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HomeMy WebLinkAboutInsurance CertificateAcoR °® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 12/12/2017 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 NAME: NiChOle Fisher James G Parker Insurance Associates PHONE (559)222_7722 (FAX, No: (559)222 -1724 License #0554959 E-MAIL ADDRESS: 7 nfisher @' arker.com P O BOX 3947 INSURERS AFFORDING COVERAGE NAIC # O Fresno CA 93650 Cp INSURERA:First Mercury Insurance Company 10657 INSURED INSURER B Ohio Security Insurance Company 24082 Robinson & Moretti Inc INSURER CNavi ators Insurance Company 42307 7780 Holsclaw Rd INSURERD:Hanover Insurance Company 22292 INSURER E: Gilroy CA 95020 1 INSURER F: rOVFRAr.FS CFRTIFICATF NI IMRFR•l7 -19 GL RA IM UM 0FVICIt11J All IIkAC2CD• 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 POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 50 , 000 MED EXP (Any one person) $ Excluded X WACGL000005993903 12/9/2017 12/9/2018 PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY I JE� 71 LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 Designated Const. Project $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ B ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS BA057548989 12/9/2017 12/9/2018 BODILY INJURY Per accident ( ) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 X AGGREGATE $ 3,000,000 C EXCESS LIAB CLAIMS MADE DED I I RETENTION$ $ SE17EXC8280091V 12/9/2017 12/9/2018 WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ D Rented /Leased Equipment REFD11358201 12/9/2017 12/9/2018 $1,000 Deductible $200,000 D Contractors Equipment REFD11358201 12/9/2017 12/9/2018 $1,000 Deductible Per Schedule DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Transportation Permit. City of Gilroy, its officers, officials, and employees are named as additional insured as per form CG2033 0413 attached. john.greer @ci.gilroy.ca.us City of Gilroy, its officers officials and employees Dan Alridge 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 J Parker III /FISHER 6-,-A-*—. ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 r2nl4nt I Policy Number: WACGL000005993903 COMMERCIAL GENERAL LIABILITY CG 20 33 0413 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 organization 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 additional insured on your policy. Such person or organization is an additional insured only with respect 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 your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the contract or agreement to provide for such 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 completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage ", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. CG 20 33 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 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 service, maintenance or repairs) to be performed by or on behalf of the additional insured(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 subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement you have entered into with the additional insured; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 33 0413 a� " CERTIFICATE OF LIABILITY INSURANCE DATE(MM1DDlYYYY) 12/8/2016 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 James G Parker Insurance Associates License #0554959 P 0 BOX 3 947 Fresno CA 93650 CONTACT Nich01_e Fisher NAME PHONE . (559)222 -7722 aC Nu, (559)222 -1724 ADDRESS: i EMAIL nfsher @ arker.com ' �� -- - INSURERS AFFORDING COVERAGE NAIC q INSURERA FirSt Mercury Insurance Company 10657 INSURED Robinson & Moretti Inc 7780 Holsclaw Rd Gilroy CA 95020 INSURERBOhio Casualty Insurance 24074 INSURER CNavi ators Insurance Company 42307 INSURER D Ranover Insurance Company 22292 INSURER E. EACH OCCURRENCE INSURER A COVERAGES CERTIFICATE NUMBER:16 -17 GL BA IM UM 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 Jam VD POLICY NUMBER MM /DDY/YYYY MM POLICY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑R OCCUR PREMISES Ea occurrence $ 50,000 MED EXP (Any one person) $ Excluded X WACGL000005993902 12/9/2016 12/9/2017 PERSONAL BADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY [K JP O [::] LOC PRODUCTS - COMP /OP AGG $ 2,000,000 Designated Const Project $ 2,000,000 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ B ALL OWNED SCHEDULED AUTOS AUTOS Ix ANY AUTO X BA057548989 12/9/2016 12/9/2017 BODILYINJURY(Peraccident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS X AUTOS _X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 C EXCESS LIAB CLAIMS -MADE DED RETENTION $ SE16EXC8280091V 12/9/2016 12/9/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE ER _ ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED ❑ N/A (Mandatory in NH) E L DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT $ • Rented /Leased Equipment RHM11358200 12/9/2016 12/9/2017 $1,000 Deductible $200,000 • Contractors Equipment RHF'D11358200 12/9/2016 12/9/2017 $1,000 Deductible Per Schedule DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Gilroy, its elected officials, officers and employees acting within the scope of their duties that are controlled and supervised by the primary (first) additional insured are named as Additional Insured as per form CG2010 0413 and CA8810 0413 attached. lrtKI IFII.AI t FIUL.UtK UANL rLLAI IUIV (408)846 -0288 daldridge @ci.gilroy.ca.us City of Gilroy Public Works Dept Water 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2014101) 1NS025 r9n14n1I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. J Parker III /FISHER �� ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 Additional Insured Person(s) Or Organization(s) Locati on(s) Of Covered Operations City of Gilroy, its Officers, Officials and Employees Locations and operations covered under this policy when required 7351 Rosanna St by written contract executed prior to the "bodily injury", "property Gilroy, CA 95020 damage" or "personal and advertising injury" Information required to completethis Schedule, if not shown above, will be shown in the Declarations. A. 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 liability for "bodily injury', "property damage" or "personal and advertising injury" caused, in whole or in part, by. 1. Your ads or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured(s) at the location(s) desionated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. Wib respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after. 1. All work, induding 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 additional in at the location of the covered 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 contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 2 of 2 Policy No.: BA057548989 COMMERCIAL AUTO CA 88 10 01 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO COVERAGE ENHANCEMENT ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage afforded by this endorsement, the provisions of the policy apply unless modified by the endorsement. COVERAGEINDEX SUBJECT ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT ACCIDENTAL AIRBAG DEPLOYMENT AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS AMENDED FELLOW EMPLOYEE EXCLUSION AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE BROAD FORM INSURED BODILY INJURY REDEFINED EMPLOYEES AS INSUREDS (including employee hired auto) EXTENDED CANCELLATION CONDITION EXTRA EXPENSE - BROADENED COVERAGE GLASS REPAIR - WAIVER OF DEDUCTIBLE HIRED AUTO PHYSICAL DAMAGE (including employee hired auto and loss of use) HIRED AUTO COVERAGE TERRITORY LOAN / LEASE GAP PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) PERSONAL EFFECTS COVERAGE PHYSICAL DAMAGE - ADDITIONAL TRANSPORTATION EXPENSE COVERAGE RENTAL REIMBURSEMENT SUPPLEMENTARY PAYMENTS TOWING AND LABOR TWO OR MORE DEDUCTIBLES UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS WAIVER OF TRANSFER OF RIGHTS OF RECOVERYAGAINST OTHERS TO US SECTION II - LIABILITY COVERAGE is amended as follows: 1. BROAD FORM INSURED PROVISION NUMBER 3 12 19 5 13 1 22 2 23 10 15 6 20 14 16 11 8 9 4 7 17 18 20 SECTION II - LIABILITY COVERAGE, paragraph A.I. - WHO IS AN INSURED is amended to include the following as an insured: d. Any legally incorporated entity of which you own more than 50 percent of the voting stock during the policy period. However, "insured" does not include any organization that: (1) Is a partnership or joint venture; or (2) Is an insured under any other automobile policy; or (3) Has exhausted its Limit of Insurance under any other automobile policy. Paragraph d. (2) of this provision does not apply to a policy written to apply specifically in excess of this policy. e. Any organization you newly acquire or form, other than a partnership or joint venture, of which you own more than 50 percent of the voting stock. This automatic coverage is afforded only for 180 days from the date of acquisition or formation. However, coverage under this provision does not apply: (1) If there is similar insurance or a self - insured retention plan available to that organization; © 2013 Uberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 7 (2) If the Limits of Insurance of any other insurance policy have been exhausted; or (3) To "bodily injury" or "property damage" that occurred before you acquired or formed the organization. 2. EMPLOYEES AS INSUREDS SECTION II - LIABILITY COVERAGE, paragraph A.I. - WHO IS AN INSURED is amended to include the following as an insured: f. Any "employee" of yours while using a covered "auto" you do not own, hire or borrow, but only for acts within the scope of their employment by you. Insurance provided by this endorse- ment is excess over any other insurance available to any "employee ". ° g. An "employee" of yours while operating an "auto" hired or borrowed under a written contract or agreement in that "employee's" name, with your permission, while performing duties re- lated to the conduct of your business and within the scope of their employment. Insurance provided by this endorsement is excess over any other insurance available to the "employee ". a 3. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT SECTION II - LIABILITY COVERAGE, paragraph A.I. - WHO IS AN INSURED is amended to include the following as an insured: e h. Any person or organization with respect to the operation, maintenance or use of a covered s"auto ", provided that you and such person or organization have agreed in a written contract, agreement, or permit issued to you by governmental or public authority, to add such person, or organization, or governmental or public authority to this policy as an "insured ". However, such person or organization is an "insured ": (1) Only with respect to the operation, maintenance or use of a covered "auto "; (2) Only for "bodily injury" or "property damage" caused by an "accident" which takes place after you executed the written contract or agreement, or the permit has been issued to you; and (3) Only for the duration of that contract, agreement or permit 4. SUPPLEMENTARY PAYMENTS SECTION II - LIABILITY COVERAGE, Coverage Extensions, 2.a. Supplementary Payments, para- graphs (2) and (4) are replaced by the following: (2) Up to $3,000 for cost of bail bonds (including bonds for related traffic violations ) required because of an "accident" we cover. We do not have to furnish these bonds. (4) All reasonable expenses incurred by the insured at our request, including actual loss of earn- ings up to $500 a day because of time off from work. S. AMENDED FELLOW EMPLOYEE EXCLUSION In those jurisdictions where, by law, fellow employees are not entitled to the protection afforded to s the employer by the workers compensation exclusivity rule, or similar protection, the following provision is added. SECTION II - LIABILITY, exclusion B.S. FELLOW EMPLOYEE does not apply if the "bodily injury" results from the use of a covered "auto" you own or hire. SECTION III - PHYSICAL DAMAGE COVERAGE is amended as follows: 6. HIRED AUTO PHYSICAL DAMAGE Paragraph A.4. Coverage Extensions of SECTION III - PHYSICAL DAMAGE COVERAGE, is amended by adding the following: If hired "autos" are covered "autos" for Liability Coverage, and if Comprehensive, Specified Causes of Loss or Collision coverage are provided under the Business Auto Coverage Form for any "auto" you own, then the Physical Damage coverages provided are extended to "autos ": a. You hire, rent or borrow; or © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 2 of 7 s s b. Your "employee" hires or rents under a written contract or agreement in that "employee's" name, but only if the damage occurs while the vehicle is being used in the conduct of your business, subject to the following limit and deductible: A. The most we will pay for "loss" in any one "accident" or "loss" is the smallest of: (1) $50,000; or (2) The actual cash value of the damaged or stolen property as of the time of the "loss'; or (3) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality, minus a deductible. B. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. C. Subject to the limit, deductible and excess provisions described in this provision, we will provide coverage equal to the broadest coverage applicable to any covered "auto" you own. D. Subject to a maximum of $1,000 per "accident ", we will also cover the actual loss of use of the hired "auto" if it results from an "accident", you are legally liable and the lessor incurs an actual financial loss. E. This coverage extension does not apply to: (1) Any "auto" that is hired, rented or borrowed with a driver, or (2) Any "auto" that is hired, rented or borrowed from your "employee ". For the purposes of this provision, SECTION V - DEFINITIONS is amended by adding the following: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. 7. TOWING AND LABOR SECTION III - PHYSICAL DAMAGE COVERAGE, paragraph A.2. Towing, is amended by the addition of the following: We will pay towing and labor costs incurred, up to the limits shown below, each time a covered "auto" classified and rated as a private passenger type, "light truck" or "medium truck" is dis- abled. a. For private passenger type vehicles, we will pay up to $50 per disablement b. For "light trucks ", we will pay up to $50 per disablement. "Light trucks" gross vehicle weight (GVW) of 10,000 pounds or less. c. For "medium trucks" , we will pay up to $150 per disablement. "Medium have a gross vehicle weight (GVW) of 10,001 - 20,000 pounds. However, the labor must be performed at the place of disablement. 8. PHYSICAL DAMAGE - ADDITIONAL TRANSPORTATION EXPENSE COVERAGE are trucks that have a trucks" are trucks that Paragraph A.4.a., Coverage Extension of SECTION III - PHYSICAL DAMAGE COVERAGE, is amend- ed to provide a limit of $50 per day and a maximum limit of $1,500 © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 3 of 7 9. RENTAL REIMBURSEMENT SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: a. We will pay up to $75 per day for rental reimbursement expenses incurred by you for the rental of an "auto" because of "accident" or "loss ", to an "auto" for which we also pay a "loss" under Comprehensive, Specified Causes of Loss or Collision Coverages. We will pay only for those expenses incurred after the first 24 hours following the "accident" or "loss" to the covered "auto." b. Rental Reimbursement will be based on the rental of a comparable vehicle, which in many cases may be substantially less than $75 per day, and will only be allowed for the period of time it should take to repair or replace the vehicle with reasonable speed and similar quality, up to a maximum of 30 days. c. We will also pay up to $500 for reasonable and necessary expenses incurred by you to remove and replace your tools and equipment from the covered "auto ". x d. This coverage does not apply unless you have a business necessity that other "autos" avail- able for your use and operation cannot fill. e. If "loss" results from the total theft of a covered "auto" of the private passenger type, we will pay under this coverage only that amount of your rental reimbursement expenses which is not already provided under Paragraph 4. Coverage Extension. 's r= f. No deductible applies to this coverage. For the purposes of this endorsement provision, materials and equipment do not include "personal effects" as defined in provision 11. 10. EXTRA EXPENSE - BROADENED COVERAGE Under SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, we will pay for the expense of returning a stolen covered "auto" to you. The maximum amount we will pay is $1,000. N 11. PERSONAL EFFECTS COVERAGE A. SECTION III - PHYSICAL DAMAGE COVERAGE, A. COVERAGE, is amended by adding the following: If you have purchased Comprehensive Coverage on this policy for an "auto" you own and that "auto" is stolen, we will pay, without application of a deductible, up to $600 for "personal effects" stolen with the "auto." The insurance provided under this provision is excess over any other collectible insurance. B. SECTION V - DEFINITIONS is amended by adding the following, For the purposes of this provision, "personal effects" mean tangible property that is wom or carried by an insured" "Personal effects" does not include tools, equipment, jewelry, money or securities. 12. ACCIDENTAL AIRBAG DEPLOYMENT SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS is amended by adding the follow- ing. If you have purchased Comprehensive or Collision Coverage under this policy, the exclusion for "loss" relating to mechanical breakdown does not apply to the accidental discharge of an airbag. Any insurance we provide shall be excess over any other collectible insurance or reimbursement by manufacturer's warranty. However, we agree to pay any deductible applicable to the other cov- erage or warranty. 13. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT COVERAGE SECTION III - PHYSICAL DAMAGE COVERAGE, B. EXCLUSIONS, exception paragraph a. to exclu- sions 4.c. and 4.d. is deleted and replaced with the following: © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 4 of 7 Exclusion 4.c. and 4.d. do not apply to: a. Electronic equipment that receives or transmits audio, visual or data signals, whether or not designed solely for the reproduction of sound, if the equipment is permanently installed in the covered "auto" at the time of the "loss" and such equipment is designed to be solely operated by use of the power from the "auto's" electrical system, in or upon the covered "auto" and physical damage coverages are provided for the covered "auto'; or If the "loss" occurs solely to audio, visual or data electronic equipment or accessories used with this equipment, then our obligation to pay for, repair, return or replace damaged or stolen property will be reduced by a $100 deductible. 14. LOAN / LEASE GAP COVERAGE A. Paragraph C., LIMIT OF INSURANCE of SECTION III - PHYSICAL DAMAGE COVERAGE -is amended by adding the following: The most we will pay for a "total loss" to a covered "auto" owned by or leased to you in any one "accident" is the greater of the: 1. Balance due under the terms of the loan or lease to which the damaged covered "auto" is subject at the time of the "loss" less the amount of: a. Overdue payments and financial penalties associated with those payments as of the date of the "loss ", b. Financial penalties imposed under a lease due to high mileage, excessive use or ab- normal wear and tear, c. Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease, d. Transfer or rollover balances from previous loans or leases, e. Final payment due under a "Balloon Loan ", f. The dollar amount of any unrepaired damage which occurred prior to the "total loss" of a covered "auto ", g. Security deposits not refunded by a lessor, h. All refunds payable or paid to you as a result of the early termination of a lease agreement or as a result of the early termination of any warranty or extended service agreement on a covered "auto ", L Any amount representing taxes, j. Loan or lease termination fees; or 2. The actual cash value of the damage or stolen property as of the time of the "loss ". An adjustment for depreciation and physical condition will be made in determining the actual cash value at the time of the "loss ". This adjustment is not applicable in Texas. B. ADDITIONAL CONDITIONS This coverage applies only to the original loan for which the covered "auto" that incurred the loss serves as collateral, or lease written on the covered "auto" that incurred the loss. C. SECTION V - DEFINTIONS is changed by adding the following - As used in this endorsement provision, the following definitions apply: "Total loss" means a "loss" in which the cost of repairs plus the salvage value exceeds the actual cash value. A "balloon loan" is one with periodic payments that are insufficient to repay the balance over the term of the loan, thereby requiring a large final payment. © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 6 of 7 15. GLASS REPAIR- WAIVER OF DEDUCTIBLE Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following. No deductible applies to glass damage if the glass is repaired rather than replaced. 16. PARKED AUTO COLLISION COVERAGE (WAIVER OF DEDUCTIBLE) Paragraph D. Deductible of SECTION III - PHYSICAL DAMAGE COVERAGE is amended by the addition of the following: The deductible does not apply to "loss" caused by collision to such covered "auto" of the private passenger type or light weight truck with a gross vehicle weight of 10,000 lbs. or less as defined by the manufacturer as maximum loaded weight the "auto" is designed to carry while it is: a. In the charge of an "insured ", b. Legally parked; and c. Unoccupied. a The "loss" must be reported to the police authorities within 24 hours of known damage. The total amount of the damage to the covered "auto" must exceed the deductible shown in the Declarations. �— This provision does not apply to any "loss" if the covered "auto" is in the charge of any person or s organization engaged in the automobile business. 17. TWO OR MORE DEDUCTIBLES Under SECTION III PHYSICAL DAMAGE COVERAGE, if two or more company policies or coverage forms apply to the same accident, the following applies to paragraph D. Deductible: a. If the applicable Business Auto deductible is the smaller (or smallest) deductible it will be waived; or b. If the applicable Business Auto deductible is not the smaller (or smallest) deductible it will be reduced by the amount of the smaller (or smallest) deductible; or c. If the loss involves two or more Business Auto coverage forms or policies the smaller (or smallest) deductible will be waived. For the purpose of this endorsement company means any company that is part of the Liberty Mutual Group. SECTION IV - BUSINESS AUTO CONDITIONS is amended as follows: 18. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS SECTION IV- BUSINESS AUTO CONDITIONS, Paragraph B.2. is amended by adding the following: If you unintentionally fail to disclose any hazards, exposures or material facts existing as of the inception date or renewal date of the Business Auto Coverage Form, the coverage afforded by this o policy will not be prejudiced. However, you must report the undisclosed hazard of exposure as soon as practicable after its discovery, and we have the right to collect additional premium for any such hazard or exposure. 19. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT, OR LOSS SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.2.a. is replaced in its entirety by the following- a. In the event of "accident', claim, "suit' or "loss ", you must promptly notify us when it is known to- 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. Member, if you are a limited liability company; 4. An executive officer or the "employee" designated by the Named Insured to give such notice, if you are a corporation. © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 6 of 7 a To the extent possible, notice to us should include: (1) How, when and where the "accident" or "loss" took place; (2) The "insureds" name and address; and (3) The names and addresses of any injured persons and witnesses. 20. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US SECTION IV - BUSINESS AUTO CONDITIONS, paragraph A.5., Transfer of Rights of Recovery Against Others to Us, is amended by the addition of the following, If the person or organization has waived those rights before an "accident" or "loss ", our rights are waived also. 21. HIRED AUTO COVERAGE TERRITORY SECTION IV - BUSINESS AUTO CONDITIONS, paragraph B.7., Policy Period, Coverage Territory, is amended by the addition of the following* f. For "autos" hired 30 days or less, the coverage territory is anywhere in the world, provided that the insured's responsibility to pay for damages is determined in a "suit ", on the merits, in the United States, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. This extension of coverage does not apply to an "auto" hired, leased, rented or borrowed with a driver. SECTION V - DEFINITIONS is amended as follows: 22. BODILY INJURY REDEFINED Under SECTION V- DEFINTIONS, definition C. is replaced by the following: "Bodily injury" means physical injury, sickness or disease sustained by a person, including mental anguish, mental injury, shock, fright or death resulting from any of these at any time. COMMMON POLICY CONDITIONS 23. EXTENDED CANCELLATION CONDITION COMMON POLICY CONDITIONS, paragraph A. - CANCELLATION condition applies except as fol- lows: If we cancel for any reason other than nonpayment of premium, we will mail to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. This provision does not apply in those states which require more than 60 days prior notice of cancella- tion. © 2013 Liberty Mutual Insurance CA 88 10 01 13 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 7 of 7 ACO i DATE (MMIDDNYYY) �� CERTIFICATE OF LIABILITY INSURANCE 3I24/2017 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 NichOlei Fisher NAME: . James G Parker. Insurance Associates' PHONE' (559);222_7722' F� No): i(559)222 -1724 License E-MAIL nfisher @ J' � arker. coin ADDRESS: ' ._ __ ...._ .. P O Box. 394.7- . INSURERS AFFORDING COVERAGE NAIC # - Fresno . CA 93650 N INSURER A National Liabili I ty & Fire. Insurance 20052 INSURED INSURER B Robinson & Moretti Inc INSURER C: 7780 Holsclaw Rd wceoo n. Cam•• COVERAGES CERTIFICATE NIIMRFR -17 -18 WC RFVIS1C11J WIIMRFR. 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 D R POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR % _. .. EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY_ - GE N'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY . PRO- LOC ] OTHER: GENERAL AGGREGATE.. $ .. - PRODUCTS- COMP /OPAGG . 'AU TOMOBILE.LIABIUTY . ANY AUTO ALL OWNED SCHEDULED Al1.0 AUTOS NON -OWNED HIRED -AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident ... . _ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident UMBRELLA LIAB �ECESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ D RETENTION' $ - A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory , in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A Y US01BB171443704C11 4/1/2017 ! 4/1/2018 X PER DTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached lf more space is required) Waiver of subrogation in favor of the City of Gilroy per form WC040306 484 attached rosanna.maestri@ City of Gilroy Attn: Rosanna Maestri 7351 Rosanna Street Gilroy, CA 95020 _ gilroy. 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 J Parker III /FISHER ©1988 -2014 ACORD ACORD 25 (2014101) The ACOR.D name and logo are registered marks of ACORD INS025 on14n11 reserved. (Ea. 4 -84) -- WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be _3_% of the California workers' compensation premium otherwise due on such remuneration. Schedule Minimum premium per person or organization is $750.00 Person or Organization Job Description BLANKET WAIVER EFFECTIVE 04/01/2017 ALL OPERATIONS AS REQUIRED BY WRITTEN CONTRACT This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement Is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. US01BH171443704C11 Endorsement No. Insured ROBINSON & MORETTI INC Insurance Company: NATIONAL LIABILITY & FIRE INSURANCE COMPANY Countersigned By WC 04 03 06 NATIONAL LIABILITY & FIRE INSURANCE COMPANY NCC1;19054 US01SH171443704C11 04/01/2017 Printed: 03/23/2017 712/8/2016 (MMIDDNYYY) A� LY CERTIFICATE OF LIABILITY INSURANCE 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: tfAhe certificate-holder is an,ADDITIONAL,INSURED, the poiicy(ies) must bei endorsed.. ff 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). r - PRODUCER ....__. _- NAMEACT:Ni Clio l® Fisher--- NAME: r r. PHONE .... _.. FAX James G.. Parker' Insurance Associates (559):222 -7722 _.. _.._ C N ._(559) 222 -1724. :. License, #0554959 An�ss.nfishe @jgparker com- _. -. P O Boz -3947 _ _. _ __.. _ . -..- . _ .DDRE . - » INSURERS AFFORDING COVERAGE NAIC Fresno _. -CA .93650 _ o - INSURERA:Fi- rst- 'Mercn Insurance Com an- 10657 INSURED - - » INSURER B Ohio Casual Insurance 24074 Robinson a Moretti Inc INSURER CNavi ators Insurance Company 42307 7780 HolsclaW Rd INSURER D Hanover Insurance Comvanv 22292 Gilroy CA 95020 1 INSURER F: COVERAGES CERTIFICATE NUMBER:16 -17 GL BA IM UM 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. ILT R LTR' TYPE OF INSURANCE D POLICY NUMBER POLICY EFF MMIDD POLICYEXP' MMIDDIYWY LIMITS X COMMERCIAL GENERAL LIABIL17Y EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE � OCCUR GET RENTED PREM PREMISES Ea occurrence 50,000 $ - - - - MED EXP (Any one person) $ Excluded X 'WACGL000005993902 12/9/2016 12/9/2017 PERSONAL & ADV INJURY $ - 1, 000., 000 " GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE- - $ 2,000,000 PRO- POLICY..: JECT a, LOC ` " -PRODUCTS - COMP/OP AGG - $ -- - -. 2 , 000 , 000 :' Designated .ConsL.ProJ ect_.. 2 ._.. _ r "000 i .000. _ OTHER: -- AUTOMOBIL E LIABILITY. ;' "„ _..._..T - - COMBINED SINGLE LIMIT Ea'accident " " ' $ 1, 000 ,.000 X' BODILY INJURY (Per person) . $ ]3 _. ALL OWNED s .SCHEDULED AUTOS - AUTOS .. ..... " „',. BA051548989 :... :.'. 12/9/2016' 12/9/2017 BODILYINJURY (Per accident) ' - -- - - - $• :X- PROPERTY DAMAGE- Per accident $ - X NOMOWNED HIRED AUTOS ' AUTOS ”' X UMBRELLA LIAB OCCUR EACH. OCCURRENCE $- 3,D00, -00.0 AGGREGATE $ 3,000,000 C EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ SEI6EXC8280091v 1.2/9/2016 12/9/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER OTH- STATUTE I I ER ANY PROPRIETOR/PARTNERIEXECUTIVE E.L. EACH, ACCIDENT $ OFFICERIMEMBER EXCLUDED? NIA E.L. DISEASE , EA EMPLOYE $ (Mandatory in NH) r yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT, ...$_ - D Rented /Leased Equipment REM11358200 12/9/2016 12/9/2017 $1,000 Deductible $200,000 D Contractors Equipment REM11358200 12/9/2016 12/9/2017 $1,000 Deductible Per Schedule DESCRIPTION OF OPERATIONS I LOCATIONS /'VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Re: Transportation Permit. City of Gilroy, its officers, officials, and employees are named as additional insured as per form CG2033 0413 attached. john.greer @ci City of Gilroy, its officers officials and employees Dan Alridge 7351 Rosanna St Gilroy, CA 95020 ca. us 3e!_11L*]2 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 J Parker III /FISHER ©1 ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (mumi All rights Policy Number: WACGL000005993902= -_ _ _ COMMERCIAL GENERAL LIABILITY _ - _- - - CG 20 33 0413. THIS ENDORSEMENT CHANGESTHE POLICY.-- PLEASE READ IT CAREFULLY -_ ADDITIONAL- INSURED -- OWNERS, L- ESSEES _:OR CONTRACTORS---- = AUTOMATIC STATUS .-1IVHE4 REQUIRED IN = CONSTRUCTION AGREEMENT 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 organization 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 additional insured on your policy. Such person or organization is an additional insured only with respect 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 your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you. are required by the contract or agreement to provide for such 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 completed. B. With respect to the insurance afforded to. these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence which caused the "bodily injury" or "property damage ", or the offense which caused the "personal and advertising injury", 'involved the rendering of or the failure to render any professional architectural, engineering or surveying services. CG 20 33 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 2. "Bodily injury" or "property damage" occurring C. With -- respect to the insurance afforded to these after: a.. 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 additional insured(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 subcontractor engaged in performing operations for a principal as a part of the same project. additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is, the amount of insurance: 1. Required by- the - contract; or - agreement you - have entered into with -the additional insured; or Z--Available under= the = applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 33 0413 ACOREP� CERTIFICATE OF LIABILITY INSURANCE DATE (MMMDIYYYY) 3/23/201.6 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 James G Parker Insurance Associates License #0554959 P O Box 3947 Fresno CA 93650 CONTACT Nchole Fisher NAME: PHONE - (559)222 -7722 FAX N : (559)222 -1724 - ADRE :nfisher @jgparker.com INSURERS AFFORDING COVERAGE NAIL # INSURERAS- tate Compensation Ins Fund 35076. INSURED Robinson & Moretti Inc 7780 $olsclaW Rd Gilroy CA 95020 INSURERS: INSURER C: INSURERD: $ INSURER E DAMAGE TO RENTED PREMISES (Fa occurrence) INSURER F. COVERAGES CERTIFICATE NUMBER:16 -17 WC 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. 1NSR LTR TYPE OF INSURANCE ADDLSUBR lum Ana POLICY NUMBER POLICY.EFF MM D NYYY) POLICY EXP (MMIDDIYYYYI LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Fa occurrence) $ MED EXP (Anyone person) $ PERSONAL '& ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY El PEOT- LOC ;OTHER: GENERAL AGGREGATE $ PRODUCTS-- COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per:accident $ UMBRELLA LIAR EXCESS uAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ - - - A WORKERS COMPENSATION- AND EMPLOYERS' LIABILITY- YIN �OFFICEOPRIETER EXCLUDED? ECUTIVE. 7 (Mandatory in NH) H yes, describe under DESCRIPTION OF OPERATIONS below N / A 9051608 -2016 4/1/2016 4/1/2017 x 'PER OTH- STATUTE ER E.L:EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1 .000 000 - E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Waiver of subrogation in favor of the City of Gilroy per form 10217 7 -2014 attached IL9 3iilli L %Yl3i101913i1 rosanna.maestri @ci.gilroy. City of Gilroy 'Attn: Rosanna Maestri 7351 Rosanna Street Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE 'WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Parker III /FISHERS ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (9ni4w ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE APRIL 1, 2016 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING APRIL 1, 2017 AT 12.01 A.M. AT 1201 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ROBINSON & MORETTI INC 7780 HOLSCLAW RD GILROY, CA 95020 REP 06 9051608 -16 RENEWAL NE 2- 44 -24 -50 PAGE 1 OF WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE. THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. .SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR 'EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: �� MARCH 28, 2016 .� / AUTHORIZED REPRESENT IVE. PRESIDENT AND CEO SCIF FORM 10217 (REV.7- 2014) 1 2572 OLD DP 217 ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 4/1/2015 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'certifcate holder is an ADDITIONAL INSURED, the policy(iss) 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 _' ' _ —. James G` Parker Insurance Associates NAME:9 Nichole Fisher PHONE, (559):222 -7722. - FAX (559)222 -1724 License... #.0554959... ...... E -ML ADOAIRES ,nfisher @jgparker.com" - INSURERS AFFORDING COVERAGE NAIC # P O _Box. 39.47 INSURERA:State Compensation Ins Fund 35076. Fresno. CA 93650 INSURED INSURER B: $ INSURER C $ Robinson & Moretti Inc INSURER D: GENERAL AGGREGATE 7780 Holselaw Rd INSURER E PRODUCTS - COMP /OP AGG INSURER F Gilroy CA 95020 COVERAGES CERTIFICATE NUMBER:15 -16 WC 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 INSURANCE POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP M D LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR ` '_ _ ., EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: _ POGIGY PRO - PRODUCTS - COMP /OP AGG - AUTOMOBILE -. LIABILITY " ' ,.. ANY AUTO ALLDWNED SCHEDULED :AUTOS .. AUTOS',':. . - NON -OWNED HIRED AUTOS' AUTOS .... .. _, , . ,,.: ...•. .. Co E act dED SINGLE LIMIT c .- BODILY INJURY (Per person) - - $ `r BODILY INJURY (Pet acciderrt) _ $ PROPERTY DAMAGE Per accident) $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $- A - WORKERS :COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY OFFICE OPRIEBER PEACLUDEDEXECUTIVE � (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N IA l 9051608 -2015 4/1/2015 4/1/2016 X TWC'STATU- 0TH- FR E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 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) Job: Galloway Court / Gilroy Gardens Gilroy CA City of Gilroy 7351 Rosanna St Gilroy, CA 95020 ACORD 25 (201 GAIVGtL.L.A I IUn 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 Parker III /FISHER ©1988 -2010 ACORD CORPORATION. All rights reserved. JNSn25 r2mnnsl m Tho AC(1Rn namo anrf Innn aro roniefororl marine of AnnRn ACOIP 7 a CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 4/1/2015 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 OW PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: 'If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION ISMAIVED, °subject to - - thdIdrms 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 _ ' James G Parker:. Insurance Associates License #0554.95.9,.._._.. . P O BOX 3947 Fresno CA 93650 CONTACT Nsah'ole` Fisher NAME: -. '. :.. - ..:.:. :..... ...... PHONE (5$9)2ZZ-7722 - 'A N : (559) 222 -1724 - E-MAIL ADDRESS: nf!Sher @jgparker:.com INSURERS AFFORDING COVERAGE NAIL # INSURERA:State Compensation Ins Fund 35076. INSURED Robinson & Moretti Inc 7780 Holsclaw Rd Gilroy CA 95020 INSURER B: INSURER C: EACH OCCURRENCE INSURER D: AI O ENT ED RREMISES Ea occurrence) INSURER E: MED EXP (Any one person) INSURER F:. PERSONAL & ADV INJURY COVERAGES CERTIFICATE NUMBER �15 -16 WC 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 TR TYPE'OFiNSURANCE ADD SUBR POLICY NUMBER POLICY EFF MM /DD POLICY EXP MM /OD LIMITS - GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F1 OCCUR X - - _._ EACH OCCURRENCE $ AI O ENT ED RREMISES Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ I GENERAL AGGREGATE $ GENT AGGREGATE LIMIT APPLIES PER: PRO - PRODUCTS - COMP /OP AGG $ . ., AUTOMOBILElIABILITY _ ANY:AUTO ALL OWNED SCHEDULED AUTOS' AUTOS NON -OWNED HIRED AUTOS AUTOS" . -- COMBINED SINGLE LIMIT Eaacdident .. BODILY INJURY (Per person), $ BODILY INJURY,(Peraccid. n) •. i'$ PROPERTY DAMAGE Per accident $ $ . UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ' ANY PROPRIETOR/PARTNERIEXECUTIVE OFFICER/MEMBEREXCLUDED? ',��� (Mandatory NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA' 051608 -2015 /1/2015 - /1/2016 X WC STATU- DTH- `u�- E.L. EACH ACCIDENT $ 1 000 0Q0 E.L.' DISEASE -EA EMPLOYEE '$ 1,000,000 E.L.DISEASE - POLICY LIMIT $ 1. 000 000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Waive= of subrogation in favor of the City of Gilroy per form 10217 7 -2014 attached I.CKIlrllrAI.t MULUCK liANI:tLL.AI IUN rosanna.maestri @ci.gilroy City of Gilroy Attn: Rosanna Maestri 7351 Rosanna Street Gilroy, CA 95020 0 /05) 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 J Parker III /FISHER ©1969 -2010 ACORD CORPORATION. All rights reserved. INS025 f7ninnsl ni Tha Ar(1Rn name anti Innn arch ranictarati manta of Arnpn ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS L a 0 r 0 0 HOME OFFICE SAN FRANCISCO EFFECTIVE APRIL 1, 2015 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AND EXPIRING APRIL 1, 2016 AT 12.01 A.M. AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ROBINSON & MORETTI INC 7780 HOLSCLAW RD GILROY, CA 95020 WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE. THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION BLANKET WAIVER OF FOR WHOM THE NAMED INSURED SUBROGATION HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER REP 06 9051606 -15 RENEWAL NE 2- 44 -24 -50 PAGE 1 OF 1 NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO- APRIL 1, 2015 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 (REV.7 -2014) 2572 OLD DP 217 ACORU® CERTIFICATE OF LIABILITY INSURANCE DATE (MMMD/YYYY) 12/10/2014 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 riot confer rights to the' certificate holder'in lieu of such endorsement(s): PRODUCER' James G' Parker ° Insurance Associates License #0554959 P O Box 3947 Fresno CA 93650 CONEACT N1Ci101e Fisher' PHONE (559) 222 -7722 FAX N . (559) 222 -1724 AoDRe s:nfisher @jgparker.com INSURERS AFFORDING COVERAGE NAIC If INSURERA:Everest Indemnity Insurance Co 10851 INSURED Robinson & Moretti Inc 7780 HOlsolaw Rd Gilroy CA 95020 INSURERB WescO Insurance Company 5011 INsuRERcNav ators Insurance Company 42307 INSURER D: INSURER E: $ 1,000,000 INSURER F: X COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER:14 -15 GL BA IM UM 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 UBR POLICY NUMBER POLICY EFF M /DD POLICY EXP MM/DD LIMITS GENERALLUlB1UTY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE $ 100,000 A CLAIMS- MADE .000UR X EF4ML05143141 2/9/2014 2/9/2015 MED EXP (Any one person) $ 10,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATELIMIT APPLIES PER:' PRODUCTS - COMP /OP AGG $ ..2,.000, 000 ', , 'POLICY - POLICY X. PRO- 'AUTOMOBILE UABICITY'� " -- - COMBINED SINGLE LIMIT Ea accident) 1,000,000. 000 000 X.. BODILY INJURY (Per person). B. ANY AUTO. � _ - ALL'OWNED' SCHEDULED AUTOS AUTOS X A103293701 2/9/2014' 2/9%2015 BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident $ HIRED AUTOS X NON -OWNED . - _ - - AUTOS Uninsured motorist combined- $ 11000,000 UMBRELLA LIAB X - OCCUR EACH OCCURRENCE $ 3,000,000 }[ AGGREGATE $ 3,000,000 C EXCESSL_IAB CLAIMS -MADE IDED..___ RETENTION $ E14EXC8280091_V 2/9/2014 2/9/2015 WORKERSCOMPENSATION WC STATU- 0TH - AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH. ACCIDENT $ OFFICERIMEMBER EXCLUDED? F7 NIA E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ • Rented /Leased Equipment A103293701 2/9/2014 2/9/2015 $1,000 Deductible $200,000 • Contractors Equipment A103293701 2/9/2014 2/9/2015 $1,000 Deductible Per Schedule DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Gilroy, its elected officials, officers and employees acting within the scope of their duties that are controlled and supervised by the primary (first) additional insured are named as Additional Insured as per form CG2010 0704 and CA2048 0299 attached. d,aK 11ris A it MULIJCK GANUI=LLA I IUN ( 408)- 846 -0288 daldridge @ci.gilroy.ca.us City of Gilroy Public Works Dept Water 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 J Parker III /FISHER �'� ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 t7nlnnsrm Thn ORr1Rr1 name and Inn^ aru raniefwrael mar&c of Or npn POLICY NUMBER: EF4ML05143141 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 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 Additional Insured Person(s) Or Organization(s): Locations Of Covered Operations Blanket where required by written contract. Information required to complete this Schedule if not shown above will be shown in the Declarations. A. 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 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 your behalf; in the performance of your ongoing operations for the additional Insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, Including materials, parts or equip- ment furnished In connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 0 ABA36574 POLICY NUMBER: WPA1032937 01 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: Countersigned By: 12/09/14 Luthcr Named Insured: ROBINSON & MORETTI INC Representative" SCHED�LE 1 U 0 Name of Person(s) or Organization(s): ANY PERSON OR ORGANIZATION WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT, EXECUTED PRIOR TO LOSS, TO NAME AS ADDITIONAL INSURED. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. WE WILL ISSUE A 30 -DAY WRITTEN NOTICE OF CANCELLATION; UNLESS FOR NON- PAYMENT OF PREMIUM, IN WHICH CASE IT WILL BE A 10 -DAY NOTICE '4� °® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYY1� 3/28/2014 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 terns 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 James G Parker Insurance Associates License #0554959 P O BOX 3947 Fresno CA 93650 CONTACT Kathleen Bsko NAME: PHONE (559)241 -7776 FAX No. (559) 241 -7976 1AIC_ No E-MAI ADMD"4 RELSS:kathleenb:Lsko@jgparker.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:State Compensation Ins Fund 35076 INSURED Robinson 6r Moretti Inc 7780 Holsclaw Rd Gilroy CA 95020 INSURER B INSURER C EACH OCCURRENCE INSURER D: GE TO PXNTE5— AEI INSURER E: MED'EXP (Any one person) L5URERF: PERSONAL & ADV INJURY COVERAGES CERTIFICATE NUMBER :14 -15 WC 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 T TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF -- POLICY -EXP- LIMBS GENERAL LIABILITY COMMERCL4L GENERAL LIABILITY CLAIMS -MADE � OCCUR X EACH OCCURRENCE $ GE TO PXNTE5— AEI $ MED'EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEHL AGGREGATE LIMIT APPLIES PER POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT a i BODILY INJURY ''(Per person) i $ BODILY INJURY (Per accdent) $ PROPERTY fRdTY DAMAGE $ $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE. $. _ AGGREGATE $ DIED I I RETENTION $- A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOWPARTNER /EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? y (Mandatory in NH) if yes, describe under DESCRIPTION OF OPERATIONS below N/A 05160814 /1/2014 /1/2015 WG STATU- OTH- ITS E:L EACH ACCIDENT $ 1 000 000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 11000,00 DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Waiver of 'subrogation in favor of the City of Gilroy has been requested from carrier. CERTIFICATE rosanna.maestri @ci.gilroy. City of Gilroy Attn: Rosanna Maestri 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE' THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE *17H THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE J Parker III /KATBIS �—iL o4�->>ie® ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025r7mnnsinl Tho ORARn name and Inns oro ronlatororl marlre of At nRn ACORO0 CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 12/10/2013 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 James G Parker Insurance Associates License #0554959 1753 E Fir Ave Fresno CA 93720 CONTACT Kathleen Bisko NAME: PHONE (rj59)222 -7722 A No: (559)222 -1724 E -MAIL ADDRESS: kathleenbisko@ J gP arker.com INSURERS AFFORDING COVERAGE NAIC # INSURER AEverest Indemnity Insurance Co 10851 INSURED Robinson & Moretti Inc 7780 HolsclaW Rd Gilroy CA 95020 INSURER B Wesco Insurance Company 25011 INSURER CNav1 ators Insurance Company 42307 INSURER D: INSURER E $ 1,000,000 1 INSURER F: X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR COVERAGES CERTIFICATE NUMBER:13 -14 GL Al, IM UMB 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 SUBR POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR X EF4ML05143131 12/9/2013 2/9/2014 DAMAGE TO RENTED PREMISES Ea ccurrence o $ 100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 POLICY X PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 X BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS WPA103293700 12/9/2013 12/9/2014 BODILY INJURY (Per accident) $ X Per a E TY DAMAGE $ NON -OWNED HIRED AUTOS X AUTOS Uninsured motorist combined $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE S 3,000,000 C EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ SE14EXC798500IV 2/9/2013 2/9/2014 WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Rented /Leased Equipment WPA103293700 2/9/2013 2/9/2014 $1,000deductible $200,000 B Contractors Equipment 7103293700 2/9/2013 12/9/2014 $1.000 deductible Per Schedule DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Job: Water mains on Santa Theresa at Miller Ave & reapir leak at Thomas Bridge over Uvas Creek. The City of Gilroy, its officers and employees are named as Additional Insured as per form CG2010 0704 attached L,rK 1 Ir It A l t MIL)LUCK L AN1L tLLA I IUN City of Gilroy Dan A1ridge 7351 Rosanna St Gilroy, CA 95020 ACORD 25 (2010/05) INSn2517mnns m 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 J Parker III /KATBIS ©1988 -2010 ACORD CORPORATION. All rights reserved. The A( ewn nnmc nnrl I— arc rcnicf —A markc mf A(`r)Pn POLICY NUMBER: EF4ML05143131 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 Additional Insured Person(s) Or Organ i zatic, n s : Locations Of Covered Operations Blanket where required by written contract. Information required to complete this Schedule if not shown above, will be shown in the Declarations. A. 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 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 your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 0704 0 ISO Properties, Inc., 2D04 Page 1 of 1 ❑ ACOROa CERTIFICATE OF LIABILITY INSURANCE DATE (MMlDD/YYYY) 12/10/2013 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 James G Parker Insurance Associates License #0554959 1753 E Fir Ave Fresno CA 93720 CONTACT Kathleen Bisko NAME: PHONE (559)222 -7722 AAIXC No: (559)222 -1724 E -MAIL ADDRESS: kathleenbisko@ j m arker.co INSURERS AFFORDING COVERAGE NAIC b INSURERA:Everest Indemnity Insurance Co 10851 INSURED Robinson & Moretti Inc 7780 Holsclaw Rd Gilroy CA 95020 INSURERB:Wesco Insurance Company 25011 INSURER C:Nav1 ators Insurance Company 42307 INSURER D: INSURER E $ 1,000,000 INSURER F: X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Ex_] OCCUR COVFRAGFS CFRTIFICATF NLJMRFR-13 -14 GL AL IM UMB 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 SUBR POLICY NUMBER POLICY EFF MM /DD/YYW POLICY EXP MM /DO/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Ex_] OCCUR X EF4NIL05143131 12/9/2013 12/9/2014 DAMA 'REM IS E TO RENTED 'RE MS Ea occurrence $ 100,000 MED EXP (Any one person) $ 10,000 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 PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1 000,000 X BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X A103293700 2/9/2013 2/9/2014 BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS X AUTOS Uninsured motorist combined $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 C EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ E14EXC7985001V 12/9/2013 2/9/2014 WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below I I E.L. DISEASE - POLICY LIMIT $ B Rented /Leased equipment A103293700 12/9/2013 2/9/2014 $1.000deducto $200,000 B Contractors Equipment A103293700 2/9/2013 2/9/2014 $1,000deductlble Per Schedule DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Gilroy, its elected officials, officers and employees acting within the scope of their duties that are controlled and supervised by the primary (first) additional insured are named as Additional Insured as per form CG2010 0704, CG2037 0704 and CA2048 0299 attached. l�i3illl�lhl1 �:P1� Ra:1 (408)846 -0288 daldridge @ci.gilroy.ca.us City of Gilroy Public Works Dept Water 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 J Parker III /KATBIS �� � ACORD 25 (2010/05) © 1988 -2010 ACORD CORPORATION. All rights reserved. INS025 onirVK1 M Th. arnp 1 na ­i Innn arc rcnicfnrcrl m rlir. of Ar(1Rr1 POLICY NUMBER: EF4ML05143131 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 Additional Insured Person(s) Or Organization(s): Locations Of Covered Operations Blanket where required by written contract. Information required to complete this Schedule if not shown above, will be shown in the Declarations. A. Section 11 — 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 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 your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 0 ISO Properties, Inc., 2DD4 Page 1 of 1 ❑ POLICY NUMBER:EF4ML05143131 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 Blanket where required by written contract. 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 liability for "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 0 ISO Properties, Inc., 2004 Page 1 of 1 ❑ ABA29814 POLICY NUMBER: WPA1032937 00 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: Countersigned By: 12/09/13 L Lcr Named Insured: ROBINSON & MORETTI INC � Representative SCHED�LE ) U Name of Person(s) or Organization(s): ANY PERSON OR ORGANIZATION WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT, EXECUTED PRIOR TO LOSS, TO NAME AS ADDITIONAL INSURED. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. WAIVER OF SUBROGATION APPLIES ACOROa CERTIFICATE OF LIABILITY INSURANCE DATE (MMDD/YYYY) 12/10/2013 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 James G Parker Insurance Associates License #0554959 1753 E Fir Ave Fresno CA 93720 CONTACT Kathleen B.isko NAME: PHONE -7722 (559)222 -1724 ( ) FAX No AIC E -MAIL ADDRESS: kathleenbisko@ j 4P m arker.co INSURER (S) AFFORDING COVERAGE NAIC # INSURERAEverest Indemnity Insurance Co 10651 INSURED Robinson 6 Moretti Inc 7780 HolsclaW Rd Gilroy CA 95020 INSURER B :WeSCO Insurance Company 25011 INSURER C .Navi ators Insurance Company 42307 INSURER D: INSURER E $ 1,000,000 INSURER F: X COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER:13 -14 GL AL IM UMB 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 SUBR POLICY NUMBER MM /DD/YYri MM DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE To PRE M SES (Ea occurrence) $ 100,000 A CLAIMS -MADE 7 OCCUR X F4ML05143131 12/9/2013 2/9/2014 MED EXP (Any one person) $ 10 , 000 PERSONAL 8 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- ircT F7 LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 X BODILY INJURY (Per person) $ B ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS WPA103293700 12/9/2013 12/9/2014 BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS X AUTOS Uninsured motorist combined $ 1 000 000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 C EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ $ E14EXC798500IV 12/9/2013 12 /9/2014 WORKERS COMPENSATION TNC STATU- OTH- AND EMPLOYERS' LIABILITY YIN E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? 71 N / A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below 12/9/2013 2/9/2014 E.L. DISEASE - POLICY LIMIT 1 $ $1,000 deductible $200,000 B Rented /Leased Equipment _ _ WPA103293700 B Contractors Equipment WPA103293700 12/9/2013 12/9/2014 $1.000 deductible Per Schedule DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Transportation permit. City of Gilroy is named as Additional Insured as per form CG2010 0704 attached (408)846 -0429 City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2010105) I N 5025 nn 1 nnsl m I.AINI,tLLA 1 IUIN 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 J Parker III /KATBIS ��'�� © 1988 -2010 ACORD CORPORATION. All rights reserved. Th. Ar:r1Rn Hama and Inn, n— ronicfnrcrl m Lr of A! rwn Date: 4 /iZ /ZO1Z Time: 3:43 PM TO: 1- 408 - 846 -04ZU L 8_1-408-846-04Z8 Page: 002 ACC?RU® CERTIFICATE OF LIABILITY INSURANCE llb i DATE (MMODNVYV) 4/12/2012 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 James G Parker Insurance Associates License #0554959 1753 E Fir Ave Fresno CA 93720 CONTACT Mar Dol NAME: Y g PHDNE (559)222 -7722 F0X N (559) 222 -1721 E-MAIL SS Doi @ arker.com ADDRESS Mr Y 9 JJP INSURERS AFFORDING COVERAGE NAIC 0 INSURERA:FINANCIAL PACIFIC INSURANCE CO 31453 INSURED Robinson 6 Moretti Inc 7780 Rolsclaw Rd Gilroy CA 95020 INSURER B INSURER C INSURER D: INSURER E $ 1,000,000 INSURER }( COMMERCIAL GENERAL LIABILITY CLAIMSMAOE 7X OCCUR COVERAGES CERTIFICATE NUMRFR•12. 13 GL AL EX IM RFVISION 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 ADDL I U POLICYNUMBER POLICY EFF MMIDDIYVVY POLICY EXP MMIODIVVYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A }( COMMERCIAL GENERAL LIABILITY CLAIMSMAOE 7X OCCUR X 176997E /11/2012 /11/2013 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 M ED EXP(Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMPlOPAGG $ 2,000,000 POLICY X PRO —1 LOC JECT —1 $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) $ A Ix ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 176997E /11/2012 /11/2013 BODILY INJURY (Per accident) $ }( NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per aom ent $ Uninsured motorist combined $ 1 00,000 UMBRELLA LIAR X: OCCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 A X EXCESS LIAR CLAIMS -MADE DED I X RETENTION $ 23210E /11/2012 /11/2013 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY YIN 1 Y LIMITS I I ER EL EACH ACCIDENT $ ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDEDI NIA EL DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under EL DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below A Contractors Equipment 176997E /11/2012 /11/2013 $1.000 Ded Per Schedule A Rented /Leased Equipment 176997E /11/2012 /11/2013 $1.000 Ded $200,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if mom space is required) Re: Transportation permit. City of Gilroy is named as Additional Insured as per form CG2010 021OR attached GtKIIFII:AIt MULUtK GANGtLLAT1UN (408)846 -0429 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 Parker III /MDOIG �i +� > � ��I ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025(minor,)w The arii name and Inn^ ara renic►ararl marite ^f arewn )ate: 4/12/2012 Time: 3:43 PM To: 1- 408 - 846 -0429 @ 9,,1-408-846-0429 Page: 003 COMMERCIAL GENERAL LIABLILTY POLICY NUMBER: 176997E CG 20 10 Blanket Additional Insured 02 10 R THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (WITH LIMITED COMPLETED OPERATIONS COVERAGE) This endorsement modifies insurance provided under the following. COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESSOWNERS COVERAGE FORM SCHEDULE NAME OF PERSON OR ORGANIZATION: Any person or organization to whom or to which the named insured is obligated by a virtue of a written contract to provide insurance that is afforded by this policy. Where required by contract the officers, officials, employees, directors, subsidiaries, partners, successors, parents, divisions, architects, surveyors and engineers are included as additional insureds. All other entities, including but not limited to agents, volunteers, servants, members and partnerships are included as additional insureds, if required by contract, only when acting within the course and scope of their duties controlled and supervised by the primary (first) additional insured. If an Owner Controlled Insurance Program is involved, the coverage applies to off - site operations only. If the purpose of this endorsement is for bid purposes only, then no coverage applies. WHO IS AN INSURED: (Section II) This section is amended to include as an insured the person or organization shown on the Certificate of Insurance, but only to the extent that the person or organization is held liable for your acts or omissions in the course of "your work" for that person or organization by or for you. The "products- completed operations hazard" portion of the policy coverage does not apply to any work involving or related to properties intended for residential or habitational occupancy (other than apartments). WAIVER OF SUBROGATION: We waive any right of recovery, when required by written contract, that we may have against the person or organization shown in the Certificate of Insurance because of payments we make for injury. LOCATION OF JOB: The job location must domicile of the named contiguous State thereto, be within the State of insured, or within any CG 2010 Blanket Additional Insured 02 10 R DESCRIPTION OF WORK: The type of work performed must be that as described under classifications in the CGL cart ueclarations. 1) EXCAVATION 2) ANY SUBCONTRACTED WORK 3) GRADING OF LAND 4) WATER MAINS /CONNECTI ONS CONSTR 5) SEWER MAINS /CONNECT] ONS CONSTRUCTION 6) TRUCKERS PRIMARY CLAUSE: When this endorsement applies and when required by written contract, such insurance as is afforded by the general liability policy is primary insurance and other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. EXCLUSION: The insurance provided to the additional insured does not apply to "bodily injury', "property damage" or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services, including: 1. The preparing, approving, or failing to prepare or approve, maps, designs, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. Endorsement EFFECTIVE DATE Endorsement 02/11/2012 Includes copyrighted material of Insurance Services Office, Inc., with its permission Page 1 of 1 )ate: 4/12/2012 Time: 3:43 PM To: 1- 408 - 846 -0429 @ 9,,1-408-846-0429 Page: 004 EXPIRATION DATE: 02/11/2013 AI`� °� CERTIFICATE OF LIABILITY INSURANCE 2/10/2012) 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 Ma I]01 NAME: g PHONE (559) 222 -7722 FAX ac (559) 222 -1724 No James G Parker Insurance Associates E-MAIL ADDRESS: Ma Doi 9@ j gparker. com License #0554959 INSURERS AFFORDING COVERAGE NAIC # 1753 E Fir Ave INSURERA:FINANCIAL PACIFIC INSURANCE CO 31453 Fresno CA 93720 INSURED INSURER 8: INSURER C : 176997E Robinson & Moretti Inc INSURER D: DAMAGE TO RENTED PREMISES Ea occurrence) 7780 Holsclaw Rd INSURER E $ 5,000 PERSONAL & ADV INJURY INSURER F: Gilroy CA 95020 COVERAGES CERTIFICATE NUMBER-12.13 GL AL EX IM RFVISInN NIIMRFR- S iJ TO CERTIF Y THAT THE POLIO. ES OF iNSURANCE L'S T CD BELOW HAVE BEEN ISSUED TO THE INSURED NAPAED 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 LT}� TYPE OF INSURANCE ADDLSUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM /DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR 176997E /11/2012 /11/2013 DAMAGE TO RENTED PREMISES Ea occurrence) $ 100,000 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 PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) 1 OOD 000 X BODILY INJURY (Per person) $ A ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 176997E /11/2012 /11/2013 BODILY INJURY (Per accident) $ X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident $ Uninsured motorist combined $ 1 000 000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3 r 000 , 000 X AGGREGATE $ 3, 000, 000 A EXCESS LIAB CLAIMS -MADE DED X RETENTION$ $ 923210E /11/2012 /11/2013 WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR /PARTNER /EXECUTIVE F7 OFFICER /MEMBER EXCLUDED? N /A TORY LIM ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below A Contractors Equipment 76997E /11/2012 /11/2013 $),000 Ded Per Schedule A Rented /Leased Equipment 176997E /11/2012 /11/2013 $),000Ded $200,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Re: Transportation permit ae City of Gilroy Attn; Zoe 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 J Parker III /MDOIG 65A-t� ��`�``�� AGURU 25 (2010105) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 romnnF) m Tha Af:OQIl name nnri Innn ora ranicfararl m2rka of Arr1Rr1 COMMERCIAL GENERAL LIABLILTY ! POLICY NUMBER: 176997E CG 20 10 Blanket Additional Insured 02 10 R THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (WITH LIMITED COMPLETED OPERATIONS COVERAGE) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESSOWNERS COVERAGE FORM SCHEDULE NAME OF PERSON OR ORGANIZATION: Any person or organization to whom or to which the named insured is obligated by a virtue of a written contract to provide insurance that is afforded by this policy. Where required by contract the officers, officials, employees, directors, subsidiaries, partners, successors, parents, divisions, architects, surveyors and engineers are included as additional insureds. All other entities, including but not limited to agents, volunteers, servants, members and partnerships are included as additional insureds, if required by contract, only when acting within the course and scope of their duties controlled and supervised by the primary (first) additional insured. If an Owner Controlled Insurance Program is involved, the coverage applies to off- site operations only. If the purpose of this endorsement is for bid purposes only, then no coverage applies. WHO IS AN INSU RED: (Section ll) This section is amended to include as an insured the person or organization shown on the Certificate of Insurance, but only to the extent that the person or organization is held liable for your acts or omissions in the course of "your work" for that person or organization by or for you. The "products- completed operations hazard" portion of the policy coverage does not apply to any work involving or related to properties intended for residential or habitational occupancy (other than apartments). WAIVER OF SUBROGATION: We waive any right of recovery, when required by written contract, that we may have against the person or organization shown in the Certificate of Insurance because of payments we make for injury. LOCATION OF JOB: The job location must domicile of the named contiguous State thereto. be within the State of insured, or within any DESCRIPTION OF WORK: The type of work performed must be that as described under classifications in the CGL Fiart ueciarations. 1) EXCAVATION 2) ANY SUBCONTRACTED WORK 3) GRADING OF LAND 4) WATER MAINS /CONNECTI ONS CONSTR 5) SEWER MAINS /CONNECTI ONS CONSTRUCTION 6) TRUCKERS PRIMARY CLAUSE: When this endorsement applies and when required by written contract, such insurance as is afforded by the general liability policy is primary insurance and other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. EXCLUSION: The insurance provided to the additional insured does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services, including: 1. The preparing, approving, or failing to prepare or approve, maps, designs, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. Endorsement EFFECTIVE DATE: 02/11/2012 Endorsement EXPIRATION DATE: 02/11/2013 CG 2010 Blanket Additional Insured 0210 R Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission A`c°R & CERTIFICATE OF LIABILITY INSURANCE 2/10/2012' 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 Ma DOi NAME: g James G Parker Insurance Associates PHONE (559)222 -7722 FAX 0): (559)222-1724 A/C N E -MAIL a oi @ arker.com ADDRESS: MD g 7 gP License #0554959 INSURERS AFFORDING COVERAGE NAIC # 1753 E Fir Ave INSURERA:FINANCIAL PACIFIC INSURANCE CO 31453 Fresno CA 93720 INSURED INSURER B INSURERC: Robinson br Moretti Inc INSURER D: A A N D PREMISES Ea occurrence 7780 Holsclaw Rd INSURER E: CLAIMS -MADE 7 OCCUR X INSURER F: 176997E Gilroy CA 95020 COVERAGES CERTIFICATE NIIMRER:12 . 13 GL AL EX IM REVISION NIIMRFR- T.I-!IS 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 POLICY NUMBER MWDDY/YYYY ) 1MM/DDNYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY A A N D PREMISES Ea occurrence $ 100,000 A CLAIMS -MADE 7 OCCUR X 176997E /11/2012 /11/2013 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 PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ A ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED 76997E /11/2012 /11/2013 AUTOS AUTOS X X NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident Uninsured motorist combined $ 1,000,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 3,000,000 X AGGREGATE $ 3,000,000 A EXCESS LIAB CLAIMS -MADE DED I X I RETENTION$ 0 $ 923210E /11/2012 /11/2013 WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY LIMITS E.L. EACH ACCIDENT $ ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under E . DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below A Contractors Equipment 176997E _ /11/2012 /11/2013 $1,000Ded Per Schedule A Rented /Leased Equipment 176997E /11/2012 /11/2013 $1,000 Ded $200,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required) Job: Gilroy Library, 6th b Rosana Street, Gilroy, CA 95020 Contract #1004 Certificate holder is named additional insured acting within the scope of their duties which are controlled and supervised by the primary(first) additional insured per CG 2010 0210r attached with respect to demo, grading, sanitary sewer and water. CERTIFICATE HOLDER CANCELLATION rosanna.maestri @ci.gilroy. City of Gilroy Attn: Rosanna Maestri 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 J Parker III /MDOIG �A-�"� ��--5;z— ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 oninns� m Th. ArrlPn rii— ­4 1n pro roni.f.—A m.rkc of Ar ewn COMMERCIAL GENERAL LIABLILTY POLICY NUMBER: 176997E CG 20 10 Blanket Additional Insured 0210 R THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (WITH LIMITED COMPLETED OPERATIONS COVERAGE) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESSOWNERS COVERAGE FORM SCHEDULE NAME OF PERSON OR ORGANIZATION: Any person or organization to whom or to which the named insured is obligated by a virtue of a written contract to provide insurance that is afforded by this policy. Where required by contract the officers, officials, employees, directors, subsidiaries, partners, successors, parents, divisions, architects, surveyors and engineers are included as additional insureds. All other entities, including but not limited to agents, volunteers, servants, members and partnerships are included as additional insureds, if required by contract, only when acting within the course and scope of their duties controlled and supervised by the primary (first) additional insured. If an Owner Controlled Insurance Program is involved, the coverage applies to off- site operations only. If the purpose of this endorsement is for bid purposes only, then no coverage applies. WHO IS AN INSURED: (Section II) This section is amended to include as an insured the person or organization shown on the Certificate of Insurance, but only to the extent that the person or organization is held liable for your acts or omissions in the course of "your work" for that person or organization by or for you. The "products- completed operations hazard" portion of the policy coverage does not apply to any work involving or related to properties intended for residential or habitational occupancy (other than apartments). WAIVER OF SUBROGATION: We waive any right of recovery, when required by written contract, that we may have against the person or organization shown in the Certificate of Insurance because of payments we make for injury. DESCRIPTION OF WORK: The type of work performed must be that as described under classifications in the CGL Coverage Part ueciarauons. 1) EXCAVATION 2) ANY SUBCONTRACTED WORK 3) GRADING OF LAND 4) WATER MAINS /CONNECTI ONS CONSTR 5) SEWER MAINS /CONNECTI ONS CONSTRUCTION 6) TRUCKERS PRIMARY CLAUSE: When this endorsement applies and when required by written contract, such insurance as is afforded by the general liability policy is primary insurance and other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. EXCLUSION: The insurance provided to the additional insured does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services, including: 1. The preparing, approving, or failing to prepare or approve, maps, designs, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. LOCATION OF JOB: Endorsement The job location must be within the State of EFFECTIVE DATE: 02/11/2012 domicile of the named insured, or within any Endorsement contiguous State thereto. EXPIRATION DATE: 02/11/2013 CG 2010 Blanket Additional Insured 02 10 R Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission A COOR a CERTIFICATE OF LIABILITY INSURANCE 3�2e�2o1�) 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 endorsement(s). PRODUCER NAME: T Mary Do:L PHONE - (5' 59) 222 -7722 A/C No: (559)222 -1724 James G Parker Insurance Associates License #0554959 nnDRESS:MaryDOig @jgparker.com 1753 E Fir Ave PRODUCER 00079033 CUSTOMER ID X. INSURER (S) AFFORDING COVERAGE NAIC s Fresno CA 93720 INSURED INSURERABenchmark Insurance Company 41394 Robinson 6r Moretti Inc INSURER B: R & M Transport Inc INSURER C : $ 7780 Holeclaw Rd INSURER D: $ INSURER E : $ Gilroy CA 95020 INSURERF: COVERAGES CERTIFICATE NUMBER:11 -12 we 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�TR TYPE OF INSURANCE IN SR WVD POLICY NUMBER MBOI/LIDDYNYW MM/DD� LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR x EACH OCCURRENCE $ DA AGE T' RENTEff- PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F7 PRO - 7 LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ DEDUCTIBLE RETENTION $ $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below ... ST5001453 /1/2011 /1/2012 X WC STATU- OT }� E.L. EACH ACCIDENT $ 11000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) Blanket Waiver of subrogation in favor of the City of Gilroy as per form WC040306 attached. rosanna.maestri @ci.gilroy. City of Gilroy Attn: Rosanna Maestri 7351 Rosanna Street Gilroy, CA 95020 VAN'-CLLA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORDD=D REPRESENTATIVE Parker III /CARRIE ^_w^� &U 14wwarwa► U 1955 -2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA — BLANKET We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization for whom RE: All California Operations The named insured is required under Written contract to furnish this waiver This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The Information below is required only when this endorsement Is Issued subsequent to preparation of the policy.) Endorsement Effective 04/01/2011 Policy No. CST5001453 Endorsement No. 1 Insured: Robinson & Moretti Inc Insurance Company: BENCHMARK INSURANCE COMPANY Benchmark Insurance Company Countersigned by ACOROr CERTIFICATE OF LIABILITY INSURANCE ��•- � DATE (MM /DD/YYYY} 2/22/2011 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 Mary 0 NAME: 1. g James G Parker Insurance Associates License #0554959 ac°N o Ell, (559) 222 -7722 F� No: (559) 222 -1724 MAfL a DSS:MaryDoig @jgparker.com 1753 E Fir Ave PRODUCER 00079033 C T MER ID INSURERS AFFORDING COVERAGE NAIC # Fresno CA 93720 INSURED INSURERA:FINANCIAL PACIFIC INSURANCE CO 31453 INSURER B $ 1,000,000 Robinson & Moretti Inc INSURER C: $ 2, 000, 000 7780 Holsclaw Rd INSURER D: $ 2,000,000 INSURER E $ A Gilroy CA 95020 INSURER F: COVERAGES CERTIFIC".TE NUMBER:11 -12 GI Ba Pr Im Umb REVISION NLIMRFIR 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 INSR SWVDR POLICY NUMBER MM /DDY� MMIL& rM, LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I—XI OCCUR 176997D /11/2011 /11/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO LOC JECT PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 76997D /11/2011 /11/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X Uninsured motorist combined $ 1,000,000 Medical payments $ 5, A X UMBRELLA UAB EXCESS LIAB X OCCUR CLAIMS -MADE 923210D /11/2011 /11/2012 EACH OCCURRENCE ]00 $ 2,000,000 AGGREGATE $ 2 , 000 , DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC STATU- OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ A A Contractors Equipment Rented /Leased Equipment 176997D 176997D /11/2011 /11/2011 /11/2012 /11/2012 $1,000 Deductible Per Schedule $1,000 Deductible $200,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Job: 7861 and 7891 Miller Avenue, Gilroy, CA 95020 Certificate holder is named additional insured acting within the scope of their duties which are controlled and supervised by the primary(first) additional insured per CG 2010 0210r attached with respect to demo, grading, sanitary sewer and water. CERTIFICATE HOLDER CANCELLATION 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; Zoe 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 J Parker III /CARRIE ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABLILTY 'PbLICY NUMBER: 176997D CG 20 10 Blanket Additional Insured 02 10 R THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (WITH LIMITED COMPLETED OPERATIONS COVERAGE) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESSOWNERS COVERAGE FORM SCHEDULE NAME OF PERSON OR ORGANIZATION: Any person or organization to whom or to which the named insured is obligated by a virtue of a written contract to provide insurance that is afforded by this policy. Where required by contract the officers, officials, employees, directors, subsidiaries, partners, successors, parents, divisions, architects, surveyors and engineers are included as additional insureds. All other entities, including but not limited to agents, volunteers, servants, members and partnerships are included as additional insureds, if required by contract, only when acting within the course and scope of their duties controlled and supervised by the primary (first) additional insured. If an Owner Controlled Insurance Program is involved, the coverage applies to off- site operations only. If the purpose of this endorsement is for bid purposes only, then no coverage applies. WHO IS AN INSURED: (Section II) This section is amended to include as an insured the person or organization shown on the Certificate of Insurance, but only to the extent that the person or organization is held liable for your acts or omissions in the course of "your work" for that person or organization by or for you. The "products- completed operations hazard" portion of the policy coverage does not apply to any work involving or related to properties intended for residential or habitational occupancy (other than apartments). WAIVER OF SUBROGATION: We waive any right of recovery, when required by written contract, that we may have against the person or organization shown in the Certificate of Insurance because of payments we make for injury. LOCATION OF JOB: The job location must domicile of the named contiguous State thereto. be within the State of insured, or within any DESCRIPTION OF WORK: The type of work performed must be that as described under classifications in the CGL cart ueciarations. 1) EXCAVATION 2) ANY SUBCONTRACTED WORK 3) GRADING OF LAND 4) WATER MAINS /CONNECTI ONS CONSTR 5) SEWER MAINS /CONNECTI ONS CONSTRUCTION PRIMARY CLAUSE: When this endorsement applies and when required by written contract, such insurance as is afforded by the general liability policy is primary insurance and other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. EXCLUSION: The insurance provided to the additional insured does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services, including: 1. The preparing, approving, or failing to prepare or approve, maps, designs, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. Endorsement EFFECTIVE DATE: 02/11/2011 Endorsement EXPIRATION DATE: 02/11/2012 CG 20 10 Blanket Additional Insured 02 10 R Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission 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 (2001108) AliC"R °r CERTIFICATE OF LIABILITY INSURANCE 21221201"1 ) THIS CERT.Ir;,, ;ATE 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 Ma Dt NAME: og James G Parker Insurance Associates WC PHONE (559) 222 -7722 ac No: (559) 222 -1724 License #0554959 ADDRESS:MaryDoig @jgparker.com 1753 E Fir Ave PRODUCER 00079033 CU TOMER ID Ill INSURERS AFFORDING COVERAGE NAIC # Fresno CA 93720 INSURED INSURERA:FINANCIAL PACIFIC INSURANCE CO 1453 INSURER B: Robinson & Moretti Inc INSURERC: GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO JE LOC CT 7780 Holsclaw Rd INSURER D: INSURER E: A AUTOMOBILE Gilroy CA 95020 INSURER F. COVERAGES CERTIFICATE NUMBER:11 -12 Gl Ba Pr Im Umb 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. ILTR TYPE OF INSURANCE I IR S BR POLICY NUMBER MM DDY/YYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IX-1 OCCUR X 176997D /11/2011 /11/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,0001 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PRO JE LOC CT PRODUCTS - COMP /OP AGG $ 2,000,0001 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 76997D /11/2011 /11/2012 COMBINED SINGLE LIMIT (Ea accident) $ 11000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ X X Uninsured motorist combined $ 1,000,000 Medical payments $ 5,000 A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 923210D /11/2011 /11/2012 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A I WC STATU- OTH- T I T E E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT 1 $ • • Contractors Equipment Rented /Leased Equipment 176997D 76997D /11/2011 /11/2011 /11/2012 /11/2012 $1,000 Deductible Per Schedule $1,000 Deductible $200,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Job: Gilroy Library, 6th & Rosana Street, Gilroy, CA 95020 Contract #1004 Certificate holder is named additional insured acting within the scope of their duties which are controlled and supervised by the primary(first) additional insured per CG 2010 0210r attached with respect to demo, grading, sanitary sewer and water. HOLDER rosanna.maestri @ci.gilroy City of Gilroy Attn: Rosanna Maestri 7351 Rosanna Street Gilroy, CA 95020 CANCELLA 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 Parker III /CARRIE � '� > ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABLILTY POLICY NUMBER: 176997D CG 20 10 Blanket Additional Insured 02 10 R THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (WITH LIMITED COMPLETED OPERATIONS COVERAGE) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESSOWNERS COVERAGE FORM SCHEDULE NAME OF PERSON OR ORGANIZATION: Any person or organization to whom or to which the named insured is obligated by a virtue of a written contract to provide insurance that is afforded by this policy. Where required by contract the officers, officials, employees, directors, subsidiaries, partners, successors, parents, divisions, architects, surveyors and engineers are included as additional insureds. All other entities, including but not limited to agents, volunteers, servants, members and partnerships are included as additional insureds, if required by contract, only when acting within the course and scope of their duties controlled and supervised by the primary (first) additional insured. If an Owner Controlled Insurance Program is involved, the coverage applies to off- site operations only. If the purpose of this endorsement is for bid purposes only, then no coverage applies. WHO IS AN INSURED:(Section II) This section is amended to include as an insured the person or organization shown on the Certificate of Insurance, but only to the extent that the person or organization is held liable for your acts or omissions in the course of "your work" for that person or organization by or for you. The "products- completed operations hazard" portion of the policy coverage does not apply to any work involving or related to properties intended for residential or habitational occupancy (other than apartments). WAIVER OF SUBROGATION: We waive any right of recovery, when required by written contract, that we may have against the person or organization shown in the Certificate of Insurance because of payments we make- for- iPJury, - - - -- -- -- DESCRIPTION OF WORK: The type of work performed must be that as described under classifications in the CGL e Hart Declarations. 1) EXCAVATION 2) ANY SUBCONTRACTED WORK 3) GRADING OF LAND 4) WATER MAINS /CONNECT[ ONS CONSTR 5) SEWER MAINS /CONNECTI ONS CONSTRUCTION PRIMARY CLAUSE: When this endorsement applies and when required by written contract, such insurance as is afforded by the general liability policy is primary insurance and other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. EXCLUSION: The insurance provided to the additional insured does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services, including: 1. The preparing, approving, or failing to prepare or approve, maps, designs, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. LOCATION OF JOB: Endorsement EFFECTIVE DATE: 02/11/2011 The job location must be within the State of domicile of the named insured, or within any Endorsement contiguous State thereto. EXPIRATION DATE: 02/11/2012 CG 20 10 Blanket Additional Insured 02 10 R Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission ACOOR °r CERTIFICATE OF LIABILITY INSURANCE 2i22/2o11W) 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 T7d D01 NAME: g James G Parker Insurance Associates License #0554959 HONE E (559) 222 -7722 ac No : (559) 222 -172a a �DRESS:MaryDoig @jgparker.com 1753 E Fir Ave CUSTOMER A0079033 ER ID INSURERS AFFORDING COVERAGE NAIC # Fresno CA 93720 INSURED INSURERA:FINANCIAL PACIFIC INSURANCE CO 31453 INSURER B: $ 1,000,000 Robinson & Moretti Inc INSURER C: $ 2,000,000 7780 Holsclaw Rd INSURER D: $ 2,000,000 INSURER E: $ A Gilroy CA 95020 INSURER F: COVERAGES CERTIFICATE NUMBER:11 -12 Gl Ba Pr Im Umb 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 INSR UBR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP MM /DD/YYYY LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX OCCUR 176997D /11/2011 /11/2012 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: Roi POLICY X P LOC JEC PRODUCTS - COMP /OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS 76997D /11/2011 /11/2012 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE (Per accident) $ X Uninsured motorist combined $ 1,000,000 Mediral payments $ 5,000 A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 923216D /11/2011 /11/2012 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DEDUCTIBLE RETENTION $ $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WC STATU- OTH- T LIM T E.L. EACH ACCIDE NT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ A A Contractors Equipment Rented /Leased Equipment 176997D 176997D /11/2011 /11/2011 /11/2012 /11/2012 $1.000 Deductible Per Schedule $1,000 Deductible $200,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Re: Transportation permit CERTIFICATE City of Gilroy Attn; Zoe 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 Parker III /CARRIE , 't . ACORD 25 (2009/09) ©1988 -2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD POLICY NUMBER:EF4ML05143131 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 Additional Insured Person(s) Or Organization(s): Locations Of Covered Operations Blanket where required by written contract. Information required to complete this Schedule if not shown above, will be shown in the Declarations. A. 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 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 your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 ❑ AC<1RDr CERTIFICATE OF LIABILITY INSURANCE 2/16i2o 0 ' PRODUCER (559) 222 -7722 FAX: (559) 222 -1724 James G Parker Insurance Associates License #0554959 1753 E Fir Ave Fresno CA 93720 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC # INSURED Robinson & Moretti Inc 7780 Holsclaw Rd Gilroy CA 95020 INSURER A. FINANCIAL PACIFIC INS IPOLICY EFFECTIVE DATE MM /DD/YY INSURERS FINANCIAL PACIFIC LIMITS INSURER C AUTHORIZED REPRESENTATIVE James Parker INSURER D INSURER E: Willi araTnxy 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 IMIT H WN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L TYPE OF INSURANCE POLICY NUMBER IPOLICY EFFECTIVE DATE MM /DD/YY POLICY EXPIRATION DATE MM /DD/YY LIMITS INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE James Parker GENERAL LiAWL;7Y EACH EACH URREN E I$ "o- PPREMI ES I a occurrence) _ $ 100,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE ❑X OCCUR 176997C 2/11/2010 2/11/2011 MED EXP (Any one person) $ 5,000 PERSONAL &A V INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP/OP A $ 2,000,000 PRO - POLICY 7C T LOC AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X BODILY INJURY (Per person) $ A ALL OWNED AUTOS SCHEDULEDAUTOS 176997C 2/11/2010 2/11/2011 X BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS X PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA A $ ANY AUTO $ AUTO ONLY AGG EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 2,000,000 7C OCCUR ❑ CLAIMS MADE AGGREGATE $ 2,000,000 $ B DEDUCTIBLE 923210C 2/11/2010 2/11/2011 5 FETEN`ION WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER /EXECUTIVE E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ OFFICER /MEMBER EXCLUDED? If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ ,A OTHER Contractors Equip 176997C 2/11/2010 2/11/2011 $1,000 Deductible Per Schedule A Rented /Leased Equip 176997C 2/11/2010 2/11/2011 $1,000 Deductible $200,000 DESCRIPTION OF OPERATIONS /LOCATIONSNEHIC LES /EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS Job: 7861 and 7891 Miller Avenue, Gilroy, CA 95020 Certificate holder is named additional insured acting within the scope of their duties which are controlled and supervised by the primary(first) additional insured per CG 2010 0108 attached with respect to demo, grading, sanitary sewer and water. *Ten day notice of cancellation IF cancelled for non payment of premium CERTIFICATE HOLDER CANCELLATION ACORD 25 (2001/08) INS025 (0108) 08a © ACORD CORPORATION 1988 Page t of 2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Gilroy EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL Attn; Zoe *30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT 7351 Rosanna Street Gilroy, CA 95020 FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE James Parker ACORD 25 (2001/08) INS025 (0108) 08a © ACORD CORPORATION 1988 Page t of 2 COMMERCIAL GENERAL LIABLLLTY POLICY NUMBER: 176997C CG 2010 Blanket Additional Insured 01 08R r THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS (WITH LIMITED COMPLETED OPERATIONS COVERAGE) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART BUSINESSOWNERS COVERAGE FORM SCHEDULE NAME OF PERSON OR ORGANIZATION: DESCRIPTION OF WORK: Any person or organization to whom or to which the named insured is obligated by a virtue of a written contract to provide insurance that is afforded by this policy. Where required by contract the officers, officials, employees, directors, subsidiaries, partners, successors, parents, divisions, architects, surveyors and engineers are included as additional insureds. All other entities, including but not limited to agents, volunteers, servants, members and partnerships are included as additional insureds, if required by contract, only when acting within the course and scope of their duties controlled and supervised by the primary (first) additional insured. If an Owner Controlled Insurance Program is involved, the coverage applies to off -site only. If the purpose of this endorsement is for bid purposes only, then no coverage applies. WHO IS AN INSU RED: (Section II) This section is amended to include as an insured the person or organization shown on the Certificate of Insurance, but only to the extent that the person or organization is held liable for your acts or omissions arising out of and in the course of "your work" for that person or organization by or for you. The 'products - completed operations hazard" portion of the policy coverage does not apply to any work involving or related to properties intended for residential or habitational occupancy (other than apartments). WAIVER OF SUBROGATION: We waive any right of recovery that we may have against the person or organization shown in the Schedule above because of payments we make for injury. LOCATION OF JOB: The job location must domicile of the named contiguous State thereto. be within the State of insured, or within any The type of work performed must be that as described under classifications in the CGL Hart Ueciarations. EXCAVATION GRADING OF LAND WATER MAINS /CONNECTI ONS CONSTR SEWER MAINS /CONNECTI ONS CONSTRUCTION PRIMARY CLAUSE: When this endorsement applies and when required by written contract, such insurance as is afforded by the general liability policy is primary insurance and other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. EXCLUSION: The insurance provided to the additional insured does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of an architect's, engineer's or surveyor's rendering or failure to render any professional services, including: 1. "The preparing, approving, or failing to prepare or approve, maps, designs, shop drawings, opinions, reports, surveys, field orders, change orders, or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. Endorsement EFFECTIVE DATE: 02/11/2010 Endorsement EXPIRATION DATE: 02/11/2011 CG 2010 Blanket Additional Insured 01 08R Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission J 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 (2001/08) Page 2 of 2 INS025 �oioe).oea ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID DATE (MMIDD/YYYY) ROBIN -1 04/15/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION POLICY NUMBER ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE Sharp Insurance- Fresno Branch HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1040 E. Herndon, Suite 104 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. GENERAL LIABILITY Fresno CA 93720 Phone:559- 432 -2544 Fax:559- 432 -2543 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: INSURER B: COMMERCIAL GENERAL LIABILITY ROBINSON & MORETTI INC. R & M TRANSPORT, INC. INSURER C: INSURER D: State C=Wensation Ins Fuad CLAIMS MADE 7 OCCUR 7780 HOLSCLAW ROAD GILROY CA 95020 -9526 INSURER E: MED EXP (Any one person) 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. INbK LTR NSR TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATMMD/YY) PTY EXPIRATION DAE MM/ LIMITS GENERAL LIABILITY EACH OCCURRENCE $ PREMISES Ea occurence $ COMMERCIAL GENERAL LIABILITY CLAIMS MADE 7 OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ POLICY jECT LOC 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 $ OCCUR CLAIMS MADE AGGREGATE $ $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- x I TORY LIMITS fR- A EMPLOYERS' LIABILITY ANY PROPRIETOR /PARTNER/EXECUTIVE 713275062007 04/01/08 04/01/09 E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 OFFICERiiviEMBE.R EXCLUDED? 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 RECEIVED" APR 1 8 2008 L,r KI It-ILA ItMULUtK r—hIf`11XII -- 11— FR'11\It9 UAIVVtLLAIIUM CITY OF GILROY ATTN: ZOE 7351 ROSANNA STREET GILROY CA 95020 CITYGI I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. ACORD 25 (2001/08) C ACORD CORPORATION 1988