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HomeMy WebLinkAboutPerma Green Hydroseeding - Insurance CertificateOP ID: KT ACORO" CERTIFICATE OF LIABILITY INSURANCE �•.• -�� DATE 21'191/YYYY, 0 02/19/13 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 408 -842 -2131 Pacific Diversified Insurance 408 -842 -0867 Gilroy Office 9015 Murray Avenue #110 CONTACT PHONE FAX No EMAIL Gilroy, CA 95020 Barry E. Link PRODUCER pERMA -1 INSURERS AFFORDING COVERAGE NAIC # $ 1,000,00 INSURED Perma Green Hydroseeding, Inc. INSURER A: Associated Industries Ins. Co. 23140 Mitch 8r Janet Chuck INSURER B:American States Insurance Co. 19704 7096 Holsclaw Road Gilroy, CA 95020 INSURERc:Oak River Insurance Company 34630 $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP /OP AGG INSURER D: INSURER E: B AUTOMOBILE NSURFR F, rnVFRAr.FSR rr-RTIFICATF Nl1MRFR- 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 TYPE OF INSURANCE ADDL SUER p CY M R POLICY EFF POLICY EXP LIMITS rA GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X X,C,U Included X AES1024720 AES1024720 10/23/12 10/23/12 10/23/13 10/23113 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 MED EXP (Anyone person) $ Exclude PERSONAL a ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP /OP AGG $ 2,000,00 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 01C165301110 10/23/12 10/23/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ r PROPERTY DAMAGE (Per accident) $ x $ UMBRELLA LAB EXCESS LAB CLAIMS -MADE EACH OCCURRENCE $ HOCCUR AGGREGATE $ DEDUCTIBLE RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA I I 2200063641131 I 02/01/13 I 02/01114 X WC STATU- OTH- RV I IT R E.L. EACH ACCIDENT Is 11000,00 E. L. DISEASE - EA EMPLOYEd $ 1,000,00 E. L. DISEASE -POLICY LIMIT I $ 1,000,00 B Equipment Coverage 01CIG5301110 10/23/12 10/23/13 Rented Eq 100,00 Installat 25,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) City of Gilroy is named as Additional Insured with respects to the General Liability, per attached carrier endorsement, provided a written contract or agreement is in place. 10 days notice for non - payment of premium. rCDTICI!`ATC uM INCD rANCFI I ATInN CITYGIL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Roseanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE t ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: AES1024720 Commercial General Liability CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: All persons or organizations where required by written contract with the Named Insured (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II —Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations per- formed for that insured. B. With respect to the insurance afforded to these Additional insureds, the following exclusion is Added: 2. Exclusions This insurance does not apply to "bodily in- jury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the addi- tional insured(s) at the site of the cov- ered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project. COMMERCIAL GENERAL LIABILITY POLICY NUMBER: AES1024720 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organizations: All persons or organizations where written contract with the Named Insured requires the 11/85 edition. This form does not apply to your work on "residential property ". (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an 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 ARE REQUIRED by a written contract to provide primary insurance, this policy shall be primary as respects your negligence and condition. Other insurance does not apply, but only with respect to coverage provided by this policy. CG20101185 OP ID: NA ACS /R�� �- CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) DATE 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 408 - 842 -2131 Pacific Diversified Insurance 408- 842 -0867 Gilroy Office 9015 Murray Avenue #110 Gilroy, CA 95020 Barry E. Link NAME: CONTACT PHONE FAX A/c No Ext : A/C No): A DRIESS: PRODUCER CUSTOMER ID #: PERMA -1 INSURER(S) AFFORDING COVERAGE NAIC # EACH OCCURRENCE INSURED Perma Green Hydroseeding, Inc. INSURER A: Associated Industries Ins. Co. 23140 Mitch & Janet Chuck INSURER B: American States Insurance Co. 19704 7096 Holsclaw Road INSURER C:Oak River Insurance Company 34630 Gilroy, CA 95020 INSURER D GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC INSURER E: $ 2,000,00 INSURER F: B AUTOMOBILE CnVFRAr:FSi CFRTIFICATF 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 LTR TYPE OF INSURANCE ADD R POLICY NUMBER MM /DD/YYYY MM /DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 41 OCCUR X X,C,U Included X Gilroy, CA 95020 AES1024720 AES1024720 10/23/12 10/23112 10/23/13 10123/13 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence) $ 100,00 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO LOC PRODUCTS - COMP /OP AGG $ 2,000,00 $ B AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON- OWNEDAUTOS 01 C165301110 10/23/12 10/23/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE Y/N OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 2200063641131 02/01/13 02/01/14 X TWO YS OTH- T RY LIMIT ER E. L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 B Equipment Coverage 01CI65301110 10/23/12 10/23/13 Rented Eq 100,00 Installat 25,00 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) The City of Gilroy is named as Additional Insured with respects to the General Liability, per attached carrier endorsement, provided a written contract or agreement is in place. 10 days notice for non - payment of premium. CFRTIFICATF Idol nFR CANCELLATION CITYOFG SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Chris Westke 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 - ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD OP ID K ACORD CERTIFICATE OF LIABILITY INSURANCE PERMA -1 DATE (MMIDDIYYYY) 02/01/10 PRODUCER Pacific Diversified Insurance THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Gilroy Office 9015 Murray Avenue #110 HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. TYPE OF INSURANCE POLICY NUMBER Gilroy CA 95020 Phone:408- 842 -2131 Fax:408- 842 -0867 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers property Casualty INSURER B. EACH OCCURRENCE Perma Green Hydroseeding, Inc. Mitch & Janet Chuck 7096 Holsclaw Road Gilroy CA 95020 INSURER C. $ INSURER D. X INSURER E: rnVFRA!_FC 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. LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MMIDDIYY POLICY EXPIRATION DATE MM /DD/YY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ PREMISES (Ea occurence) $ X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ CLAIMS MADE D OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ PRO-LOC POLICY JECT AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE (Per accident) $ -. GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO $ AUTO ONLY: AGG EXCESS /UMBRELLA LIABILITY EACH OCCURRENCE $ AGGREGATE $ OCCUR CLAIMS MADE $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND X TORY LIMITS ER E.L. EACH ACCIDENT $1,000,000 - --- - $ 1 , 000 , 000 A EMPLOYERS' LIABILITY ANY PROPRIETQR/PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? XJUB3400T81310 02/01/10 02/01/11 - - - -- -- -- - - - - -- E.L. DISEASE - EA EMPLOYEE If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT 1 $ 1 , 000 , 000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Operations of the Insured for the Certificate Holder. Only 10 days notice of cancellation in the event of non - payment of premium. CFRTIFICATF HOI I)FR CANCELLATION ACORD 25 (2001108) UAL;URD L;UKNUKAI IUN 19tftf SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN The City of Gilroy NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Attn : Risk Management Dept. 7351 Rosanna St. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Gilroy CA 95020 REPRESENTATIVES. AU SE e = ACORD 25 (2001108) UAL;URD L;UKNUKAI IUN 19tftf OP ID: KT A�C7R° CERTIFICATE OF LIABILITY INSURANCE F DAT 10 /25DtYYYY) 10!25/11 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 Pacific Diversified Insurance 408 - 842 -2131 Gilroy Office 408 - 842 -0867 9015 Murray Avenue #110 Gilroy, CA 95020 Barry E. Link CONTACT NAME: PHONE FAX No)' xt: E -MAIL ADDRESS, PRODUCER PERMA -1 CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # LIMITS INSURED Perma Green Hydroseeding, Inc. Mitch & Janet Chuck 7096 Holsclaw Road Gilroy, CA 95020 INSURER _A :Alterra Excess & Surplus Ins. _ INSURER B:American States Insurance Co. INSURER c. Travelers Property Casualty t EACH OCCURRENCE J Y 1,000.00 A INSURER D' X INSURER E: MAX2GL0002135 10/23/11 INSURER F DAMAGE TO RL Jf1ED PRELVIIS S (Ea ucuurrenue) COVERAGES CFRTIFICATF NLIMRFR• oCtnernnt nuII%Ji o• 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 R TYPE OF INSURANCE ADDL MAP SUBR VJVn POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE J Y 1,000.00 A rX COMMERCIAL GENERAL LIABILITY X MAX2GL0002135 10/23/11 10/23/12 DAMAGE TO RL Jf1ED PRELVIIS S (Ea ucuurrenue) s loo oo � �.LAIMS -MADE ( X-) OCCUR MED XP "Any o,.. pery Exclude X X.C,U Included _ IMAX2GL0002135 10/23/11 10/23112 -- - - -_ r 1.000.001' _ rr_t< I IH ,x SI n -- A-3 RC GA. E GENT "GGREGATE LIMIT APPLIES PER _GENERAL. PRODUCTS 2,000.0010 C X .111 t. 'y r 7 PRO- -1 L.00 AUTOMOBILE LIABILITY j COMEINED SINGLE LIMIT 5 1,000,00 B X .ANY ,ALTO j 01CG2473880 10/23/11 10/23/12 IEaacc!dent, - -- - - - - -- BODILY INJURY (Pei person) ALL OWNED AUTOS eODILV IN_IURV SCHEDULED AUl "OS PROPERTY DAMAGE X HIRED AUTOS (Per accident) X NON-OWNED AUTOS UMBRELLA LIAB ')CC1 JR I I EPCH Or GURFt rJ :F PV.CESS LIF.B I I - LR DI.,D UCT I6Lr- ENTiOrl $ WORKFRSCOMPENSATION li WC STATU- OTH- X AND EMPLOYERS' LIABILITY Y / N i TORY" LIMITS — ER E.I_ EACH ACCIDENT 1,000,00 G IANY PROPRIETOR /PARTNER /EXECUTIVE ❑ 11FFK LNfIVILMBER EXGLUUEU! N I A iXJUB340OT81311 02/01/11 02/01/12 (Mandatory in NH) EL.DISEASE - EA EMPLOYE ¢ 1,000,00 If yes, describe under I DESCRIPTION OF OPERATIONS below - - -_ - - -- - -- C.L. DISEASE - POLICY LIMIT - - - - - -- c, 1,000.00C B JEquipment Coverage 01CG2473880 101231 11 10/23!12 Rented Eq 100.00 Installat 25,00 DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (Attach ACORD iC1, Additanal R ma , 5 A,j!e, ..t r. c,:, spa:;e is recluired) The Certificate Holder is named as an Additional Insured per the CG 033 07104 & CG2037 07104 forms attached for commercial work. Only -10 days notice of cancellation in the event of non - payment of premium. City of Gilroy Attn: Chris Westke 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 O 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009iO9) The ACORD mama and iogo are r egistti marks rjP A.r:ORD POLICY NUMBER: MAX2GL0002135 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS- COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations Information required to complete this Schedule. If not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liabilityfor "bodily injury" or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 POLICY NUMBER: MAX2GL0002135 COMMERCIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or or- ganization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an addi- tional insured on your policy. Such person or or- ganization is an additional insured only with re- spect to liability for "bodily injury ", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on ynur behalf; in the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are com- pleted. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury ", "property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying ser- vices, including: a. I he preparing, approving, or tailing to pre- pare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifica- tions; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per formed by or on behalf of the additional in- sured(s) at the location of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontrac- tor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 O ISO Properties, Inc., 2004 Page 1 of 1 PERMA -1 OP ID: NA Ia,. O CERTIFICATE OF LIABILITY INSURANCE �� DATE 11 /05D/YYYV) 11 /05112 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 408 - 842 -2131 Pacific Diversified Insurance 408- 842 -0867 Gilroy Office 9015 Murray Avenue #110 Gilroy, CA 95020 Barry E. Link CONTACT NAME: PONE o t FAX (A/C. No): ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA:American States Insurance Co. 19704 INSURED Perma Green Hydroseeding, Inc INSURER B:Travelers Property Casualty $ 1,000,00 Mitch & Janet Chuck 7096 Holsclaw Road INSURER C:Associated Insustries Ins. Co. C X COMMERCIAL GENERAL LIABILITY X Gilroy, CA 95020 INSURER D: 10/23112 10/23/13 CLAIMS -MADE Fx_1 OCCUR INSURER E: 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. 1 TR TYPE OF INSURANCE ADDLSUBR POLICYNUMBER POLICVEFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 100,00 C X COMMERCIAL GENERAL LIABILITY X AES1024720 10/23112 10/23/13 CLAIMS -MADE Fx_1 OCCUR MED EXP (Any one person) $ Exclude PERSONAL & ADV INJURY $ 1,000,00 X XCU Included GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMITAPPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,00 POLICY X PRO LOC I I $ AUTOMOBILE LIABILITY COMBINED S INGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A X ANYAUTO 010165301110 10/23/12 10/23113 ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTYDAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ HCLAIMS-MADE AGGREGATE $ EXCESS LIAB DIED I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE Y OFFICER /MEMBER EXCLUDED? (Mandatory in NH) N / A XJUB340OT81312 02101/12 02/01/13 X I WC STATU- OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEd $ 1,000,00 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 1 X000 00 $ , A Equipment Coverage 01C165301110 10/23/12 10/23113 R /B /L 100,00 linstl Flt 50,00 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) The City of Gilroy is named as Additional Insured with respects to the eneral Liability, per attached carrier endorsement, provided a written contract or agreement is in place. 10 days notice for non - payment of premium. CERTIFICATE HOLDER CANCELLATION CITYOFG 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. Attn: Chris Westke 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE uz�f ACORD 25 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: AES1024720 Commercial General Liability CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: All persons or organizations where required by written contract with the Named Insured (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II — Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations per- formed for that insured. B. With respect to the insurance afforded to these Additional insureds, the following exclusion is Added: 2. Exclusions This insurance does not apply to "bodily in- jury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the addi- tional insured(s) at the site of the cov- ered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another con- tractor or subcontractor engaged in performing operations for a principal as a part of the same project. COMMERCIAL GENERAL LIABILITY POLICY NUMBER: AES1024720 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED — OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Person or Organizations: All persons or organizations where written contract with the Named Insured requires the 11/85 edition. This form does not apply to your work on "residential property ". (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an 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 ARE REQUIRED by a written contract to provide primary insurance, this policy shall be primary as respects your negligence and condition. Other insurance does not apply, but only with respect to coverage provided by this policy. CG20101185