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HomeMy WebLinkAboutInsurance CertificateAMERCOM -01 JMYDLARCZYK CERTIFICATE OF LIABILITY INSURANCE °AT° 7/22/2N015 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,pollcy(les) 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 endomement(s). PRODUCER License # CA#0658748 AHT IDSUr8nCB One Eveitrust Plaza Suite 1202 Jersey City, NJ 07302 CONTACT NAME: PHONE 703 7772341 a A/c No: (703) 771 -1852 E-MAIL _ ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER'A:Great Northern Insurance Company 20303 EACH OCCURRENCE INSURED INSURER 3: Federal Insurance Company 20281 AmeriNational Community Services INSURER c: Chubb Indemnity Insurance Company 12777 INSURER D: Colony Insurance Company 39993 217 S. Newton Avenue Albert Lea, MN 56007 . .. INSURER E: - POLICY ECTT LOC IOTH L AGG REGATE LIMIT APPLIES PER: ER:. _ INSURER F: $ 2,000,00 PRODUCTS-- COMP/OPAGG 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 CONTRACTOR 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 O_ F SUCH POLICIES.. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ INSR LTR TYPE OF INSURANCE -- POUCYNUMBER POLICY EF MM/DD IYYYY) POLICY (MMIDONYM LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X 36031757 05/29/2015 0512912016 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 1,000,00 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,00 POLICY ECTT LOC IOTH L AGG REGATE LIMIT APPLIES PER: ER:. _ GENERAL AGGREGATE $ 2,000,00 PRODUCTS-- COMP/OPAGG $ 2,000,00 - - - - -S - -- - -- - - A AUThMOBILEUABIUTY' ANY AUTO ALL OS SCHEDULED AUTOS AUTOS NON- OWNED HIRED AUTOS X AUTOS - 73588835 0512912015 0512912016 COMBINED SINGLE LIMIT Ea'axident is - - - -- 1,000,00 BODILY INJURY (Per. person) $ .. -- - X BODILY INJURY (Per accident) - $ _ PROPERTY DAMAGE peracddent $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 79898650 0512912015 05/2912016 EACH OCCURRENCE $ 5,000,00 AGGREGATE S 5,000,00 OED RETENTIONS $ C ANY PROPRIETOR/ EXCLUDE/EXECUTIVE Y OFYPER/MEM EXCLUDED? N (Mandatory in NH) If yes;.deauibe under. DESCRIPTION OF OPERATIONS'. below N/A 77171555 0512912015' 05/29/2016 E. STATUTE. ER E.L. EACH ACCIDENT $ 1ti000,00 E.L. DISEASE —EA EMPLOYE $ 1,000,00 E. L. DISEASE - POLICY LIMITJ $ '1,000,00 D Managment Liability ML 7601398 -00 05/2812015 05/2912016 See Next Page - -- DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Addkional RemaAcs'Sehedule, may M attached If more space is required)" ' — General Liability, Automobile Liability and Umbrella Liability include OSP as a Named insured— SEE:ATTACHED ACORD 101 ,c nWc M SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE ,EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna St ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE 0 1988- 2014,ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD � 1 ACOREP" AGENCY CU_ STOMER ID: AMERCOM -01 LOC #: 1 ADDITIONAL REMARKS SCHEDULE JMYDLARCZYK Page 1 of 1 AGENCY License # CA#0658748 ,NAMED INSURED HT Insurance AmeriNational Community Services 217 S.. Newton Avenue Albert Lea, MN 66007 POLICY NUMBER EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECnVE HATE: EE _ THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD35 FORM TITLE: Certificate of Liability_Insurance Description of,OperationslLocationsNehicies: Managment Liability (D &O/EPLUFID) Maximum Aggregate Limit: $5,000,060 Directors &.Officers Liability (D &O) Limit: $3,006,060 Retention: $0/$150,000/$150,000 Employment 'Practices Liability (EPLI) Limit: $2,000,000 Retention: $75,000 Fiduciary Liability (FID) Limit: $2,000,000 Retention: $50,000 Cyber Liability Policy Number: B0507 N1SFT05340 Carrier: Underwriters at Lloyd's, London Effective Dates: 05129%2015 -05/29/2016 Limits: $3,060,000 Retention: $10,060 Errors & Omissions Liability: Policy Number B0507 N16FT05350 Carrier: Underwriters at Lloyd's, London Effective Dates: 05/29 /2015 -05/29/2016 Limits: $3,560,060 Retention: $150,000 Mortgage Bond: Policy; Number: MBB -14 -00013 Carrier Undenivriters'.at Lloyd's, London Effective Dates: 08/01/2015 6 05/29/2016 Limits: $6,500,000 Deductible: $50,000 Certificate Holder, its officers, representatives, agents and employees are included as Additional Insureds under the General Liability as required by written contract perform #80 -02 -2367 (05107). 101 (2008101) © 2008 ACORD CORPORATION. All The ACORD name and logo are registered marks of ACORD lAMERINATIONAL CoMMUNMSERVICEs July 23, 2015 TO: Certificate Holder FROM: Bobbi J. Hobbie, Executive Assistant A RE: Certificate of Liability Insurance for coverage with AmeriNational This letter is to inform you that AmeriNational has switched insurance producers from Maguire Agency to AHT Insurance for our Mortgage Bankers Bond effective 08/01/15. Enclosed is a revised insurance certificate from AHT Insurance reflecting the addition of the Mortgage Bankers Bond policy effective 8/1/2015 — 5/29/2016. Please be aware that you may be receiving a cancellation notice from Maguire Agency as we have cancelled our policy with them. There has been no lapse of coverage. The attached certificate of insurance is now the only certificate of insurance that you will have for your insurance coverage with AmeriNational. Your previous policies with McNamara Company and Maguire Agency have been cancelled. Please feel free to contact me at 866 -779 -5504 or via email at bhobbie @amerinational.net if you have any questions. (888) 263 -7628 • (507) 377 - 6030.217 S Newton Ave., Albert Lea, MN 56007 • www.amerinational.net Quality Through Innovation and Experience AMER -11 OP ID: GC A�oR° CERTIFICATE OF LIABILITY INSURANCE �r D06 /08 /2015 Y) 06/08/2015 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 Phone: 651-426-0607 McNamara Company Fax: 651 - 426 -5790 WWW.mCnamdraCOmpdny.COm 1330 East Highway 96 St Paul, MN 55110 CONTACT NAME: PHONE FAX A/C No Ext: A/C No: E -MAIL ADDRESS: 35800320 08101/2014 Patrick K. McNamara INSURERS AFFORDING COVERAGE NAIC # INSURER A: Chubb Group of Ins Co A ++ $ 1,000,00 MED EXP (Any one person) INSURED AmeriNational Community INSURER B: NAIC: 20303 $ 1,000,00 Services Inc, American Bank of St. Paul Inc INSURER C GENERAL AGGREGATE INSURER D: GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO X LOC 217 South Newton Ave INSURER E : Mtg Prot Albert Lea, MN 56007 INSURER F: AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS Ix NON -OWNED AUTOS COVERAGES CERTIFICATE Nt]MRFR- RFVIRInN N1111i 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. ILTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER MM /DDNYYY MM /DDmYY LIMITS • GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FXI OCCUR • Mtg Protection 35800320 08101/2014 08101/2015 EACH OCCURRENCE $ 1,000,00 A P DREAMMISES G 0 RE Ea occurrence $ 1,000,00 MED EXP (Any one person) $ 5,00 PERSONAL& ADV I NJ URY $ 1,000,00 • Inc Contract Liab GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO X LOC PRODUCTS - COMP /OP AGG $ 2,000,00 Mtg Prot $ 3,000,00 • AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS Ix NON -OWNED AUTOS 74983745 08101/2014 08/01/2015 COMBINED SINGLE LIMIT Ea accident 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ • X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE 79813523 08/01/2014 08101/2015 EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,00 DED I X I RETENTION $ 10,000 $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER7MEMBER EXCLUDED? L J (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 71712722 (CALIFORNIA) 71712593 (MN, KS, FL, MD) 12/31/2014 1213112014 12/31/2015 12/31/2015 X WC STATU- OTH- E.L. EACH ACCIDENT $ 500,00 1 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICL (A 7 o rwftule, I ore Certificate Holder is named as coverage. 55143 1 15 CERTIFICATE HOLDER CONCFI I OTInN GILROY1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy y y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. its officers, representatives, agents and employees 7351 Rosanna St AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD AMERCOM -01 JMYDLARCZYK , ila e " CERTIFICATE OF LIABILITY INSURANCE �� DATE D/YYYY) 6/1/2015 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 Iieu of such endomement(s). PRODUCER License # CA #0658748 AHT Insurance One Evertrust Plaza Suite 1202 Jersey City, NJ 07302 .NAME: CT - PHONE FAX A1C No E><c : (703) 777 -2341 A/C Nb . (703) 7714852 E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE - _ NAIC S INSURER A: Great Northern Insurance Company 20303 EACH OCCURRENCE INSURED INSURER B: Federal Insurance Company 20281 INSURER C: Chubb IndemniV Insurance Company, 12777 AmeriNational Community Services INSURER D: Colony Insurance Company 39993 217 S.. Newton Avenue Albert Lea, MN 56007 INSURER E: GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [:] JE O- XX- LOC OTHER: INSURER F.: $ 2,000idO PRODUCTS - COMPIOP AGG 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 RTHE 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 INSD WVD POLICY NUMBER POLICY EFF MMMO POLICY EXP MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR X 36031757 05/29/2016 0512912016 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence $ 11000,00 MED EXP (Any one person) $ 10;099 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [:] JE O- XX- LOC OTHER: GENERAL AGGREGATE $ 2,000idO PRODUCTS - COMPIOP AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 73588835 05/29/2015 05/29/2016 CEO eBIINN D SINGLE LIMIT .1,000,00 BODILY INJURY (Per person) $ X BODILY - INJURY(Peracddent) $ PROPERTY DAMAGE Per accident $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 79898650 05/29/2015 05/29/2016 EACH OCCURRENCE S 5,000,00 AGGREGATE $ 5,000,000 DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ (Mandatory In NH) If yes, desaibe under DESCRIPTIONOFOPERATIONS below NIA 77171555 0512912015 0611912016. X PER OTH- STATUTE ER. E.L. EACH ACCIDENT $. 1,000,00 - E.L. DISEASE - EA EMPLOYEO $ 1,000,00 E.L DISEASE- .POLICY.LIMIT_. b - 1,000,000 D Managment Liability ML 7601398 -00 06/29/2015 05/29/2016 See Next Page DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES pxokc 101,. Additional Remarks Schedule, may be attached H more space is required) '""'"'General Liability, Automobile Liability and Umbrella Liability include OSP as a Named Insured— SEE ATTACHED ACORD 101 City of Gilroy 7351 Rosanna St Gilroy, CA 95020 ACORD 25 (2014101) VANUr_LLA 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 The ACORD name and logo are registered marks of ACORD TION. All rights reserved ACORV' AGENCY CUSTOMER ID: AMERCOM -01 LOC 0: 1, ADDITIONAL REMARKS SCHEDULE JMYDLARCZYK Page 1_ of 1_ AGENCY License # CA#0658748 NAMED INSURED HT insurance AmerlNationalCommunity Services 217 S. Newton Avenue Albert Lea, MN 56007 POLICY NUMBER EE PAGE 1 CARRIER NAIL CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE:. SEE PAGE I ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations/LocationsNehicles: Managment Liability (D &O/EPLUFID): Maximum Aggregate Limit: $5,000,000 Directors & Officers Liability (D&O). Limit: $3,000,000 Retention:$0/$150,0001$150,000 Employment Practices Liability (EPLI) Limit: $2,000,000 Retention: $75,000 Fiduciary Liability (FID) Limit: $2,000,000 Retention: $50,000 Cyber Liability Policy Number: 80507 N15FT05340 Carrier: Underwriters at Lloyd's, London Effective Dates: 05/29/2015 -05/29/2016 Limits: '$3,000,000 Retention: $10,000 Errors & Omissions Liability: Policy Number. 80507 N15FT05350 Carrier: Underwriters at .Lloyd's, London Effective Dates: 0512912015 -05/29/2016 Limits: $3,506,000 Retention: $156,000 Certificate Holder, Its officers, representatives, agents and employees are included as Additional Insureds under the General Liability as required by written contract per form #80 -02 -2367 (05/07). ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AMERINATIONAL COMMUNITY SERVICES, INC. June 4, 2015 City of Gilroy 7351 Rosanna St. Gilroy, CA 95020 To Whom It May Concern: This letter is to inform you that AmeriNational has switched insurance producers and carriers for various policies effective 5/29/15. The Maguire Agency will remain the producer for the existing Mortgage Bankers Bond and Mortgagee E &O policy effective through 08/01/2015. AHT Insurance is the new provider for the following coverages: • Commercial General Liability • Automobile Liability • Workers Compensation Liability • Umbrella Liability • Cyber Liability • Management Liability • Directors & Officers Liability • Employment Practices Liability • Fiduciary Liability • Errors & Omissions Liability You will have two Certificate of Insurance forms for your coverage with AmeriNational Community Services; one from AHT Insurance and one from Maguire Agency. Enclosed you will find a Certificate of Insurance from AHT Insurance for the above mentioned policies. Since the Mortgage Bankers Bond policy has not changed, we did not include another insurance certificate for that policy at this time. Please feel free to contact me at 866 - 779 -5504 or via email at bhobbiea_amerinational.net if you have any questions. Sincerely, Bobbi J. Hobbie Executive Assistant Enclosure (888) 263 -7628 • (507) 377 -6030 • Fax: (562) 745 -1281 • 217 S. Newton Ave., Albert Lea, MN 56007 • www.amerinational.net Quality Through Innovation and Experience AMER-11'_ .._. 0P IW GC., .. _ ACOOPR15% CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/04/2014 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 Phone:. 651 -426 -0607 NAME CT McNamara Company www.mcnamaracompanycom Fax: 651-426-5790 1330 East Highway 96 St Paul, MN 55110 PHONE FAX c N, Ext : A/c No): ADDRESS: 08/0112014 08/01/2015 Patrick K. McNamara INSURERS AFFORDING COVERAGE NAIC # INSURER A: Chubb Group of Ins Co A ++ MED EXP (Any one arson $ 5,00 INSURED AmeriNational Community INSURER B:NA1C: 20303 X Services Inc, American Bank of St. Paul Inc' INSURER C: $ 1,000,00 - GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- X LOC PRODUCTS - COMP /OP AGG 217 South Newton Ave INSURER D: $ 3,000,00. INSURER E: AUTOMOBILE LIABILITY X ANY AUTO ALL OW NED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS Albert Lea, MN 56007 INSURER F: 74983745 08/01/2014 CnVFRArFC CFRTIFIr`ATF NI IMRFR• RFVISinN MIi1111RFR -- 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 L POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDDIYYYY LIMBS A ' GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fil OCCUR X Mtg Protection 35800320 08/0112014 08/01/2015 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurre ce $ 1,000,000 MED EXP (Any one arson $ 5,00 PERSONAL& ADV INJURY $ 1,000,00 X Inc Contract Liab GENERAL AGGREGATE $ 1,000,00 - GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- X LOC PRODUCTS - COMP /OP AGG $ 1,000,000 Mtg Prot $ 3,000,00. A AUTOMOBILE LIABILITY X ANY AUTO ALL OW NED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 74983745 08/01/2014 08/01/2015 COMBINED SINGLE LIMIT Ea accident 1000000 r - + . BODILY INJURY (Per person) .$ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Pera�GdenI) $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 79813523 08/0112014 08101/2015 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 1o,0oo,0oo DED_ X_. RETENTION$ 10,000 $ • • 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. NIA 71712722 (CALIFORNIA) 71712593 (MN, KS, FL, MD) 112/31/2014, 12/31/2014 12/3112015 12/31/2015 X WCSTATU- OTH- I TORY LIMITS _ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS /LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule,. If more space Is required) Certificate Solder is named as additional insured for General Liability coverage. GILROYI City of Gilroy its officers, representatives, agents and employees 7351 Rosanna St 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 0 ACORD CORPORATION. All riahts reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AMER -04 OP ID: M1 AC ®RO- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD1YYYY) 09/2412014 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 Maguire Agency 1935 West County Road B -2, #241 Roseville, MN 55113 'Jeff Erager, CPCU Jeff Era er, CPCU -NAME: PHONE FAX ac No Ext : 651- 638 -9100 A/C No): 651 - 638 -9762 E-MAIL ADDRESS: jerager@maguireagency.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Houston Specialty Ins CO INSURED AmeriNational Community INSURER B: Underwriters At Lloyds London EACH OCCURRENCE Services Inc 217 S Newton Avenue INSURER C: Travelers Casualty & Surety Co CLAIMS -MADE F OCCUR Albert Lea, ION 56007 INSURER D: INSURER E : DAMAGE TO RENTED PREMISES. Ea occurrence) $ INSURER F: MED EXP (Any one person) $ 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 LTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF MM /D POLICY EXP MM/DD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE F OCCUR DAMAGE TO RENTED PREMISES. Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO LOC JECT PRODUCTS - COMP /OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION PER OTH- I AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N/A STATUTE ER E:L EACH ACCIDENT $ E. L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ A Management HFIN0100002501 09/24/2014 09/24/2015 Aggregate 5,000,00 Liability-See Pg 2 I CLAIMS MADE -RETRO 8/1/02 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SEE PAGE 2 FOR ADDITIONAL COVERAGES. City of Gilroy, its officers, representatives, agents 8r employees 7351 Roaanna Street Gilroy, CA 95020 ACORD 26 (2014101) XGILROY 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 %4 Y, ` ° � Cc� 1988 -201 The ACORD name and logo are registered marks of ACORD riahfs rPCPrvPd AMER -11 OP ID: JT CERTIFICATE OF LIABILITY INSURANCE 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 LTR DATE 0 712 412 0 1 YY) 07/24/2014 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 Phone: 651 -426 -0607 McNamara Company Fax: 651 - 426 -5790 www.mcnamaracompany.com 1330 East Highway 96 St Paul, MN 55110 CONTACT NAME: PHONE FAX C o Ext : A/C No ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Patrick K. McNamara INSURER A: Chubb Group of Ins CO A ++ PREMISES Ea occu ence $ 1,000,00 INSURED AmeriNational Community INSURER B. NAIC: 20303 PERSONAL & ADV INJURY Services Inc, American Bank of St. Paul Inc INSURERC: Inc Contract Liab GENERAL AGGREGATE $ _ _ 7,000A0. 217 S Newton Ave INSURER D: $ 1,000,00 INSURER E: $ 000,00 Albert Lea, MN 56007 INSURER F: LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 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 LTR TYPE OF INSURANCE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM /DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FK! OCCUR • Mtg Protection 35800320 08/01/20141, 0810112015 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occu ence $ 1,000,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,0.0. 0,OQ_ • Inc Contract Liab GENERAL AGGREGATE $ _ _ 7,000A0. GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7 PRO - FX1 Loc PRODUCTS - COMP /OP AGG $ 1,000,00 Mtg Prot__ $ 000,00 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 74983745 0810112014 08101/2015 COMBINED SINGLE LIMIT Ea accident 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) - $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE 79813523 08/01/2014 08/0112015 EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,00 DED I X 11 ' ,RETENTION $ 10,000 $ A A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/ N OFFICER/MEMBER EXCLUDED? a (Mandatory In NH) If yyes, describe under DESCRIPTION.OF OPERATIONS below N/A 71712722 (CALIFORNIA) 71712593 (MN, KS, FL, MD) 08/27/2014 08/01/2014 12/31/2014 12/3112014 X I WC STATU- 0TH- DRY LIM T:S E:L. EACH ACCIDENT $ 500,00( E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT i $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Certificate Holder is named as additional insured for General Liability coverage. CERTIFICATE HOLDER CONrFI 1 OTInN GILROY1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gil ty Gilroy its officers, representatives, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. agents and employees 7351 Rosanna St AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD cIc �u�B Liability Insurance Endorsement Policy Period AUGUST 1, 2014 TO AUGUST 1, 2015 Effective Data AUGUST 1, 2014 Policy Number 3580 -03 -20 DMO Insured AMERICAN BANK OF ST PAUL AMERINATIONAL COMMUNITY SERVICES INC Name of Company GREAT NORTHERN INSURANCE COMPANY Date Issued JULY 28 2014 This Endorsement applies to the following forms: GENERAL LIABILITY Under Who Is An Insured, the following provision is added: WHO IS AN INSURED Designated Person Or Organization Any person or organization designated below is an insured; but they are insureds only with respect to Iiability arising out of your operations or premises owned by or rented to you. City of Gilroy, it's officers, representatives, agents and employees 7351 Rosanna Street Gilroy, CA 95020 Insurance is primary and non - contributory All other terms and conditions remain unchanged. Authorized Representattva Llab111ty Insurance ADDL INS - SCHEDULED PERSON OR ORGANIZATION last page Form 80-02 -2373 (Ed 4-94) Endorsement Page 1 AMER -04 OP ID: SH ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DDNYYY) 10/08/13 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 651- 638 -9100 NAAME: Jeff Era er Maguire Agency 651 - 638 -9762 1935 West County Road B -2, #241 Roseville, MN 55113 Jeff Erager, CPCU PHONE 651 - 635 -2724 FAX Na:651- 638 -9762 Arc No EM E-MAIL ADDRESS: era er ma uirea enc .com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Houston Specialty Ins Co INSURED American Bancorporation; INSURER B: Berkley Regional Insurance Co AmeriNational Community Services Inc; American Bank of INSURER C: Travelers Insurance Companies 28188 INSURER D: St. Paul 1060 Dakota Drive Mendota Heights, MN 55120 INSURER E: $ CLAIMS -MADE F-1 OCCUR 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 LTR TYpE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ CLAIMS -MADE F-1 OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ $ POLICY PRO LOC AUTOMOBILE LIABILITY (CE SINGLE LIMIT Ea M accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY �,/ N WC STATU- OTH- E ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? F—] NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ A Management HFIN0100002500 09/24113 09/24114 Aggregate 5,000,00 Liability-See Pg,2 CLAIMS MADE -RETRO 8/1102 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) SEE PAGE 2 FOR ADDITIONAL COVERAGES. L"gNIIaP1L\I;4i Lai 1151gil XGILROY City of Gilroy, its officers, representatives, agents & employees 7351 Roaanna 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 tw"" '�_ ` < � ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AMER -04 OP ID: M1 CERTIFICATE OF LIABILITY INSURANCE 1 DATE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 09/30/13) 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 651- 638-9100 NAME: Jeff Era er Maguire Agency 651- 638 -9762 1935 West County Road B -2, #241 PHONE 651 -635 -2724 AIC No: 651- 638 -9762 ruc No Ext E-MAIL ADDRESS: era er ma uirea enc .com Roseville, MN 55113 Jeff Erager, CPCU EACH OCCURRENCE $ INSURERS AFFORDING COVERAGE NAIC # INSURER A: Houston Specialty Ins Co INSURED American Bancorporation; INSURER B: Berkley Regional Insurance Co DAMAGE TO RENTED PREMISES Ea occurrence Amvices Inc; Community Services Inc; American Bank of INSURER C: Travelers Insurance Companies 28188 INSURER D : CLAIMS -MADE F—I OCCUR St. Paul 1060 Dakota Drive Mendota Heights, MN 55120 INSURER E : PERSONAL & ADV INJURY $ INSURER F r1n%1P0A(,`.FC (`I:RTIFIrATF NI IMRPR• 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. I R LTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER MM DY/YYYY D MMIDD EXP LT LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ CLAIMS -MADE F—I OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ $ POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS PROPERTYDAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ IT $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR /PARTNER/EXECUTIVE WC STATU- OTH- RY L E E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? F-1 N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below A Management HFIN0100002500 09124/13 09124114 Aggregate 5,000,00 Liability-See Pg 2 CLAIMS MADE -RETRO 811/02 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) SEE PAGE 2 FOR ADDITIONAL COVERAGES. CERTIFICATE HOLDER CANCELLATION XGILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy, its officers, THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. representatives, agents & employees 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010105) The ACORD name and logo are registered marks of ACORD OP ID: AS ,d►�oR °c CERTIFICATE OF LIABILITY INSURANCE 1 DAr08 /O2I 3YY) 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 651 -426 -0607 CONTACT NAME: McNamara Company www.mcnamaracompany.com 651 - 426 -5790 1330 East Highway 96 St Paul, MN 55110 Patrick K. McNamara PHONE FAX A/c No Ext : A/C No): A DRIESS: PRODUCER AMER -11 CUSTOMER ID #: INSURERS AFFORDING COVERAGE NAIC # $ 1,000,00 INSURED AmeriNational Community INSURER A: Chubb Group of Ins. Co. (A++) MED EXP (Any one person) INSURER B: NAIC: 20303 PERSONAL BADVINJURY Services Inc, American Bankcorporation, American Bank of St Paul Inc 217 S Newton Ave INSURERC: GENERAL AGGREGATE INSURER D GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO X LOC PRODUCTS - COMP /OP AGG $ included Albert Lea, MN 56007 INSURER E : A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS INSURER F 74983745 rnvvown_vc ,^FDTICICATF Pill IMRFa• REVISION NLIMBER: vTHIS 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/YYYY POLICY EXP MM /DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_v] OCCUR X Mtg Protection Gilroy, CA 95020 0 35800320 35800320 08/01/13 08/01/13 08/01/14 08/01/14 EACH OCCURRENCE $ 1,000,00 pREM SES ER occur ante $ 1,000,000 MED EXP (Any one person) $ 5,00 PERSONAL BADVINJURY $ 1,000,000 X Inc Contract Liab GENERAL AGGREGATE $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO X LOC PRODUCTS - COMP /OP AGG $ included Mtg Prot $ 3,000,000 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 74983745 08/01/13 08/01/14 COMBINED SINGLE LIMIT accident) $ 1,000,00 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 79813523 08101/13 08/01/14 EACH OCCURRENCE $ 10,000,00 AGGREGATE $ 10,000,00 DEDUCTIBLE RETENTION $ 10,000 $ X $ • • WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE ❑ OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A 71712722 (CALIFORNIA) 71712593 (MN, KS, FL, MD) 08/27/13 08/01113 08/27114 08/01114 WCS TATU OTH- X T RY LIMIT - X ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,000 E.L. DISEASE - POLICY LIMIT I $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is named as additional insured for General Liability coverage. t`COTICIP`ATF unl nGR CANCFI I ATION GILROY1 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. its officers, representatives, agents and employees AUTHORIZED REPRESENTATIVE 7351 Rosanna St Gilroy, CA 95020 0 © 1988 -2009 ACORD CORPORATION. All rights reserved. ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD Liability Insurance ci -tweet Endorsement Policy Period AUGUST 1, 2013 TO AUGUST 1, 2014 AUGUST 1, 2013 Effective Date Policy Number 3580 -03 -20 DMO Insured AMERICAN BANCORPORATION, AMERICAN BANK ON ST. PAUL Name of Company GREAT NORTHERN INSURANCE COMPANY Date Issued AUGUST 9, 2013 This Endorsement applies to the following forms: GENERAL LIABILITY WHO IS AN INSURED Under Who Is An Insured, the following provision is added: Designated Person Or Organization Any person or organization designated below is an insured; but they are insureds only with respect to liability arising out of your operations or premises owned by or rented to you. City of Gilroy, it's officers, representatives, agents and employees 7351 Rosanna Street Gilroy, CA 95020 Insurance is primary and non- contributory All other terms and conditions remain unchanged. Authorized Representative Liability Insurance ADDL INS - SCHEDULED PERSON OR ORGANIZATION Form 80 -02 -2373 (Ed. 4 -94) Endorsement lastpage page i AMERCOM -A1 IYALCH /ACOO2De �_,_� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 05(MMIDDN7 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 ri hts to the,certiflcate holder in lieu of such'eodorsement(s). PRODUCERcLicense 8 CA#0658748 - RRIJACT AHT Insurance One Evertrust Plaza PHONE NC, No, Ela : (703) 777 -2341 A/c No): (703) 7714852. " X Suite 1202 Jersey City, NJ 07302 INSURERS AFFORDING COVERAGE NAIC A INSURER A: Great Northern Insurance Company 20303 INSURED INSURER 8: Federal Insurance Company 20281 INSURER C: Colony Insurance Company 39993 AmeriNational Community Services, LLC dba AmeriNat INSURER D: PERSONAL & ADV INJURY 217 S. Newton Avenue Albert Lea, MN 56007 .INSURER E GENERAL AGGREGATE INSURER.F : PRODUCTS- COMP/OPAGG Included CBVFRArFS CFRTIFIt ATIP NIIMRFR- RI= VIStnM IW INARCR- 4 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 AODL SUER POLICY NUMBER POLICY. EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE T OCCUR X 36031757 _ 05/29/2017 _ .. 05/29/2018 .... EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED ISES (Ea occurrence) $ 1,000,000 MED EXP,(Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY j LOC °.._ .. OTHER: GENERAL AGGREGATE 2,000,000 PRODUCTS- COMP/OPAGG Included _.. A AUTOMOBILE' LIABILITY ANY AUTO::'. , _.... _. -.... .. ' OWNED SCHEDULED AUTOOS ONLY" AUUTNOSy "yNEp AUTOS ONLY X AUTO ONLY 73588835. 0512812017 0512912018 COMBINED SINGLE LIMIT (Ea accident) 3 1,000,000 BODILY - INJURY Per: eison _ BODILY IN Per accident $ X (Moor p�dOent AMAGE B X UMBRELLA LIAB EXCESS LIAS �dl IOCCUR CLAIMS -MADE 79898650 05/29/2017 051`2912018 EACH OCCURRENCE 5,000,000 AGGREGATE 5,000,000 DED RETENTION :$ B — ANOD EMPLOYERS' UABIILITNY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN FFICERIM EXCLUDED? �N yes, describe In �i It es, eescribe under . .DESCRIPTION OF OPERATIONS below NIA 77171555 05/28/2017 05/29/2018 X STEARTUTE OTH- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE 1,000;000 E.L. DISEASE - POLICY LIMIT 1 000,000 . . _' _ __ C' Management Liability ML 760138842 05/29/2017 0512812018 See Next Page - DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101 Additional Remarks Schedule, may be attached H in apace Is required) — General Liability, Automobile Liability and Umbrella Liability Include OSP as a Named Insured— SEE ATTACHED ACORD 101 The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI of Gilroy y 7351 Rosanna St THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 85020 - AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ®1988 -2015 ACORD CORPORATION. All riahts reserved. The ACORD name and logo are registered marks of ACORD ACOREP" AGENCY CUSTOMER ID: AMERCOM -01 LOC a: 1 ADDITIONAL REMARKS SCHEDULE JYALCH Page 1 of 1 AGENCY HT Insurance _ License # CA#0658748 NAMED INSURED AmeriNational Community Services, LLC dba AmeriNat 217 S. Newton Avenue MN 56007 - USA voucY NuMaQi SEE EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIVE DATE: SEE PAGE 1 ;4a 'l►_A:I:�7 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability insurance Description of Operations/Locations/Vehicles: Management. Liability (D &O/EPLI/FID) Maximum Aggregate Limit: $5,000,000 Directors & Officers Liability (D &O) Limit: $3,000,000. Retention: $01$150,000/$150,000 Employment Practices Liability (EPLI) Limit: $2,000,000 Retention: $75,000 Fiduciary Liability (FID) Limit: $2,000,000 Retention: $50,000 Cyber Liability Policy Number. ASF17DO01692 Carrier: Underwriters at Lloyd's, London Effective Dates: 0512912017 -05/29/2018 Limits: $3,000,000 Retention: $10,000 Errors & Omissions Liability: Policy Number. B0507 N17FT09380 Carrier: Underwriters at Lloyd's, London Effective Dates: 05/29/2017 -05129_/2018 Limits: $3,500,000 Retention: $150,000 Mortgage Bond: Policy Number: MBBA -16 -00205 Carrier. Underwriters at Lloyd's; London Effective Dates: 05/29/2017 -05/29/2018 Limits: $8,500,000 Deductible: $50,000 Certificate Holder, its officers, representatives, agents and employees are included as Additional Insureds under the General Liability as required by written contract per form #80 -02 -2367 (05107) attached. ACORD 101 120081011 © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CHUBS° UaNifty Insurance Endorsement PO&7 POW MAY 29, 2017 TO MAY 29, 2018 EJfeciive Date MAY 29, 2017 Aunty Number 3603 -17 -57 ECE Insured OSP, LLC DRA OSRIEN- STANLEY PA,R7NE W Name of G xAmy [TREAT NORIUM DISURANCE COMPANY Bete Issued MARCH 9, 2017 This BOMMMent, applies to the Mowing t GENERAL LdABILM Under Who is An bmnvd, the Wowing providion is added Who to An Insured Add&lbi l Insured - POISON or MlXdzaftm shown m the Schedule are but they ar$ >ceorede only, It you. ere Scheduled Persian oblisaW pm cant to a contract or W== to pravide them with such woe as is aftded by Or Orgenlrslfan us pommy, However, the person or organization is an bssaead only: • if and titan only W this oxtett the person or cWAzadon is in the S lc, • to the I I ' ' I such contractor egraementmqutft the peaaon or oxgani»tonto be dh*d staaos as an banvd; • for activities that did not oaxn, in whole or in part, before the execution of the contractor agroenhent; and • with m dpmasos, las% cost or eapense For injury or damage to which this insaramx No pawn or mVmIWW is an ho wed under this p v4 d= • that is mace specifically identified under any other provision of the Who ra An bsured =don (retpudiessofany litwia app&ablethereto). ' with respect to any assumption of liabiHiy (of anotherperaoa or mgW1=11on)by them in a contractor agrnemaht. This iimiaton does not apply to the liability for damages, lass, cost or es x=for injury or damage, to which this inaunince gTliM that tho pesaou or ag miratan would have in the absence of auch contractor agrmient. LW ft bmurmme AdAMWk=W &ftdWsdPer W01OpgW on ROW 002367 (Rev. "7) Enda�aement -- t CHU' E3ET L(abMfy Endorsomsnt (oontinusd) Undw Otiadidaus.dw followingpmvidw is added to the cto dem titledOtbw Ium=c e. commons Other ftwxhnce — If you are obligated, pubot to acontractor ag=mout,to provide the pa= or won Prhrwyl shown In dte Sdodule wfdt primary i wmm each sa is affm&d by this policy, dm lu such ear Insurance — Scheablsd this im mum is pslrnary and•we will not seek canufbntton ftm imsmance avaflableto such person Person Or Qrgwkgfran or orgamzatfon. Persons or orgsaiz was that you we obligated, pm um to a c omut or agroe=t, to pmvW v ftb mssch inmsace as is afi<arded by d*Vliey. All othat teYmB and conditioas main nnchaag 4 Atrt W&SdRepr9aerltatMa bra was A*UNWlMasd- W"dedit agOr09W&RUM iwpw rte. CH U B Be Liability Insurance Endorsement Pb&y Period EICwft Dote Pb&yNumber Msured MAY 29, 2017 TO MAY 29, 2019 MAY 29, 2017 3603 -17 -37 Eta± AMERWATIONAL COhDAUMff SERVICES, LLC DAA AMERINAT. Neme of Company GREAT NORTHM INSURANCE CDWANY Date Issued MAY 12.2017 This Eudorsemnt applies to the following forms: GENERAL UAW= Under Who Is An Insured, rho following provision is added. Who Is An knuned AddlBonW Insured - Persons or orgenizadons shown in the Schedule are homnode; but they aria humveds only if you ere ScdteMed Penon obligated parent to a con= or agreement to provide them with such insurance as is Warded by Or p on this policy. However, the person or orgaaizedon is an hmnvd only. • if and thew only to the eatmt dw person or organization is described in the Sdwdule; • to the eaM such contract m agreement rem the person or otganizffion to be afforded statas as anhMM4. • for activities that did not occur, in whole or in part, before the eaecudon of the contract or agreement a • with nespecttp damages. Ions, cost or expanse for injury or damage to which this inea:a m applies. No person or organization is an im wW under this provisiao: • thatis more specifically idendfled under any odwprovldon of the Who Is An Iosuted section ftardless of any limitation applicable thereto). • with respect to any asenmpdon of liability (of another person or ) by them in a contract or egteemmt. This limitation does not apply to the liability for dmn mss, im cost or expense for injary or darmga, to which this Insurance applies, that ihe person or n would hame in the absence of each contractor agreement. LhWft twurenm AMtlorrsl h%xn d - Sd"WP8MW OrQV nt 0W COO SAW Faun 8o Q2MW(Rev. 847) Endaraer W9 - -- - PO M h ) to m a� tl..l �s m C g� S g i pO� A 9 AMERCOM -01 JYALCH ,d►` o��zo, CERTIFICATE OF LIABILITY INSURANCE DATE D/YYYY) 5//25/225 /2 016 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(les) 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 License # CA #0658748 AHT Insurance One Evertrust Plaza Suite 1202 Jersey City, NJ 07302 CONTACT NAME: PHONE 703 777 -2341 FAX 7 A/C No x<:( I A/c No): (03) 771 -1852 E -MAIL ADDRESS: 36031757 0512912016 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Great Northern Insurance Company 20303 PREMISES Ea occurrence INSURED INSURER B: Federal Insurance Company 20281 INSURER C: Chubb Indemnity Insurance Company 12777 AmeriNational Community Services INSURER D: Colony Insurance Company 39993 217 S. Newton Avenue Albert Lea, MN 56007 INSURER E: PRODUCTS - COMP /OP AGG INSURER F: I $ COVERAGES CERTIFICATE NUMBER: REVISION NLIMRFR- 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 IN WVD POLICY NUMBER POLICY EFF MM/DD POLICY EXP MM/DD/WW LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE PCI OCCUR X 36031757 0512912016 05/29/2017 EACH OCCURRENCE $ 1,000,00 PREMISES Ea occurrence $ 1,000,00 MED EXP (Any one person) $ 10,000 PERSONAL& ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT a LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP /OP AGG 1 $ 2,000,000 I $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS X AUTOS 73588835 05/29/2016 0512912017 (Ea BINEDtSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ X BODILY INJURY Per accident) ( ) $ PROPERTY DAMAGE Per accident $ a B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 79898650 05/29/2016 05/29/2017 EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MEMB PROPRIETOR/PARTNER/EXECUTIVE ECUTIVE a (Mandatory In NH) If es, describe under DESCRIPTION OF OPERATIONS below N / A 77171555 05/2912016 05/29/2017 X I PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE. POLICY LIMIT $ 1,000,00 D Managment Liability ML 7601398 -01 05/29/2016 05/2912017 See Next Page DESCRIPTION OF OPERATIONS 1 LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) ""General Liability, Automobile Liability and Umbrella Liability include OSP as a Named Insured— SEE ATTACHED ACORD 101 City of Gilroy 7351 Rosanna St 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 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: AMERCOM -01 LOC #: 1 AFRO ADDITIONAL REMARKS SCHEDULE JYALCH Page 1 of 1 AGENCY License # CA #0658748 NAMED INSURED HT Insurance AmeriNational Community Services 217 S. Newton Avenue Albert Lea, MN 56007 USA POLICY NUMBER EE PAGE 1 CARRIER NAIC CODE EE PAGE 1 SEE P 1 EFFECTIvE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Description of Operations /Locations/Vehicles: Management Liability (D &O /EPLI /FID) Maximum Aggregate Limit: $5,000,000 Directors & Officers Liability (D &O) Limit: $3,000,000 Retention: $0/$150,000/$150,000 Employment Practices Liability (EPLI) Limit: $2,000,000 Retention: $75,000 Fiduciary Liability (FID) Limit: $2,000,000 Retention: $50,000 Cyber Liability Policy Number: ASE16DO01692 Carrier: Underwriters at Lloyd's, London Effective Dates: 05/29/2016- 05/2912017 Limits: $3,000,000 Retention: $10,000 Errors & Omissions Liability: Policy Number: B0507 N16FT06290 Carrier: Underwriters at Lloyd's, London Effective Dates: 05/2912016 - 05/29/2017 Limits: $3,500,000 Retention: $150,000 Mortgage Bond: Policy Number: MBB -14 -00013 Carrier: Underwriters at Lloyd's, London Effective Dates: 05/29/2016- 05/29/2017 Limits: $6,500,000 Deductible: $50,000 Certificate Holder, its officers, representatives, agents and employees are included as Additional Insureds under the General Liability as required by written contract per form #80 -02 -2367 (05/07) attached. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Liability Insurance Endorsement Policy Period MAY 29, 2016 TO MAY 29, 2017 Effective Date MAY 29, 2016 Policy Number 3603 -17 -57 ECE Insured OSP, LLC DBA O'BRIEN- STANLEY PARTNERS Name of Company GREAT NORTHERN INSURANCE COMPANY Date Issued MARCH 3, 2016 This Endorsement applies to the following forms: GENERAL LIABILITY Under Who Is An Insured, the following provision is added. Who Is An Insured Additional Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. Liability Insurance Additional lnp&.f e;jc4pAv4W Pe9r Organization continued Form 80 -02 -2367 (Rev. 5 -07) Endorsement Page 1 Liability Endorsement (continued) Conditions Other Insurance — Primary Noncontributory Insurance — Scheduled Person Or Organization Under Conditions, the following provision is added to the condition titled Other Insurance. If you are obligated, pursuant to a contract or agreement, to provide the person or organization shown in the Schedule with primary insurance such as is afforded by this policy, then in such case this insurance is primary and we will not seek contribution from insurance available to such person or organization. Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Authorized Representative Q—?--' Liability Insurance Additional lniv&ct Pe-&,59r Organization last page Form 80 -02 -2367 (Rev. 5 -07) Endorsement Page 2 AHT Dennis Gustafson, FI Practice Leader & Principal AHT Insurance One Evertrust Plaza, Suite 1202 Jersey City, NJ 07302 p: 973 - 286 -3572 Dear AmeriNational Community Services Certificate Holder, May 26, 2016 Included please find the certificate of insurance for the 5/29/16 — 5/29/17 policy term representing the following insurance coverages have been renewed and as such are in place for AmeriNational Community Services: q> Commercial General Liability (Policy # 36031757) W Automobile Liability (Policy # 73588835) W Umbrella Liability (Policy # 79898650) q> Workers Compensation (Policy # 77171555) q> Management Liability (Policy # ML 7601398 -01) q> Cyber Liability (Policy # ASE16D001692) q> Errors & Omissions (Policy # B0507 N16FT06290) q> Mortgage Bond (Policy # MBB -14- 00013) To expedite the certificate process for future renewals, we would like to start collecting e-mail addresses for those certificate holders who are interested in receiving these certificates via e-mail in addition to or in lieu of physical mail. If you are interested in such a process, please send the following pieces of information either via mail to the address above or via e-mail to any of the contacts below. Certificate Holder Company Name: Certificate Holder Contact Person Name: Certificate Holder Contact Person e-mail: Feel free to send this information to: • Bobbi Hobbie, AmeriNational Community: bhobbie @amerinational.net • Dennis Gustafson, AHT Insurance: dsustafson @ahtins.com • Jagoda Yalch, AHT Insurance: jyalch @ahtins.com Thank you, in advance, for your time and consideration in this matter. t Dennis Gustafson AHT Insurance Chicago I New Jersey I San Francisco I Seattle I Washington, D.C. One Evertrust Plaza, Suite 1202, Jersey City, NJ 07302 www.ahtins.com