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HomeMy WebLinkAboutSanta Clara County Library - Insurance CertficateC RDO CERTIFICATE OF LIABILITY INSURANCE DATE 09/14//17' 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((es) must be endorsed. If SUBROGATION IS WAIV ED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not con far rights to the certificate holder In lieu of such endorsement(s). PRODUCER Alliant Insurance Services, Inc 1301 Dove St, Suite 200 Newport Beach, CA 92660 CONTACT PHONE I PHONE A/C No: E4MLADDRESS PRODUCER 949- 756 -0271. Fax 949- 756 -2713• License No. OC36861 09/29/17 CUSTOM M ID 0 INSURED. SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER INSURER(S) AFFORDING COVERAGE "Co SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY BOARD INSURER A- GREAT AMERICAN E8S INSURANCE COMPANY 37352 INSURER B. $10,000,000 1370 DELL AVENUE CAMPBELL, CA 95008 INSURER C PRODUCTS - COMP /OP AGG INSURER D AUTOMOBILE INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PER IOD 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 SUC H POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR L, TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER PO C (MMIDD/YY) (MM/DD/YY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X OCCUR GL DED $1,000 DED X 2145100 00 09/29/17 09/29/18 EACH OCCURRENCE $10,000,000 DA AGE TO RENTED PREM SES Ea Occurrence $1,000,000 MED EXP (Any one person) N/A PERSONAL 8 ADV INJURY $10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY n PR0. LOC GENERAL AGGREGATE NA' PRODUCTS - COMP /OP AGG $10,000,000 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 ti UMBRELLA LIM OCCUR EXCESS LIAB CLAIMS EACH OCCURRENCE AGGREGATE �I DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETORY /PARTNER /EXECUTIVE OFFICER/ MEMBER EXCLUDED' (MANDATORY IN NH) IF YES DESCRIBE UNDER DESCRIPTION OF OPERATIONS BELOW N/A wcsrATU arrh- roar uMrts ER E L EACH ACCIDENT E L DISEASE - EA EMPLOYEE E L DISEASE - POLICY LIMIT DESCRIPTION OF OPE_ RATIONS/LOCATIONSIVEHICLES (ACaeh Acord 101, Additional Remarks Schedules, If more space Is required) 'POLICY FORM DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE AS RESPECTS BIKE FIX -IT STATION KICK OFF EVENT OCCURRING SEPTEMBER 30, 2017 CITY OF GILROY, ITS OFFICERS, REPRESENTATIVES, AGENTS AND EMPLOYEES SHALL BE NAMED AS ADDITIONAL INSURED ADDITIONAL INSURED ENDORSEMENT ATTACHED SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS CERTIFICATE HOLDER CANCELLATION CITY OF GILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 ROSANNA STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GILROY, CA 95020 ACCORDANCE NTH THE POLICY PROVISIONS. AUTHORIZED REP S TA�� ACORD 25 (2009109) The ACORD name and logo era registered marls of ACORD 02008 ACORD CORPORATION All rights reserved AGENCY CUSTOMER ID: LOC #: ACORD® ADDITIONAL REMARKS SCHEDULE `../ Page 2 of 3 AGENCY NAMED INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER ALLIANT INSURANCE SERVICES, INC. SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY BOARD POLICY NUMBER 2145100 00 1370 DELL AVENUE CAMPBELL, CA 95008 CARRIER NAIC CODE GREAT AMERICAN E&S INSURANCE COMPANY 37352 EFFECTIVE DATE: 09/29/17 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 (2009109) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Notice of cancellation will be delivered only to the participating named insured as stated In Item 1 of the Participation Endorsement GII nnMn rwnwn.wA The ACORD name and logo are regintered marks of ACORO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured - Designated Person or Organization This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON - PROFIT CORPORATIONS Name of Person or Any person or entity that the "Named Insured" has entered into a written agreement, prior to a loss, to provide defense, indemnity or additional insured protection. City of Gilroy, its officers, representatives, agents and employees shall be named as Additional Insured with respect to Bike fix -it station kick off on September 30, 2017. The following is added to Section V. PERSONS OR ENTITIES INSURED: Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only as respects "Personal Injury" (including `Bodily Injury") and "Property Damage" arising, in whole or in part, out of the operations of the Named Insured. The inclusion of such Additional Insured shall not serve to increase the "Company's" Limit of Liability as specified in the participation endorsement of this Policy: However, additional insured coverage provided by this insurance will not be broader than coverage required in the written agreement. GL330138 0916 Includes copyrighted material of ISO Properties, Inc., 2004 with Page 1 of 1 its permission ACORDD OF LIABILITY INSURANCE TE DA07/05/17 ' 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 WAIV ED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not con fer rights to the certificate holder in lieu of such endorsement (s). PRODUCER CONTACT NAME Alllant Insurance Services, Inc PHONE PHONE 1301 Dove St ,.Suite 200 AIC NO Newport Beach, CA 92660 E -MAIL ADDRESS 949- 756 -0271• Fax 949- 756 -2713• License No OC36861 PRODUCER CUSTOMER 10 0 INSURED SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER INSURER(S) AFFORDING COVERAGE NAIC # SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY INSURER BOARD ASSOCIATED INDUSTRIES-INSURAN-CE CO 23140 1370 DELL AVENUE INSURER B CAMPBELL, CA 95008 INSURER C INSURER D INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS IN TR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDnY) (MM DD/YY) I LIMITS A GENERAL LIABILITY X PAC 1000001 05 09/29/16 09/29/17 EACH OCCURRENCE $10,000,000 X — COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED — $1,000,000 PREMISES (Ea Occurrence] _ —MED CLAIMS MADE I X I OCCUR EXP (Any one person) I N/A GL DED $1,000 DED PERSONAL & ACV INJURY __I $10,000,000 GENERAL AGGREGATE I NA`- GEN L AGGREGATE LIMIT APPLIES PER POLICY I I PRO- I LOC PRODUCTS- COMP /OPAGG $10,000,000 AUTOMOBILE LIABILITY u COMBINED SINGLE LIMIT (Ea Accident) ANY AUTO BODILY INJURY ( Per person) ALL OWNED AUTOS BODILY INJURY (Per accident) SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE IS EXCESS LIAB MADE AGGREGATE DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y/N I _ WC STATU OTH TORYLIMITS ER _ AN V PROPRIETORY /PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? N/A E L EACH ACCIDENT (MANDATORY IN NH) IF YES DESCRIBE _ I EL DISEASE - EA EMPLOYEEY UNDER DESCRIPTION OF OPERATIONS BELOW EL DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES (Attach Acord 101 Additional Remarks Schedules, If more space Is required) 'POLICY FORM DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE AS RESPECTS BIKE FIX -IT STATION KICK OFF EVENT OCCURRING AUGUST 26, 2017 CITY OF GILROY, ITS OFFICERS, REPRESENTATIVES, AGENTS AND EMPLOYEES SHALL BE NAMED AS ADDITIONAL INSURED ADDITIONAL INSURED ENDORSEMENT ATTACHED SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS CERTIFICATE HOLDER CANCELLATION CITY OF GILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 ROSANNA STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GILROY, CA 95020 ACCORDANCE WITH THE POLICY PROVISIONS AUTHORIZED TATIVE 2!:�'77 AGENCY CUSTOMER ID: LOC #: AC D� ADDITIONAL REMARKS SCHEDULE Page 2 of AGENCY NAMED INSURED SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER ALLIANT INSURANCE SERVICES, INC SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY POLICY NUMBER BOARD PAC 1000001 05 1 1370 DELL AVENUE CAMPBELL, CA 95008 CARRIER NAIC CODE j ASSOCIATED INDUSTRIES INSURANCE CO 23140 : EFFECTIVE DATE 09/29/16 DITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 (2009/09) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Notice of cancellation will be delivered only to the participating named Insured as stated in Item 1 of the Participation Endorsement 101 (2008101) I ne AC;UMU name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured - Designated Person or Organization This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON - PROFIT CORPORATIONS Name of Person or Any person or entity that the "Named Insured" has entered into a written agreement, prior to a loss, to provide defense, indemnity or additional insured protection. City of Gilroy, its officers, representatives, agents and employees shall be named as Additional Insured with respect to Bike fix -it station kick off on August 26, 2017. The following is added to Section V. PERSONS OR ENTITIES INSURED: Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only as respects "Personal Injury" (including `-`Bodily Injury ") and "Property Damage" ansing, in whole or in part, out of the operations of the Named Insured. The inclusion of such Additional Insured shall not serve to increase the "Company's" Limit of Liability as specified in the participation endorsement of this Policy: However, additional insured coverage provided by this insurance will not be broader than coverage required in the written agreement. GL330138 0916 Includes copyrighted material of ISO Properties, Inc , 2004 with Page 1 of 1 its pernussion 17ER I Issu Y I I PROP- 67 EVIDENCE OF PROPERV COVERAGE 03/28/2017 THIS EVIDENCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS EVIDENCE OF COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND ADDITIONAL INTEREST. CSAC Excess Insurance Authority (CSAC EIA) COVERAGE C/O ALLIANT INSURANCE SERVICES, INC. AFFORDED BY: A - CSAC Excess Insurance Authority PO BOX 6450 NEWPORT BEACH, CA 92658 -6450 COVERAGE PHONE (949) 756 -0271 / FAX (619) 699 -0901 AFFORDED BY: B LICENSE #OC3686 MEMBER TOWER NUMBER MEMORANDUM NUMBER SANTA CLARA COUNTY IV EIAPPR17 -20 C/OLANCE INSURANCE EFFECTIVE DATE (MMIDD)YYYY) EXPIRATION DATE (MWDD/YYM C/O ESA INSURANCE CONT. uNTa ❑ 2310 NORTH FIRST STREET, SUITE 203 03/31/2017 03/31/2018 TERMINATED IF SAN JOSE, CA 95131 1 1 CHECKED THIS REPLACES PRIOR EVIDENCE: I r a [ LOCATION 1 DESCRIPTION AS RESPECTS LEASE AGREEMENT BETWEEN THE COUNTY OF SANTA CLARA AND CITY OF GILROY FOR THE LEASE OF LOC. 443, THE NEW GILROY LIBRARY LOCATED AT 350 W. SIXTH STREET, GILROY, CA. THIS IS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE LISTED ABOVE HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE PERIOD INDICATED, NOTWITY HSTANDINGANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH. RESPECT TO WHICH THIS EVIDENCE MAY BE ISSUED OR MA PARTAIN, THE COVERAGE AFFORED BY THE MEMORANDUMS DESCRIBED HEREIN IS SUBJECT TO ALL TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUMS.-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COVERAGE/PERILS/FORMS AMOUNT OF INSURANCE ALL RISK OF DIRECT PHYSICAL LOSS OR DAMAGE, INCLUDING FLOOD. $25,000,000 PER OCC +FOR ALL RISK AND ANN AGG FOR FLOOD EARTHQUAKE IS EXCLUDED. EARTHQUAKE LIMIT IS NOT APPLICABLE. $25,000,000 PER OCC /ANN AGG REPAIR OR REPLACEMENT COST VALUATION SUBJECT TO MEMORANDUM OF COVERAGE PROVISIONS FOR EARTHQUAKE VEHICLE/BUSES ARE SUBJECT TO ACTUAL CASH VALUE OR REPLACEMENT COST PER SCHEDULE ON FILE WITH THE AUTHORITY ALL �� UMITS A-RE Y SHARED. ... ........... nR. e.b ..,.. ......... ... ...., oi.. ,. ...: ...... .. . ,. ,.. >.: ... :: :'r n, r ... .. .,u...,. a,.,iaA ,�......<.. , .w....,...,,,.,,....,,....., ,,..,.,.,.,..,..,.gR,vi ...... .. DEDUCTIBLES: ALL RISK OF DIRECT PHYSICAL LOSS OR DAMAGE (EXCLUDING FLOOD AND EARTHQUAKE): $50,000 PER OCCURRENCE AS PER SCHEDULE ON FILE WITH THE AUTHORITY FLOOD: $50,000 EXCEPT FOR CRITICAL FLOOD (LOCATIONS IN FEMA. :FLOOD ZONE A OR V) DEDUCTIBLE IS $100,000 VEHICLES AND MOBILE EQUIPMENT IF COVERAGE IS SCHEDULED AND PURCHASED, DEDUCTIBLE APPLIES PER SCHEDULE ON FILE WITH THE AUTHORITY. r ,.....':......... SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUM(S) OF COVERAGE BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE MEMORANDUM(S) OF COVERAGE PROVISIONS. pIICSIt41I�Ii� NAME AND ADDRESS NATURE OF INTEREST CITY OF GILROY MORTGAGEE ATTN: DAN JOHNSON 7351 ROSANNA STREET LOSS PAYEE (OTHER) EVIDENCE ONLY GILROY, CA 95020 AUTHORIZED REPRESENTATIVE CSAC EXCESS INSURANCE AUTHORITY A..cORDO CERTIFICATE OF LIABILITY INSURANCE DA 11/15/16 ' 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 Alliant Insurance Services, Inc. 1301 Dove St., Suite 200 Newport Beach, CA 92660 CONTACT NAME: PHONE: PHONE: ac. No:. E-MAIL ADDRESS: —" 949 - 756 -0271• Fax 949 -756 -2713• License No. OC36861 PRODUCER: — A CUSTOMER ID i INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: ASSOCIATED INDUSTRIES INSURANCE CO. 23140 BOARD 1370 DELL AVENUE INSURER B: X COMMERCIAL GENERAL LIABILITY CAMPBELL, CA 95008 INSURER C: INSURER.D: DAMAGE TO PREMISES Ea 0acurrence $1,000,000 INSURER E N/A INSURER F: CLAIMS MADE ® OCCUR COVERAGES CERTIFICATE NUMRER- RCVLCIf)u unlucco• 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�rn TYPE OF INSURANCE "NSR s� POLICY NUMBER (MWDDrfY) (MMIDDIYY) LIMITS A GENERAL LIABILITY X X PAC 1000001 05 09/29/16 09/29/17 EACH OCCURRENCE $10,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO PREMISES Ea 0acurrence $1,000,000 MED EXP (Any one person) N/A CLAIMS MADE ® OCCUR PERSONAL & ADV INJURY _ $10,000,000 GL DED: $1.000 DED GEN'LAGGREGATE!LIMIT APPLIES PER: GENERALAGGREGATE NA` POLICY F7 PRO' L7 LOC PRODUCTS- COMP /OPAGG. $10,000,000 AUTOMOBILE'LIABILITY COMBINED SINGLE LIMIT (Ea Accident) _ BODILY INJURY ( Per person) ANY AUTO BODILY INJURY (Per accident) ALL OWNED AUTOS PROPERTY DAMAGE SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAS OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS MADF AGGREGATE DEDUCTIBLE - .RETENTION - WORKERS COMPENSATION WC STATU- OTI1, AND EMPLOYERS LIABILITY YY//NN TORY LIMITS ER ANY PER I MEMBER /EXECUTIVE � I OFFICER / MEMBER EXCLUDED? ��_JJ wA E.L. EACH ACCIDENT (MANDATORY IN NH) IF YES, DESCRIBE UNDER DESCRIPTION OF OPERATIONS BELOW E.L. DISEASE - EA EMPLOYEE E.L. DISEASE -. POLICY LIMIT DESCRIPTION OF OPERATIONS ILOCATIONSIVEHICLES (Amen Acold Tot, Additional Remarks Schedules, H more space is required) 'POLICY FORM DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE AS RESPECTS LEASED PREMISES LOCATED AT 350 WEST SIXTH STREET, GILROY, CA. CITY OF GILROY, ITS ELECTED OFFICIALS, OFFICERS, EMPLOYEES, AGENTS,.AND REPRESENTATIVES SHALL BE NAMED AS ADDITIONAL INSURED. THIS INSURANCE IS PRIMARY AND ANY OTHER INSURANCE OR SELF.,INSURANCE MAINTAWED BY SUCH ADDITIONAL INSUREDS IS EXCESS AND NONCONTRIBUTING WITH THIS POLICY, WAIVER OF SUBROGATION: THE "COMPANY" WILL WAIVE ITS RIGHT OF SUBROGATION AGAINST ANY PERSON OR ORGANIZATION FOR WHOMTHE INSURED" IS PERFORMING OPERATIONS. BUT ONLY IF: 1. THAT PERSON OR ORGANIZATION REQUIRES IN THE WRITTEN AGREEMENT WITH THE "PARTICIPATING NAMED INSURED" THAT THE "PARTICIPATING NAMED INSURED" WAIVE ITS RIGHT OF RECOVERY AGAINST THAT PERSON OR ORGANIZATION AND, 2, THE WRITTEN AGREEMENT WAS MADE PRIOR TO THE DATE OF THE "OCCURRENCE ". ADDITIONAL INSURED ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. CITY OF GILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: CITY ADMINISTRATOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 ROSANNA STREET ACCORDANCE WITH THE POLICY PROVISIONS. GILROY, CA 95020 AUTHORIZED REPRESENTATIVE !CORD 25.(2009109) "The ACORD name and logo are registered marks of ACORD m2008 ACORD CORPORATION. All fights reserved. AGENCY CUSTOMER ID: LOC #: ACO�® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 �f. AGENCY NAMED INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: ALLIANT INSURANCE SERVICES,, INC. SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY BOARD POLICY NUMBER PAC 1000001 05 1370 DELL AVENUE CAMPBELL, CA 95008 CARRIER Naic cone ASSOCIATED INDUSTRIES INSURANCE CO. 23140 EFFECTIVE DATE: 09/29/16 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 (2009/09) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the Participation Endorsement. The Company may cancel the coverage by mailing to the first Participating Named Insured at the address shown in the participation endorsement written notice stating when, not less than sixty (60) days thereafter, such cancellation shall be effective. Provided that the Participating Named Insured fails to discharge, when due, any of its obligations in connection with the payment of premium for the policy or any installment thereof, the coverage may be canceled by the Company by mailing to the Participating Named Insured at the address shown in the participation endorsement, written notice stating when, not less than ten (10) days thereafter, such cancellation shall' be effective. i ne m—mu name ana logo are regisrerea manes or Nuunu THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured - Designated Person or Organization This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON - PROFIT CORPORATIONS Name of Person or Organization: Any person or entity that the "Named Insured has entered into a written agreement, prior to a loss, to provide defense, indemnity or additional insured protection. The following is added to Section V. PERSONS OR ENTITIES INSURED: Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only as respects "Bodily Injury" and "Property Damage" arising, in whole or in part, out of the operations of the Named Insured. The inclusion of such Additional Insured shall not serve to increase the "Company's" Limit of Liability as specified in the participation endorsement of this Policy: However, additional insured coverage provided by this insurance will not be broader than coverage required in the written agreement. Includes copyrighted material of ISO Properties, Inc., 2004 with Page 1 of 1 its permission THIS EVIDENCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS EVIDENCE OF COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND ADDITIONAL INTEREST. CSAC Excess Insurance Authority (CSAC EIA) COVERAGE C/O ALLIANT INSURANCE SERVICES, INC. AFFORDED A CSAC Excess Insurance Authority PO BOX 6450 NEWPORT BEACH, CA 92658 -6450 COVERAGE PHONE (949) 756-02711 FAX (619) 699 -0901 AFFORDED 13- MEMBER I TOWER NUMBER IMEMORANDUM NUMBER LOCATION / DESCRIPTION AS RESPECTS LEASE AGREEMENT BETWEEN THE COUNTY OF SANTA CLARA AND CITY OF GILROY FOR THE LEASE OF LOC. 443, THE NEW GILROY LIBRARY LOCATED AT 350 W. SIXTH STREET, GILROY, CA. THIS IS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE LISTED ABOVE HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENC MAY BE ISSUED OR MAY PARTAIN. THE COVERAGE AFFORED BY THE MEMORANDUMS DESCRIBED HEREIN IS SUBJECT TO ALL TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUMS. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. COVERAGE /PERILS /FORMS OF INSURANCE ALL RISK OF DIRECT PHYSICAL LOSS OR DAMAGE, INCLUDING FLOOD. $25,000,000 PER OCC FOR ALL RISK AND ANN AGG FOR FLOOD EARTHQUAKE IS EXCLUDED. EARTHQUAKE LIMIT IS NOT APPLICABLE. $25,000,000 PER OCC/ANN AGG FOR EARTHQUAKE REPAIR OR REPLACEMENT COST VALUATION SUBJECT TO MEMORANDUM OF COVERAGE PROVISIONS VEHICLE/BUSES ARE SUBJECT TO ACTUAL CASH VALUE OR REPLACEMENT COST PER SCHEDULE ON FILE WITH THE AUTHORITY ALL LIMITS ARE SHARED. DEDUCTIBLES - ALL RISK OF DIRECT PHYSICAL LOSS OR DAMAGE (EXCLUDING FLOOD AND EARTHQUAKE): $50,000 PER OCCURRENCE AS PER SCHEDULE ON FILE WITH THE AUTHORITY FLOOD: $50,000 EXCEPT FOR CRITICAL FLOOD (LOCATIONS IN FEMA FLOOD ZONE A OR V) DEDUCTIBLE IS $100,000 VEHICLES AND MOBILE EQUIPMENT: IF COVERAGE IS SCHEDULED AND PURCHASED, DEDUCTIBLE APPLIES PER SCHEDULE ON FILE WITH THE AUTHORITY. SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUM(S) OF COVERAGE BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE MEMORANDUM(S) OF COVERAGE PROVISIONS. NAME AND ADDRESS CITY OF GILROY ATTN: DAN JOHNSON 7351 ROSANNA STREET GILROY, CA 95020 NATURE OF INTEREST MORTGAGEE LOSS PAYEE AUTHORIZED REPRESENTATIVE �lrsl� CSAC EXCESS INSURANCE AUTHORITY (OTHER) EVIDENCE ONLY T ACOR DO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 02/12/14 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 Alliant Insurance Services, Inc. 1301 Dove St., Suite 200 CONTACT NAME: PHONE: PHONE: A/C. NO: Newport Beach, CA 92660 E-MAIL ADDRESS: PRODUCER: 949- 756 -0271• Fax 949 - 756 -2713• License No. OC36861 X CUSTOMER ID INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: INSURERS) AFFORDING COVERAGE NAIC # SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY BOARD INSURER A: ASSOCIATED INDUSTRIES INSURANCE CO. 23140 INSURER B: 14600 WINCHESTER BLVD. INSURER C: LOS GATOS, CA 95032 INSURER D: CLAIMS MADE 7x 1 OCCUR INSURER E: INSURER F: MED EXPR (Any one person) rnVFRarFS CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER (MWDD/YY) (MWDD/YY) LIMITS A GENERAL LIABILITY X X PAC 1000001 02 09/29/13 09/29/14 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea Occurrence $1,000,000 CLAIMS MADE 7x 1 OCCUR MED EXPR (Any one person) N/A PERSONAL 8 ADV INJURY $2,000,000 GL DED: $1,000 DIED GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE NA` PRODUCTS - COMP /OP AGG. $2,000,000 POLICY PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea Accident) ANY AUTO BODILY INJURY ( Per person) BODILY INJURY (Per accident) ALL OWNED AUTOS SCHEDULED AUTOS PROPERTY DAMAGE HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAR CLAIMS DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY Y/N we STATU- ER CV uMlTS ER E.L. EACH ACCIDENT ANY PROPRIETORY /PARTNER / EXECUTIVE U OFFICER /MEMBER EXCLUDED? N/A E.L. DISEASE - EA EMPLOYEE (MANDATORY IN NH) IF YES, DESCRIBE UNDER DESCRIPTION OF OPERATIONS BELOW E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES (Attach Acord 101, Addldonal Remarks Schedules, K more space Is required) 'POLICY FORM DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE AS RESPECTS LEASED PREMISES LOCATED AT 350 WEST SIXTH STREET, GILROY, CA. CITY OF GILROY, ITS ELECTED OFFICIALS, OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVES SHALL BE NAMED AS ADDITIONAL INSURED. THIS INSURANCE IS PRIMARY AND ANY OTHER INSURANCE OR SELF - INSURANCE MAINTAINED BY SUCH ADDITIONAL INSUREDS IS EXCESS AND NONCONTRIBUTING WITH THIS.POLICY. WAIVER OF SUBROGATION: THE "COMPANY" WILL WAIVE ITS RIGHT OF SUBROGATION AGAINST ANY PERSON OR ORGANIZATION FOR WHOM THE "INSURED" IS PERFORMING OPERATIONS, BUT ONLY IF: 1. THAT PERSON OR ORGANIZATION REQUIRES IN THE WRITTEN AGREEMENT WITH THE "PARTICIPATING NAMED INSURED" THAT THE "PARTICIPATING NAMED INSURED" WAIVE ITS RIGHT OF RECOVERY AGAINST THAT PERSON OR ORGANIZATION AND, 2. THE WRITTEN AGREEMENT WAS MADE PRIOR TO THE DATE OF THE "OCCURRENCE ". ADDITIONAL INSURED ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. rpirriRrATF Nrn. nFR CANCELLATION ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 02008 ACORD CORPORATION. All rights resemed. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF GILROY CI CI THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TN: CITY ADMINISTRATOR CITY ACCORDANCE WITH THE POLICY PROVISIONS. 7351: A STREET GILROY, CA 95020 AUTHORIZED REPRES TATNE ,Q ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD 02008 ACORD CORPORATION. All rights resemed. AGENCY CUSTOMER ID: LOC #: ACOR D® ADDITIONAL REMARKS SCHEDULE AGENCY ALLIANT INSURANCE SERVICES, INC. POLICY NUMBER PAC 1000001 02 CARRIER NAIC CODE ASSOCIATED INDUSTRIES INSURANCE CO. 23140 ADDITIONAL REMARKS Page 2 of 3 SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY BOARD 14600 WINCHESTER BLVD. LOS GATOS, CA 95032 EFFECTIVE DATE: 09/29/13 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 (2009/09) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the Participation Endorsement. The Company may cancel the coverage by mailing to the first Participating Named Insured at the address shown in the participation endorsement written notice stating when, not less than sixty (60) days thereafter, such cancellation shall be effective. Provided that the Participating Named Insured fails to discharge, when due, any of its obligations in connection with the payment of premium for the policy or any installment thereof, the coverage may be canceled by the Company by mailing to the Participating Named Insured at the address shown in the participation endorsement, written notice stating when, not less than ten (10) days thereafter, such cancellation shall be effective. I ne AUUKU name ana. logo are registema malls W AGUKU THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured - Designated Person or Organization This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON - PROFIT CORPORATIONS Name of Person or Organization: Any person or entity that the "Named Insured" has entered into a written agreement, prior to a loss, to provide defense, indemnity or additional insured protection. The following is added to Section V. PERSONS OR ENTITIES INSURED: Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only as respects "Bodily Injury" and "Property Damage" arising, in whole or in part, out of the operations of the Named Insured. The inclusion of such Additional Insured shall not serve to increase the "Company's" Limit of Liability as specified in.the participation endorsement of this Policy: However, additional insured coverage provided by this insurance will not be broader than coverage required in the written agreement. Includes copyrighted material of ISO Properties, Inc., 2004 with Page 1 of 1 its permission A.CQRVO CERTIFICATE OF LIABILITY INSURANCE DA04/07/16 (MMtDDNYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR.NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate_ does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Alliant Insurance Services, Inc. 1301 Dove St., Suite 200 CONTACT NAME: PHONE: PHONE: A/C. NO: Newport Beach, CA 92660 E-MAIL ADDRESS: 949- 756 -0271• Fax 949- 756 - 2713• License No. OC36861 PRODUCER: 09/29/16 ,) CUSTOM. ID # INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: INSURER(S) AFFORDING COVERAGE NAIC # SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY INSURERA: ASSOCIATED INDUSTRIES INSURANCE CO. 23140 BOARD INSURER B: GENERAL AGGREGATE 1370 DELL AVENUE INSURER C: $1,000,000 CAMPBELL, CA 95008 INSURER D: LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS INSURER E: _ INSURER. F: COMBINED SINGLE LIMIT- Ea Accident COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED 'NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. " INSR T TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER -IC (MMlDDlYY) POLICY EXP (MM/DD/YY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR GL DED: $1,000 DED X PAC 1000001 04 09/29/15 09/29/16 ,) EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES. Ea Occurrence $1.000,000 MED EXPR (Any one person) N/A PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY pg Lac GENERAL AGGREGATE NA' PRODUCTS- COMP /OPAGG: $1,000,000 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 UMBRELLA UAB EXCESS LIAR OCCUR CLAIMS MADE EACH OCCURRENCE AGGREGATE DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABIUTY AIJY PROPRIETORY /PARTNER /EXECUTNE OFFICER / MEMBER EXCLUDED? (MANDATORY IN NH) IF YES. DESCRIBE UNDER DESCRIPTION OF OPERATIONS BELOW - VA WCSTATU- oTH- Tolxv U. ER E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE - E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONSILOCATIONSMEHICLES (Attach Acord 101, Additional Remarks Schedules, if more space Is required) 'POLICY FORM DOES NOT CONTAIN GENERAL LIABILITY AGGREGATE . AS RESPECTS USE OF PREMISES FOR THE SUMMER READING KICK OFF CARNIVAL EVENT BEING HELD ON JUNE 11, 2016. THE CERTIFICATE HOLDER SHALL BE NAMED AS ADDITIONAL INSURED. ADDITIONAL'1NSURED ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. CERTIFICATE HOLDER GANGtLLA 1 IUN CITY OF GILROY -SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 ROSANNA ST. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GILROY, CA 95020 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESqNTATIVE . ACORD ?1(2009109) The ACORD name and logo are registered marks of ACORD 02008 ACORD CORPORATION. All rights reserved. AGENCY CUSTOMER ID: LOC #: ACDlt ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: ALLIANT INSURANCE SERVICES, INC. SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY BOARD POLICY NUMBER PAC 1000001 04 1370 DELL AVENUE CAMPBELL, CA 95008 CARRIER NAIC CODE ASSOCIATED INDUSTRIES INSURANCE CO. 23140 EFFECTIVE DATE: 09/29/15 KMMAKKO THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 (2009/09) _ FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the Participation Endorsement. � na n�..vw amnia a�iu iuyu ra rnyirroraa marrts o� ia�.urtu THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured - Designated Person or Organization This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON - PROFIT CORPORATIONS Name of Person or Organization: Any person or entity that the "Named Insured" has entered into a written agreement, prior to a loss, to provide defense, indemnity or additional insured protection. The following is added to Section V. PERSONS OR ENTITIES INSURED: Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only as respects "Bodily Injury" and "Property Damage" arising, in whole or in part, out of the operations of the Named Insured. The inclusion of such Additional Insured shall not serve to increase the "Company's" Limit of Liability as specified in the participation endorsement of this Policy: However, additional insured coverage provided by this insurance will not be broader than coverage required in the written agreement. Includes copyrighted material of ISO Properties, Inc., 2004 with Page 1 of 1 its permission CERTIFICATE NUMBER EVIDENCE OF PROPERTY COVERAGE ISSUE DATE(MMIDDNYYY) .PROP -1496 03/30/2016 THIS EVIDENCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS EVIDENCE OF COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND ADDITIONAL INTEREST. CSAC Excess Insurance Authority (CSAC EIA) COVERAGE C/O ALLIANT INSURANCE SERVICES, INC. AFFORDED A - CSAC Excess Insurance Authority PO BOX 6450 COVERAGE NEWPORT BEACH, CA 92658 -6450 FORDED B - PHONE (949) 756 -0271 / FAX (619) 699 -0901 LICENSE *OC36861 MEMBER TOWER NUMBER MEMORANDUM NUMBER SANTA CLARA COUNTY IV EIAPPRI6 -19 ATTN: LANCE SPOSITO EFFECTIVE DATE(MMIDD/YYYI� EXPIRATION DATE (MWDDIYYM C/O ESA INSURANCE 2310 NORTH FIRST STREET, SUITE 203 03/31/2016 03/3172017 CONT. UNTIL TERMINATED IF ❑ SAN JOSE, CA 95131 CHECKED THIS REPLACES PRIOR EVIDENCE: n �y: / F LOCATION /DESCRIPTION AS RESPECTS LEASE AGREEMENT BETWEEN THE COUNTY OF SANTA CLARA AND CITY OF GILROY FOR THE LEASE OF LOC. 443, THE NEW GILROY LIBRARY LOCATED. AT 350 W. SIXTH STREET, GILROY, CA. THISIS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE LISTED ABOVE HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE PERIOD -_ _ - CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR _ MAY BE ISSUED OR MAY PARTAIN. THE COVERAGE' AFFORED BY THE MEMORANDUMS DESCRIBED HEREIN 1S SUBJECT TO ALL TERMS, EXCLUSIONS, AND CONDITIONS_O_F SUCH MEMORANDUMS. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - - y s.,,>< >.w,:uxzas,sz+:s, •. ,.., "'...r'wsaAa!'�i,,. ,., ,,.,,. ,_. >7 x;, -s w, ,.,;,;.- r-„r,,,...,.,„,; W.._ M. w' r.. z✓wra,:.C^"�..,,,.b�5s'.uks;d:, nr �,a.C.z.Kx, .,..z. COVERAGE I PERILS 1 FORMS AMOUNT OF INSURANCE ALL RISK OF',DIRECT PHYSICAL LOSS OR DAMAGE, INCLUDING FLOOD. $25,000,000 PER OCC FOR ALL RISK AND ANN AGG FOR FLOOD EARTHQUAKE IS EXCLUDED. EARTHQUAKE LIMIT IS NOT APPLICABLE. $25,000,000 PER OCC/ANN AGG FOR EARTHQUAKE REPAIR OR REPLACEMENT COST VALUATION SUBJECT TO MEMORANDUM OF COVERAGE PROVISIONS VEHICLE/BUSES ARE SUBJECT TO ACTUAL CASH VALUE OR REPLACEMENT COST PER SCHEDULE ON FILE WITH THE AUTHORITY ALL. LIMITS ARE SHARED. :. DEDUCTIBLES: - -- — - - - -- -- -- ALL RISK OF DIRECT PHYSICAL LOSS OR DAMAGE (EXCLUDING FLOOD AND EARTHQUAKE): $50,000 PER OCCURRENCE AS PER SCHEDULE ON FILE WITH THE AUTHORITY FLOOD: $50,000 EXCEPT FOR CRITICAL FLOOD (LOCATIONS IN FEMA FLOOD ZONE A OR V) DEDUCTIBLE IS $100,000 VEHICLES AND MOBILE EQUIPMENT: IF COVERAGE IS SCHEDULED AND PURCHASED, DEDUCTIBLE APPLIES PER SCHEDULE ON FILE WITH THE AUTHORITY. L/.G'Y,a�.y. MT"iq,>rfi, "s i,r m..: " -=k. "•: i..., "% , <. iit>i✓/s'� £ s.s°!n£0' .;; �5 :r „� -.. -r ,r., SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUM(S) OF COVERAGE BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE MEMORANDUM(S) OF COVERAGE PROVISIONS. ! Y i' � W % S %v�. i it /v �� ^/ � '%/ yu i£ fi'Efr� 4>�Srj';• /v ldri%w'9 .,. ., �1v' NAME AND ADDRESS ` NATURE OF INTEREST CITY OF GILROY MORTGAGEE ATTN:.DAN JOHNSON -r= ”" LOSS PAYEE (OTHER) EVIDENCE ONLY 7351 ROSANNA STREET GILROY, CA 95020 AUTHORIZEDREPRESENTATIVE r€ y''" CSAC EXCESS INSURANCE AUTHORITY T A�'n'in® CERTIFICATE OF LIABILITY INSURANCE DATE {MMIDDIYYYY) 01/20/16 THIS CERTIFICATE 1S 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 Alliant Insurance Services, Inc. 1301 Dove St., Suite 200 CONTACT NAME: PHONE: PHONE: ac. No: Newport Beach, CA 92660 E-MAIL ADDRESS: PRODUCER: CUSTOMER ID p 949- 756 -0271• Fax 949 - 756 - 2713•. License No. OC36861 INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: INSURER(S) AFFORDING COVERAGE NAIC A SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY 09/29/16 EACH OCCURRENCE BOARD INSURER A. ASSOCIATED INDUSTRIES INSURANCE CO. 23140 INSURER B: X 1370 DELL AVENUE INSURER C: CAMPBELL, CA 95008 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH, THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE'BEEN REDUCED BY PAID CLAIMS. LTR -TYPE OF INSURANCE ASR S� POLICY NUMBER (MWDD/YY) (MMIDD/YY) LIMITS A GENERAL LIABILITY X X PAC 1000001 04 09/29/15 09/29/16 EACH OCCURRENCE PREMISES Ea Occurrence $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS MADE ® OCCUR MED EXPr (Any one person) N/A PERSONAL 8 ADV INJURY $2,000,000 GL DIED: $1,000 DIED GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE NA' - CMP /PAGG. $2,000,000 71 LOC PoucY PRO AUTOMOBILEILIABILITY COMBINED SINGLE LIMIT (Ea Accident) BODILY INJURY (Per person) ANYAUTO BODILY INJURY (Per accident) ALL OWNED AUTOS SCHEDULED AUTOS PROPERTY DAMAGE (Per Arrident) HIRED AUTOS NON -OWNED AUTOS UMBRELLAUA13 OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS AGGREGATE DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY VM I WC STATU- oTH- TORY LIMITS ER E:L. EACH ACCIDENT ANYPROPRIETORY /PARTNER /EXECUTIVE OFFICER /.MEMBER U EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE (MANDATORY IN NH) IF YES,. DESCRIBE UNDER DESCRIPTION OF OPERATIONS BELOW E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach Acord 101, Additional Remarks Schedules, if more space is required) 'POLICY FORM DOES NOT CONTAIN rA GENERAL LIABILITY AGGREGATE AS RESPECTS LEASED PREMISES LOCATED AT 350 WEST SIXTH STREET, GILROY, CA CITY OF GILROY, ITS ELECTED OFFICIALS, OFFICERS, EMPLOYEES, AGENTS, AND REPRESENTATIVES SHALL BE NAMED AS ADDITIONAL INSURED: THIS INSURANCE IS PRIMARY AND ANY OTHER INSURANCE OR SELF-INSURANCE MAINTAINED BY SUCH ADDITIONAL INSUREDS IS EXCESS AND _ __ NONCONTRIBUTING WITH THIS POLICY. WAIVER OF SUBROGATION: THE "COMPANY" WILL WAIVE ITS RIGHT OF SUBROGATION AGAINST ANY PERSON OR ORGANIZATION FOR WHOM THE "INSURED" IS PERFORMING OPERATIONS, BUT ONLY IF: 1. THAT PERSON OR ORGANIZATION REQUIRES IN THE AGREEMENT WITH THE "PARTICIPATING NAMED INSURED' THAT THE "PARTICIPATING NAMED INSURED" WANE:ITS RIGHT OF RECOVERY AGAINST THAT PERSON OR ORGANIZATION AND, 2. THE WRITTEN AGREEMENT WAS MADE PRIOR TOTHE DATE OF THE "OCCURRENCE'. ADDITIONAL INSURED ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. CERTIFICATE HOLDER CANCELLATION CITY OF GILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: CITY ADMINISTRATOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 ROSANNA STREET ACCORDANCE WITH THE POLICY PROVISIONS. GILROY, CA 95020 AUTHORIZED REPRESI§NTATIVE Q .C11 ACORD 25 (2009109) The ACORD name and logo are Mistered marks of ACORD 02008 ACORD CORPORATION. All rights reserved. AGENCY CUSTOMER ID: LOC #: ACO D® ADDITIONAL REMARKS SCHEDULE Page 2 of 3. AGENCY NAMED INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER ALLIANT INSURANCE SERVICES, INC. SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY BOARD POLICY NUMBER PAC 1000001 04 1370 DELL AVENUE - CAMPBELL, CA 95008 CARRIER NAIC CODE ASSOCIATED INDUSTRIES INSURANCE CO. 23140 EFFECTNt DATE: 09 129/15 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 (2009/09) FORM TITLE: CERTIFICATE OF LIABILITY' INSURANCE Notice of.cancellation will be delivered only to the participating named insured as stated in Item 1 of the Participation Endorsement. The Company may cancel the coverage by mailing to the first Participating Named Insured at the address shown in the participation endorsement written notice stating when, not less than sixty (60) days thereafter, such cancellation shall be effective. Provided that the Participating Named Insured fails to discharge, when due, any of its obligations in connection with the payment of premium for the policy or any installment thereof, the coverage may be canceled by the Company by mailing to the Participating Named Insured at the address shown in the participation endorsement, written notice stating when, not less than ten (10) days thereafter, such cancellation shall be effective. i no AI:V,tU name am OW efe MgMonW mains a AwKU THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured - Designated Person or Organization This endorsement modifies insurance provided under the following: . SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON - PROFIT CORPORATIONS Name of Person or Organization: Any person or entity that the "Named Insured" has entered into a written agreement, prior to a loss, to provide defense, indemnity or additional insured protection. The following is added to Section V. PERSONS OR ENTITIES INSURED: Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only as respects "Bodily Injury" and "Property Damage" arising, in whole or in part, out of the operations of the Named Insured. The inclusion of such Additional Insured shall not serve to increase the "Company's" Limit of Liability as specified in the participation endorsement of this Policy: However, additional insured coverage provided by -this insurance will not be broader than coverage required in the written agreement. Includes copyrighted material of ISO Properties, Inc., 2004 with Page 1 of 1 its permission Acoxv® CERTIFICATE OF LIABILITY INSURANCE DATE f /20/16 ' 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 "nof confer rights to the certificate holder in lieu of such endorsements . PRODUCER Alliant Insurance Services, Inc. 1301 Dove St., Suite 200 - - - - - - - - - - - NAME: NONE, PHONE: PHONE: i A/c. NO: Newport Beach, CA 92660 E-MAIL ADDRESS: 949 -756 -0271• Fax 949-756-2713-,License No. OC36861 PRODUCER: X CUSTOMER 10 9 INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP). MEMBER: INSURER(S) AFFORDING COVERAGE NAIC# SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY INSURERA: ASSOCIATED INDUSTRIES INSURANCE CO. 23140 BOARD INSURER B: 1370 DELL AVENUE INSURER C: DAMAGE To RENTED , PREMISES Ea Oaaurence CAMPBELL, CA 95008 INSURER D: CLAIMS MADE Fx-1 OCCUR INSURER E: INSURER F: MED EXPr (Any one person) N/A COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING_ANY REQUIREMENT, TERM OR CONDITION' OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH .POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR- SUER WVD- POLICY NUMBER POLICY (MWDDIYY) (MW/DDIYY) LIMITS A GENERAL LIABILITY X X PAC 1000001 04 09/29/15 09/29/16 EACH OCCURRENCE X COMMERCIAL GENERAL LIABILITY DAMAGE To RENTED , PREMISES Ea Oaaurence $1,000,000 CLAIMS MADE Fx-1 OCCUR MED EXPr (Any one person) N/A PERSONAL 8 ADV INJURY $2,000,000 GL DED: $1,000 DED GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE NA' PRODUCTS - COMP /OP AGG. $2,000,000 POLICY PRO- LOC FCT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea Accident)' BODILY INJURY ( Per person) ANY AUTO BODILY INJURY (Per accident) ALL OWNED AUTOS SCHEDULED AUTOS PROPERTY DAMAGE 'per A HIRED AUTOS NON - OWNED. AUTOS UMBRELLA LAS OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS DEDUCTIBLE _ .RETENTION -- - WORKERS COMPENSATION �- AND EMPLOYERS LIABILITY E AN V PROPRIETORY /PARTNER / EXECUTIVE OFFICER / MEMBER EXCLUDED? F N/A - - - -- - WCSTATU• OTPI - TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE -'EA EMPLOYEE (MANDATORY IN NH) IF YES, DESCRIBE UNDER DESCRIPTION OF OPERATIONS BELOW E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS /LOCATIONSIVEHICLES (Attach Acard 701, Additional Remarks Schedules, If more space is required ) 'POLICY'FORM DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE AS RESPECTS LEASED PREMISES LOCATED .AT350.WEST SIXTH. STREET, GILROY, CA. CITY OF GILROY, ITS ELECTED OFFICIALS, OFFICERS, EMPLOYEES, AGENTS, AND'REPRESENTATIVES SHALL BE NAMED AS ADDITIONALINSURED..THIS INSURANCE IS PRIMARY AND ANY OTHER INSURANCE OR SELF- INSURANCE',MAINTAINED BY SUCH ADDITIONAL INSUREDS.IS EXCESS AND NONCONTRIBUTING WITH'THIS POLICY: WAIVER OF SUBROGATION: THE "COMPANY" WILL WAIVE ITS RIGHT OF SUBROGATION AGAINST ANY PERSON OR ORGANIZATION- FOR:WHOM THE "INSURED" IS PERFORMING OPERATIONS, BUT ONLY IF 1. THAT PERSON ORDRGANIZATION REQUIRES IN THE WRITTEN AGREEMENT WITH THE "PARTICIPATING NAMED INSURED" THAT THE "PARTICIPATING NAMED'INSURED "WAIVE ITS RIGHT OF RECOVERY AGAINST THAT PERSON OR ORGANIZATION AND, 2. THE WRITTEN AGREEMENT' WAS MADE PRIOR TO THE DATE OF THE "OCCURRENCE ". ADDITIONAL INSURED ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. CERTIFICATE HOLDER GANGtLLA I ION CITY OF GILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE_ ATTN: CITY ADMINISTRATOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 ROSANNA STREET ACCORDANCE WITH THE POLICY PROVISIONS. GILROY, CA 95020 AUTHORIZED REPRESraNTATIVE R - ACORD 25 .(2ry 0`0910"9)" The ACORD name and logo are registered marks of ACORD 02008 ACORD CORPORATION. All rights reserved. AGENCY CUSTOMER ID: LOC #: AcOR�® ADDITIONAL REMARKS SCHEDULE Page 2 of 3 AGENCY NAMED INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: ALLIANT INSURANCE SERVICES, INC. SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY POLICY NUMBER BOARD - PAC 1000001 04 1370 DELL AVENUE CAMPBELL, CA 95008 CARRIER NAIC CODE ASSOCIATED INDUSTRIES JNSURANCE CO. 23140 1 EFFECTIVE DATE: 09 /29/15 4DDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 (2009/09) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the Participation Endorsement. The Company may cancel the coverage by mailing to the first. Participating Named Insured at the address shown in the participation endorsement written notice stating when, not less than sixty (60) days thereafter, such cancellation shall be effective. Provided that the Participating Named Insured fails to discharge, when due, any of its obligations in connection with the payment of premium for the policy or any installment thereof, the coverage may be _canceled by the Company by mailing to the Participating Named Insured at the address shown in the participation endorsement, written notice stating when, not less than ten (10) days thereafter, such cancellation shall be effective. me AOUKU name ano logo are regism,90 maars of AGUKU THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured - Designated Person or Organization This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON - PROFIT CORPORATIONS Name of Person or Organization: Any person or entity that the "Named Insured" has entered into a written agreement, prior to a loss, to provide defense, indemnity or additional insured protection. The following is added to Section V. PERSONS OR ENTITIES INSURED: Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only as respects `Bodily Injury" and "Property Damage" arising, in whole or in part, out of the operations of the Named Insured. The inclusion of such Additional Insured shall not serve to increase the "Company's" Limit of Liability as specified in the participation endorsement of this Policy: However, additional insured coverage provided by this insurance will not be broader than coverage required in the written agreement. Includes copyrighted material of ISO Properties, Inc., 2004 with Page 1 of 1 its permission CERTIFICATE NUMBER ISSUE DATE MM/DD/YYYY � � �. 9 m 1( PROP -1346 „P „" „,. 03/3 /2015 THIS EVIDENCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS EVIDENCE OF COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND ADDITIONAL INTEREST. CSAC Excess Insurance Authority (CSAC EIA) COVERAGE C/O ALLIANT INSURANCE SERVICES, INC. AFFORDED A - CSAC Excess Insurance Authority PO BOX 6450 COVERAGE NEWPORT BEACH, CA 92658 -6450 AFFORDED 13- PHONE (949) 756 -0271 / FAX (619) 699 -0901 LICENSE #OC36861 MEMBER TOWER NUMBER MEMORANDUM NUMBER SANTA CLARA COUNTY IV EIAPPR15 -18 ATTN: LANCE SPOSITO EFFECTIVE DATE(MWDD/YYYY) EXPIRATION DATE (MWDD/YYYY) C/O ESA INSURANCE 2310 NORTH FIRST STREET, SUITE 203 03/31/2015 03/31/2016 TERMINATED TERMINATED IF ❑ SAN JOSE, CA 95131 CHECKED THIS REPLACES PRIOR EVIDENCE: s .......: ... .. .: ... », a... ,,�u,..e ........ ....... :... x:,. s.. LOCATION /DESCRIPTION AS RESPECTS LEASE AGREEMENT BETWEEN THE COUNTY OF SANTA CLARA AND CITY OF GILROY FOR THE LEASE OF LOC. 443, THE NEW GILROY LIBRARY LOCATED AT 350 W. SIXTH STREET, GILROY, CA. THIS IS TO CERTIFY THAT THE MEMORANDUMS, OF COVERAGE LISTED ABOVE HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE MAY BE ISSUED OR MAY PARTAIN. THE COVERAGE AFFORED BY THE MEMORANDUMS DESCRIBED HEREIN IS SUBJECT TO ALL TERMS, EXCLUSIONS, AND CONDITIONS OF SUCH MEMORANDUMS. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. mom- w.....,, ,., ..,.. . COVERAGE / PERILS / FORMS AMOUNT OF INSURANCE ALL RISK OF DIRECT PHYSICAL LOSS OR DAMAGE, INCLUDING FLOOD. $25,000,000 PER OCC:FOR ALL RISK AND ANN AGG FOR FLOOD EARTHQUAKE IS EXCLUDED. EARTHQUAKE LIMIT IS NOT APPLICABLE. $25,000,000 PER OCC/ANN AGG FOR EARTHQUAKE REPAIR OR REPLACEMENT COST VALUATION SUBJECT TO MEMORANDUM OF COVERAGE PROVISIONS VEHICLE/BUSES ARE SUBJECT TO ACTUAL CASH VALUE OR REPLACEMENT COST PER SCHEDULE ON FILE WITH THE AUTHORITY ALL LIMITS ARE SHARED. DEDUCTIBLES: ALL RISK OF DIRECT PHYSICAL LOSS OR DAMAGE (EXCLUDING FLOOD AND EARTHQUAKE): $50,000 PER OCCURRENCE AS PER SCHEDULE ON FILE WITH THE AUTHORITY FLOOD: $50,000 EXCEPT FOR CRITICAL FLOOD (LOCATIONS IN FEMA FLOOD ZONE A OR V) DEDUCTIBLE IS $100,000 VEHICLES AND MOBILE EQUIPMENT: IF COVERAGE IS SCHEDULED AND PURCHASED, DEDUCTIBLE APPLIES PER SCHEDULE ON FILE WITH THE AUTHORITY. ... f s r -wu ' ri '.» OR - g s .: n ;- '' /i`� 3 GI s '�� r :: � �,�"#",,..: ��..;, uy:fi 5: ,w ......... ..... ...i :.. ..a;' >az ✓s,a,ui.::. »,:w.,u man »,h,.. »r. .,.,....,,,., /s :;,.: :.:: . SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUM(S) OF COVERAGE BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED 'IN ACCORDANCE WITH THE MEMORANDUM(S) OF COVERAGE PROVISIONS. ? ...,,., r..:��a: ».�z�,�,��;. :r... �'�; �5�.;'�.. .> -; .z�... R>YS.��K„<,.M w�l� >r.,r..r.. <n<x�. <y« ,:. Via: >.. : ✓1:,.. ,. : :�r,:r >�... NAME AND ADDRESS 3 3 NATURE OF INTEREST CITY OF GILROY MORTGAGEE ATTN: DAN JOHNSON 7351 ROSANNA STREET � LOSS PAYEE � (OTHER) EVIDENCE ONLY A GILROY, CA 95020 P?' % %. AUTHORIZED REPRESENTATIVE CSAC EXCESS INSURANCE AUTHORITY CERTIFICATE NUMBER � ��y�,� �i �� ISSUE DATE (MM/DD/YYYY) PROP -1346 w, w. £s. < ., , ,._ ,«,x ,,££.,,",., k f., £.,:. 03/31/2015 THIS EVIDENCE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE ADDITIONAL INTEREST. THIS EVIDENCE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BELOW. THIS EVIDENCE OF COVERAGE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND ADDITIONAL INTEREST. CSAC Excess Insurance Authority (CSAC EIA) COVERAGE C/O ALLIANT INSURANCE SERVICES, INC. AFFORDED A - CSAC Excess Insurance Authority PO BOX 6450 COVERAGE NEWPORT BEACH, CA 92658 -6450 AFFORDED B - PHONE (949) 756 -0271 / FAX (619) 699 -0901 LICENSE #OC36861 MEMBER TOWER NUMBER MEMORANDUM NUMBER SANTA CLARA COUNTY IV EIAPPR15 -18 ATTN: LANCE SPOSITO C/O ESA INSURANCE EFFECTIVE DATE (MWDDrrCM EXPIRATION DATE (MWDD/YYYY) CONT. UNTIL 2310 NORTH FIRST STREET, SUITE 203 03/31/2015 03/31/2016 TERMINATED IF ❑ 1 1 CHECKED SAN JOSE, CA 95131 THIS REPLACES PRIOR EVIDENCE: 's LOCATION l DESCRIPTION AS RESPECTS LEASE AGREEMENT BETWEEN THE COUNTY OF SANTA CLARA AND CITY OF GILROY FOR THE LEASE OF LOC. 443, THE NEW GILROY LIBRARY LOCATED AT 350 W. SIXTH STREET, GILROY, CA. THIS IS TO CERTIFY THAT THE MEMORANDUMS OF COVERAGE LISTED ABOVE HAVE BEEN ISSUED TO THE MEMBER NAMED ABOVE FOR THE PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EVIDENCE MAY BE ISSUED OR MAY PARTAIN. THE COVERAGE AFFORED BY THE MEMORANDUMS DESCRIBED HEREIN IS SUBJECT TO ALL TERMS, EXCLUSIONS, AND CONDMO�bNSS OF SUCH MEMORANDUMS. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. :�i�l�w���lR 3':�z 4.. °'j : { xny �Fy Y/ r.Y -x y { ��,. � q..••u, : r„I:'y /f fj ����..,�..L�:,, �.a� y •.• ;. {s._,. £m .. , ,. ,., .£.. a,£a,x 4m,.Y.<. .r,,, r.?%y.S.. /u .. ..:+'��. ..:sn.: ; . ,aa..�,: %..., •.. •. ... ••,. ,,.ro�K'.., •., >f # : . , COVERAGE / PERILS / FORMS AMOUNT OF INSURANCE ALL RISK OF DIRECT PHYSICAL LOSS OR DAMAGE, INCLUDING FLOOD. $25,000,000 PER OCC FOR ALL RISK AND ANN AGG FOR FLOOD EARTHQUAKE IS EXCLUDED. EARTHQUAKE LIMIT IS NOT APPLICABLE. $25,000,000 PER OCCIANN AGG FOR EARTHQUAKE REPAIR OR REPLACEMENT COST VALUATION SUBJECT TO MEMORANDUM OF COVERAGE PROVISIONS VEHICLEIBUSES ARE SUBJECT TO ACTUAL CASH VALUE OR REPLACEMENT COST PER SCHEDULE ON FILE WITH THE AUTHORITY ALL UMJTS ARE SHARED. n • •_... .. �r '. si' fi�tr'„j,i 3 / �A`.,s. ri,...,;. ,:s ;,,,..<fi/:2A'»�v., ,, f,•,::x zH ; DEDUCTIBLES: ALL RISK OF DIRECT PHYSICAL LOSS OR DAMAGE (EXCLUDING FLOOD AND EARTHQUAKE): $50,000 PER OCCURRENCE AS PER SCHEDULE ON FILE WITH THE AUTHORITY FLOOD: $50,000 EXCEPT FOR CRITICAL FLOOD (LOCATIONS IN F.EMA FLOOD ZONE A OR V) DEDUCTIBLE IS $100,000 VEHICLES AND MOBILE EQUIPMENT: IF COVERAGE IS SCHEDULED AND PURCHASED, DEDUCTIBLE APPLIES PER SCHEDULE ON FILE WITH THE AUTHORITY. . h Y � f £ ::;. <v „• .. i:...,.::;c r!S i.;s •, .,,.r....: a:z.r •,, ,, :::. V ....:.'< . SHOULD ANY OF THE ABOVE DESCRIBED MEMORANDUM(S) OF COVERAGE BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE MEMORANDUM(S) OF COVERAGE PROVISIONS. - -- �>�ry� ... ._;�, .... �,�•aY - S � -E x,.�`� n<' �a <.! «ua' :�k:� y_ -,•, axJ,.���x,u...m.....ma� - NAME AND ADDRESS €> NATURE OF INTEREST CITY OF GILROY MORTGAGEE ATTN: DAN JOHNSON 7351 ROSANNA STREET ❑ LOSS PAYEE (OTHER) EVIDENCE ONLY GILROY, CA 95020 Y? AUTHORIZED REPRESENTATIVE Y�< CSAC EXCESS INSURANCE AUTHORITY W- HI ACORD® CERTIFICATE OF LIABILITY INSURANCE °Aitio4na Y' 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 Alliant Insurance Services, Inc. 1301 Dove St., Suite 200 NAME: r NAME: PHONE: A/C. NO: Newport Beach, CA 92660 ._.N E-MAIL ADDRESS: PROOUC:�- CUSTOMER IDd 949 - 756-0271• Fax 949- 756 -2713• License No. OC36861 INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: INSURERS) AFFORDING COVERAGE NAIC A SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY BOARD INSURER.^: ASSOCIATED INDUSTRIES INSURANCE;, CO,,,,,,,,,,,,,,,,, „23140,,,,,,,,,,,,,,,,.,.,,,, 1370 DELL AVENUE INSURER B: INSURER C: ............................... _ ...... __..___._.... .... _ ...... __ ...... _. . ..__ ........................................ --- .................................. _ .... _ .......... _. ........ ....... _.._ ....._...._... _........_....... CAMPBELL, CA 95008 INSURER D: $1,000,000 _INSURER E: _ ............................... _ __ ........ __ .................................................................. .................................................... _ ... _ .... _.__._ ... ...................... INSURER F: CnVFRAGFS CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR T TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MMlDDIYY) POLICY EXP (MMIDDIYY) LIMITS A GENERAL LIABILITY X X PAC 1000001 03 09129/14 09/29/15 EACH OCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTE PREMISES Ea Occurrence $1,000,000 CLAIMS MADE ® OCCUR MED EXPR (Any one person) N/A PERSONAL 8 ADV INJURY $2,000,000 GL DED: $1,000 DED GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE NA. PRODUCTS - COMP /OP AGG. $2,000,000 POUCV PR,-; LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea Accident) BODILY INJURY( Per person) ANY AUTO BODILY INJURY (Per accident) ALL OWNED AUTOS SCHEDULED AUTOS PROPERTY DAMAGE IPA Amielpritl HIRED AUTOS .NON -OWNED AUTOS UMBRELLA LIABT OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAR culMS DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY yal. 0THWC - TOR ORY S A LIMITS - ER -^ E.L. EACH ACCIDENT ANY PROPRIETORY/PARTNER I EXECUTIVE U OFFICER I MEMBER EXCLUDED? N/A E.L. DISEASE - EA EMPLOYEE (MANDATORY IN NH) IF YES, DESCRIBE E.L. DISEASE- POLICY LIMIT UNDER DESCRIPTION OF OPERATIONS BELOW DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES (Attach Aeord 101, Additional Remarks Schedules, If mom space Is mqulred) 'POLICY FORM:DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE AS RESPECTS LEASED PREMISES LOCATED AT 350 WEST SIXTH STREET, GILROY, CA. CITY OF GILROY, ITS ELECTED OFFICIALS, OFFICERS, EMPLOYEES, AGENTS; AND REPRESENTATIVES SHALL BE NAMED AS ADDITIONAL INSURED. THIS INSURANCE IS PRIMARY AND ANY OTHERINSURANCE OR SELF - INSURANCE MAINTAINED BY SUCH. ADDITIONAL INSUREDS IS.EXCESS AND NONCONTRIBUTING WITH THIS POLICY. WAIVER OF SUBROGATION: THE "COMPANY” WILL WAIVE ITS RIGHT OF SUBROGATION AGAINST ANY PERSON OR ORGANIZATION FOR WHOM THE "INSURED' IS PERFORMING OPERATIONS, BUT ONLY IF: 1. THAT PERSON OR ORGANIZATION REQUIRES IN THE WRITTEN AGREEMENT WITH THE "PARTICIPATING NAMED INSURED" THAT THE "PARTICIPATING NAMED .INSURED" WAIVE ITS RIGHT OF RECOVERY AGAINST THAT PERSON OR ORGANIZATION AND, 2. THE WRITTEN AGREEMENT WAS MADE PRIOR TO THE DATE OF THE "OCCURRENCE ". ADDITIONAL INSURED ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. CERTIFICATE HOLDER GAN(;ll I IUN CITY OF GILROY CI CI SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TN: CITY ADMINISTRATOR CITY A THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351: A STREET ACCORDANCE WITH THE POLICY PROVISIONS. GILROY, CA 95020 AUTHORIZED REPRES TATIVE Q l .7 ACO)RD 11 (2� OOg /0g) she ^CORD name end logo ere registered marks of ^CORD 02008 ACORD CORPORATION. All rights reserved. 4 AGENCY CUSTOMER ID: LOC #: ACORD'® ADDITIONAL REMARKS SCHEDULE #4�. Page 2 of 3 AGENCY NAMED INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: ALLIANT INSURANCE SERVICES, INC. SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY BOARD POLICY NUMBER PAC 1000001 03 1370 DELL AVENUE CAMPBELL, CA 95008 CARRIER NAIC CODE ASSOCIATED INDUSTRIES INSURANCE CO. 23140 EFFECTIVE DATE: 09 /29/14 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 (2009/09) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the Participation Endorsement. The Company may cancel the coverage by mailing to the first Participating Named Insured at the address shown in the participation endorsement written notice stating when, not less than sixty (60) days thereafter, such cancellation shall be effective. Provided that the Participating Named Insured fails to discharge, when due, any of its obligations in connection with the payment of premium for the policy or any installment thereof, the coverage may be canceled by the Company by mailing to the Participating Named Insured at the address shown in the participation endorsement, written notice stating when, not less than ten (10) days thereafter, such cancellation shall be effective. .--- name —.9. arer g,-- morns. -- THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Additional Insured - Designated Person or Organization This endorsement modifies insurance provided under the following: SPECIAL LIABILITY POLICY FOR PUBLIC ENTITIES AND NON - PROFIT CORPORATIONS Name of Person or Organization: Any person or entity that the "Named Insured" has entered into a written agreement, prior to a loss, to provide defense, indemnity or additional insured protection. The following is added to Section V. PERSONS OR ENTITIES INSURED: Any person(s) or organization(s) listed in the Schedule above is an Additional Insured, but only as respects "Bodily Injury" and "Property Damage" arising, in whole or in part, out of the operations of the Named Insured. The inclusion of such Additional Insured shall not serve to increase the "Company's" Limit of Liability as specified in the participation endorsement of this Policy: However, additional insured coverage provided by this insurance will not be broader than coverage required in the written agreement. Includes copyrighted material of ISO Properties, Inc., 2004 with Page 1 of 1 its permission �1 HzacORDO CERTIFICATE OF LIABILITY INSURANCE 09/29/DlN4yyy ' 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 Alliant Insurance Services, Inc. NAME: PHONE: PHONE: 1301 Dove St., Suite 200 - __ AIC. NO: — Newport Beach, CA 92660 EMAIL ADDRESS: 949 - 756 -0271. Fax 949 -756 -2713• License No. OC36861 PRODUCER: INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: INSR LTR TYPE OF INSURANCE INSURER(S) AFFORDING COVERAGE NAIC A SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY POLICY NUMBER POLICY EFF (MM/DDIYY) POLICY EXP (MMIDDNY) LIMITS BOARD GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE LX 1 OCCUR GL DED: $1,000 DIED INSURER A: ASSOCIATED INDUSTRIES INSURANCE CO. 23140 14600 WINCHESTER BLVD. 09/29/15 INSURER B: $1,000,000 DAMAGE TO RENTED PREMISES Ea Occurrence) LOS GATOS, CA 95032 MED EXPR (Any One person) INSURER C: PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO" LOC GENERAL AGGREGATE INSURER D: PRODUCTS - COMP /OPAGG. $1,000,000 AUTOMOBILE INSURER E: INSURER F: COMBINED SINGLE LIMIT CAVFRAGFS CFRTIFICATF NIIMRFR• BODILY INJURY ( Per person) RFVIRInN NIIMRFR- 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 SUBR WVO POLICY NUMBER POLICY EFF (MM/DDIYY) POLICY EXP (MMIDDNY) LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE LX 1 OCCUR GL DED: $1,000 DIED X PAC 1000001 03 09/29/14 09/29/15 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea Occurrence) $1,000,000 MED EXPR (Any One person) N/A PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER POLICY PRO" LOC GENERAL AGGREGATE NA` PRODUCTS - COMP /OPAGG. $1,000,000 AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT BODILY INJURY ( Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS EACH OCCURRENCE AGGREGATE DEDUCTIBLE RETENTION WORKERS COMPENSATION AND EMPLOYERS LIABILITY YIN._ ANY PROPRIETORY /PARTNER / EXECUTIVE OFFICER /MEMBER EXCLUDED? I (MANDATORY IN NH) IF YES, DESCRIBE UNDER DESCRIPTION OF OPERATIONS BELOW N/A we sTATU- OTH. TORY LIMITS ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS /LOCATIONSNEHICLES (Attach Acord 191, Additional Remarks Schedules, H mors space Is nquhed) •POLICY FORM DOES NOT CONTAIN A GENERAL LIABILITY AGGREGATE AS RESPECTS USE OF PREMISES FOR AN IMPALA CLUB SHOW BEING HELD ON OCTOBER 18, 2014. THE CITY OF GILROY, ITS OFFICERS, REPRESENTATIVES, AGENTS AND EMPLOYEES SHALL BE NAMED AS ADDITIONAL INSURED. ADDITIONAL INSURED ENDORSEMENT ATTACHED. SUBJECT TO POLICY TERMS, CONDITIONS AND EXCLUSIONS. CITY OF GILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 ROSANNA STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GILROY, CA 95020 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRES TATIVE ACORD 25 (2008109) The ACORD name and logo are registered marks d ACORD 02DO8 ACORD CORPORATION. All rights reserved. AGENCY CUSTOMER ID: LOC #: AcORD® ADDITIONAL REMARKS SCHEDULE kl�� Page 2 of 3 AGENCY NAMED INSURED: SPECIAL LIABILITY INSURANCE PROGRAM (SLIP) MEMBER: ALLIANT INSURANCE SERVICES, INC. SANTA CLARA COUNTY LIBRARY JOINT POWERS AUTHORITY BOARD POLICY NUMBER PAC 1000001 03 14600 WINCHESTER BLVD. LOS GATOS, CA 95032 CARRIER NAIC CODE ASSOCIATED INDUSTRIES INSURANCE CO. 23140 EFFECTIVE DATE: 09/29/14 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 (2009/09) FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Notice of cancellation will be delivered only to the participating named insured as stated in Item 1 of the Participation Endorsement.