAX 850 838 8964 ABDInS. Construction LANDMARK AMERICAN INSURANCE COMPANY This Endorsement Changes The Policy. Please Read It Carefully_ ADDITIONAL INSURED BLANKET - PRIMARY This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE Name of Person or Organization: Any person or organization to whom or to which you are obligated by virtue of a written contract or by the issuance or existence of a written permit,to provide insurance such as is afforded by this policy. (lf no entry appears above, lnfom ation required to complete this endorsement will be shown in the Declarations as applicable to this endorsement) SECTION II -WHO IS AN INSURED is amended to include as en insured the person or organization shown in the SCHEDULE, but only with respect to liability arising out of"your work"for that insured by or for you. If you ere required by a written contract to provide primary insurance,this policy shall be primary as respects to your negligence and SECTION N— COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance does riot apply,but only with respect to coverage provided by this policy. This endorsement effecti 09/1512005 forms part of Policy Number LHA130487 issued to CALEB PAVING, INC_, GALEB PAVING CO. by Landmark American Insurance Company Endorsement No.; RSG 15001 0306 Includes copNrighted material of Insurance Services Office, Inc. 1954 (CG 2010 1185) with its permission