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HomeMy WebLinkAboutGoodwin Consulting Group - Insurance Certificate�o CERTIFICATE OF LIABILITY INSURANCE 5/5/2014 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 acid conditions of thei p oii cy; certain policies c es ma require uire an-endorsement. A statement on,this � cei rtficate doe,s not confer rights to the certificate;holder,in lieu of s40 endorsemer _ PRODUCER I,.. CONIAUT (916) 939 - 85533 916 ac NG EErnie Dillard (.vC ND) ( ) 933_5532- DILLARD :INSURANCE AGENCY PHONE FAx -5'145;GOlden Foothill Pkwy #100 -' _I -E- MAIL= - ! ADDRESS edillard @fatmersagent Com - E1 Dorado Hills, CA 95762 -- - - - - - -- - - INSURER(s) AFFORDING =00VERAGE NAICN- Ob45426 -.._ ___ INSURER A Mid Century 21687. INSURED Goodwin Consulting Group -Inc INSURER B Truck Insurance Exchange - 21709 555 University Ave STE 280 INSURERC Capital Specialty Ins. Corp 10328 Sacramento, CA 95825 INSURER D 1 (916) 561 -0890 INSURER E I 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. NOTWITHSTANDIN R G ANY REQUIREMENT, TERM, O 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 IN SD wvO ! POLICY NUMBER (MMlDD�) � (MWDD�) I LIMITS X; COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2, 000 ,000 CLAIMS -MADE 1 X OCCUR PREMISES (Ea occurrence $ 250 , 000 DESCRIPTION OF OPERATIONS /LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) !The insurer shall give additional insured thirty (30) days advance written 'notice by the insurer prior to cancellation of the policy. Upon nonpayment of premium, 10 days notice of cancellation applies. Ali California Operations. Additional Insured: City of Gilroy 1:Job Location: Deer Park CFD CERTIFICATE HOLDER - CANCELLATION City of Gilroy Community Development Department 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. �REPRESENTATIVE ©1988 -2013 ACORD CORPORATION. All rights reserved. AC0RD25 k2013I04) The ACORD name and logo are registered marks of ACORD MED EXP (Any one person) $ 5 goo A _ _ X 605454772 ;PERSONAL&ADVINJURY $ 2,000,000 c GE_N L AGGREGATE LIMIT APPLIES PER .5/1/2014.,5/.1 /2015 i GENERAL AGGREGATE $ 4 , 0.00.., 000 POLICY-!- !PRO- - JECT '1 LOC 'PRODUCTS - COMP /OP AGG $ 4 , 000 , 000 OTHER. :;:r _ - ?. -. -$- `— ' ._. AUTOMOBILE LIABILITY ;. I. COMBINED SINGLE:LIMIT-- - _;acbidenl {'$ 1 , Q00 „00'Q ANYAUTO -_ - -. BODILY INJURY (Per person) $ ALL" OWNED: SCHEDULED A" AUTOS AUTOS X; NONOWNED 605454772 BOU II Y INJURY (Peraccident) $ 5/1/2014 5/1/2015 X HIRED AUTOS X AM pR0 $ (Per e ew X 'UMBRELLA LIA3 ! X OCCUR 605454636 EACH OCCURRENCE $ 1,000,000 $ EXCESS LIAR ! CLAIMS- MADEII - - 5/1/2014 5/1/2015 AGGREGATE $ - -- - 1,000,000 -_ -- i. i. DED. i I RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY .PROPRIETOR /PARTNER /EXECUTIVE A OFFICER /MEMBER N II NIA A09463819 Y E�L. EACH ACCIDENT - ER__; ',.$. 1,000,000 EXCLUDED? (AAnnaat", In NHI �'i 5/1/2014 ,5/1/2015 E L DISEASE- CA- EMPLOYEIE S, � , 0.00 00.0. r If es, describe under yy ESCRIPTION OF OPERATIONS below E L DISEASE -POLICY LIMIT $ - - - -- 1,000,000 C E &O / Prof. Liab. I SGC03576 -01 5/1/2014'I5/1/2015 CM Retro 5/1/2001: $1 mil A EPLI '605454772 5/1/2D1a',,5/1/2015 EPLI: $1 million DESCRIPTION OF OPERATIONS /LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) !The insurer shall give additional insured thirty (30) days advance written 'notice by the insurer prior to cancellation of the policy. Upon nonpayment of premium, 10 days notice of cancellation applies. Ali California Operations. Additional Insured: City of Gilroy 1:Job Location: Deer Park CFD CERTIFICATE HOLDER - CANCELLATION City of Gilroy Community Development Department 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. �REPRESENTATIVE ©1988 -2013 ACORD CORPORATION. All rights reserved. AC0RD25 k2013I04) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE 5/1/2013 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). ODUCER CONTACT NAME: )ILLARD INSURANCE AGENCY PHONE (916) 939-8553(916) 939-8553 FAX (916)933-5532 1145 Golden Foothill Pkwy #100 E-MAIL (A/C,No): Dorado Hills, CA 95762 ADDRESS:edillard@farmersagent.com INSURER(S) AFFORDING COVERAGE NAIC# )b45426 INSURER A: Truck Insurance Exchange 21687 ;URED Goodwin Consulting Group Inc INSURER B: Truck Insurance Exchange 21709 555 University Ave STE 280 INSURER C: Capital Specialty Ins. Corp 10328 Sacramento, CA 95825 INSURER D: (916) 961-0890 INSURERE: INSURER F: )VERAGES 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. TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP INSD mm POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR PREMISES O(Eat ccurrrrence) $ 250,000 MED EXP(Any one person) $ 5,000 X 605454772 5/1/2013 5/1/2014 PERSONAL&ADVINJURY $ 2,000,000 •GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY PE0 LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) _ ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X 605454772 5/1/2013 5/1/2014 $ X HIRED AUTOS X AUTO-SWNED PROPERTY accident)DAMAGE $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE 605454636 5/1/2013 5/1/2014 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION X ;MUTE EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE A09463819 5/1/2013 5/1/2014 E.L.EACH ACCIDENT $ 1,000,000 L OFFICER/MEMBER EXCLUDED? N N/A Y (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 E&O / Prof. Liab. SGC03576-01 5/1/2013 5/1/2014 CM Retro 5/1/2001: $1 mil EPLI I 605454772 5/1/2013 5/1/2014 EPLI: $1 million SCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ie insurer shall give additional insured thirty (30) days advance written >tice by the insurer prior to cancellation of the policy. Upon nonpayment of -emium, 10 days notice of cancellation applies. All California Operations. iditional Insured: City of Gilroy )b Location: Deer Park CFD ERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Community Development Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna St ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 —AUTHORIZED REPRESENTATIVE • 11/J411101--' ©1988-2013 ACORD CORPORATION. All rights reserved. ;ORD 25(2013/04) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 60545-47-72 BUSINESSOWNERS THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS POLICY SCHEDULE* Name Of Person Or Organization: CITY OF GILROY COMMUNITY DEVELOPMENT DEPT Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations. The following is added to Paragraph C. Who Is An Insured in the Businessowners Liability Coverage Form: 4. Any person or organization shown in the Sched- ule is also an insured, but only with respect to liability arising out of your ongoing operations or premises owned by or rented to you. BP 04 48 01 97 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 ❑ FARMERS ��T�_-uPC/o. FARMER S - WC 99 0619 WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY Named • GOODWIN CONSULTING GROUP INC Insured . (DBA) GOODWIN CONSULTING GROUP 555 UNIVERSITY AVE # 280 Agent • • SACRAMENTO CA 958256521 95-49-310 A0946-38-19 2013 Policy Number Policy of the Company Year Effective Date 05/01/13 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT- 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 for which you perform work under a written contract that requires you to obtain this agreement from us. The additional premium for this endorsement shall be 3-0 %of the Workers'Compensation premium otherwise due for the state(s)listed below on such remuneration,subject to a minimum charge of All written contracts in the state(s)of: CA This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to all the terms of the policy. Countersigned Authorized Representative 93-6369 1ST EDI110N 9-07 J6369121 PAGE 1 OF 1 WC9906198 IC-VIC u CERTIFICATE OF LIABILITY INSURANCE 5/1/2013 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). ODUCER CONTACT NAME: )ILLARD INSURANCE AGENCY (a�No,EXt): (916) 939-8553 FAX 1145 Golden Foothill Pkwy #100 EMAIL (A/C,No): (916)933-5532 W146edillard@farmersagent.com com U. Dorado Hills, CA 95762 INSURER(S) AFFORDING COVERAGE NAIC# )b45426 INSURER A: Truck Insurance Exchange 21687 LURED Goodwin Consulting Group Inc INSURER B: Truck Insurance Exchange 21709 555 University Ave STE 280 INSURER C: Capital Specialty Ins. Corp 10328 Sacramento, CA 95825 INSURER D: (916) 961-0890 INSURER E: INSURER F: )VERAGES 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. TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP w LIMITS INSD WD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS-MADE X OCCUR DAMAGE 10 REN LED PREMISES(Ea occurrence) $ 250,000 MED EXP(Any one person) $ 5,000 X 605454772 5/1/2013 5/1/2014 PERSONAL&ADVINJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY PRO- JECT LOC PRODUCTS-COMP/OP AGG $ 4 r 000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000 000 (Ea accident) , , ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED I, AUTOS AUTOS X 605454772 5/1/2013 5/1/2014 BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PPI OPERTY DAMAGE AUTOS (Per accident) X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE 605454636 5/1/2013 5/1/2014 AGGREGATE $ 1,000,000 DED RETENTION$ $ WORKERS COMPENSATION X PER 0TH- AND EMPLOYERS LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N A09463819 5/1/2013 5/1/2014 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? IlV N/A Y (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe und DESCRIPTION OF eOPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 : E&O / Prof. Liab. SGC03576-01 5/1/2013 5/1/2014 CM Retro 5/1/2001: $1 mil EPLI 605454772 5/1/2013 5/1/2014 EPLI: $1 million SCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) ie insurer shall give additional insured thirty (30) days advance written )tice by the insurer prior to cancellation of the policy. Upon nonpayment of :emium, 10 days notice of cancellation applies. All California Operations. iditional Insured: City of Gilroy )b Location: Deer Park CFD ERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Community Development Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna St ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE / / �,,y. • �.tiGi7�ii ier+4 fit ©1988-2013 ACORD CORPORATION. All rights reserved. ;ORD25(2013/04) The ACORD name and logo are registered marks of ACORD AW CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4.---- 05/08/2012 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 N ME: Ally Pexa Professional Insurance Associates/Pexa InsuranceN lertcy s1s-7ss�2oo FAX PO 60x1266 (A/C.No.Extl: (A/C,Not: 916-788-4204 San Carlos, CA 94070 ADDRESS: apexa @pexausa.com License#: 0G56726 INSU RER(S)AFFORDING COVERAGE NAIC# INSURER A: Hanover 22292 INSURED INSURER B: Travelers Goodwin Consulting Group Inc. INSURERC: Hanover Victor lrzyk INSURERD: Aspen Specialty Insurance 555 University Ave STE 280 Sacramento,� CA ��� INSURER E: Philadelphia Insurance Company __�__ Sa.r amento, CA 95825 COVERAGES CERTIFICATE NUMBER: 80231737-75387 REVISION NUMBER: 28 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL.SUBR 1 POLICY EFF POLICY EXP LIMITS LTR __INSR,WVD POLICY NUMBER IMM/DDIYYYY) (MM/DDIYYYY) A GENERAL LIABILITY Y N OBF-9108859-00 05/01/2012 05/01/2013 EACH OCCURRENCE $ 2,000,000 DAMAGE X COMMERCIAL GENERAL LIABILITY PREMISES O(Ea occurrence) $ 500,000 CLAIMS-MADE X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 GE 'L AGGREGATE LIMIT APPLIES PER. PRODUCTS-COMP/OP AGG $ 4,000,000 X POLICY PRO PR LOC T $ B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Y N BA-4277X735 02101/2012 02/01/2013 {Ea accdent) $ 1,000,000 X ANY AUTO BODILYINJURY(Perperson) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS (Per accident) $ A X UMBRELLA LIAR OCCUR N N OBF-9108859-00 05/01/2012 05/01/2013 EACH OCCURRENCE $ 1,000,000 EXCESS LIAR X CLAIMS-MADE AGGREGATE $ 1,000,000 , DED X RETENTION$ 5000 ' $ C WORKERS COMPENSATION Y 9503353 05/01/2012 05/01/2013 X WC STATU- ER AND EMPLOYERS'LIABILITY TORY LIMITS ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N N/A' (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT $ 1,000,000 D Professional Liab. N N 05/01/2012 05/01/2013 CM Retro:5/1/2001 1,000,000 E Employment Practices N N PHSD728009 03/20/2012 03/20/2013 Employment Practice 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) The Insurer shall give additional insured thirty(30)days advance written notice by the insurer prior to cancellation of the policy Upon nonpayment of premium, 10 days notice of cancellation applies. All California Operations Additional Insured: (See CG20 equivalent attached) City of Gilroy (continued on ACORD 101 Additional Remarks Schedule) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Community Development Department ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy, CA 95020 AUTHORI D REPRESENTATIVE � �___./� e�`��'c�-cal/" ���r'S (ACP) ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Printed by ACP on May 08,2012 at 02:52PM AGENCY CUSTOMER ID: 80231737 LOC#: AC-0R ® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY NAMED INSURED Professional Insurance Associates/Pexa Insurance Agency Goodwin Consulting Group Inc. POLICY NUMBER Victor Irzyk CARRIER NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance (continued from Description of Operations) Job Location:Deer Park CFD ACORD 101 (2008/01) ©2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Printed by ACP on May 08,2012 at 02:52PM AC •R?$ CERTIFICATE OF LIABILITY INSURANCE 02/09/2012 THS CERTIFICATE IS ISSN AS A MATTER OF INFOR MT10N ON_Y ANO CONFERS NO RIGHTS.UPON THE CERTIFICATE HOLDER THS CERTIFICATE DOTS NOT AFFIRMATIVELY OR NEGATIVELY ANE D,EXTEND OR ALTER THE COVERAGE AFFORDED BY 71-E POLICIES BE.IOAt THS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERS),AUTHORI2ED REPRESENTATIVE OR PRODUCER,AND TFE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURE,the policy(ies)mist be endorsed. If SLEROG+ATiON IS WAIVED,subject to the Isms and condtlons 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 CCNTA T Zane Poo Professional Insurance InStranc i 916488-4200 I I FAX (Ac,/4,*916-788-4204 PO BQX1266 Amaws& Qa cant San Carlos,CA 94070 License#-0G56726 INSURER(S)AFPOROrNG COVERAGE need INSURER A: Hanover 22292 INS INSURERS Travelers Goodwin Consulting Group Inc. INSURER C: CNA Victor Irzylc 555 University Ave STE 290 INSURER D: General Star Indemnity Company 37362 Sacramento,CA 95825 INSIJ�E r INSURER F: COVERAGES CERTIRCATE NUMBER 80231737-75357 REVISION i UMEIE7 t 18 THS IS TO CERTIFY THAT THE PCUC/ES OF INSURANCE USTED BELCVVHAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PB CD INDICATED NallATTFISTANEING ANYi REMENIT,TBRlVICROONDITICNCF ANY OONTRftC'TCR on-ER DOClJv 4TWTH RESPECT TOWiCHTHS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN 11-E INSURANCE AFFCFDED BY THE POLICIES'DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS DCCLUSICNBAND OChDITICNS CF SUCH POUCIIEESS UMTS SI-CLAN MAY HAVE 8B3J REDUCED BY PAID CLAIMS r TTRR TYPE OF INSURANCE ORR AND I POLICY NASSER (rodYYrY) free xerwr) IdS A GENERAL LIABIUTY Y N OBF-9108899-00 05/01/2011 05(01/2012 E's-103a $ 2000,000 �X CONuBRait_ $ L LfY ( ) $ 500,000 aAMSMACE X CCC.R MEDE>0,'(Any cos perecr>) $ 55,E PERrNOLSOOvuwzr _ $ 2,000,000 GlaNERPL AGGREGATE $ 4,000,000 GBVLAC33FECATEUMTAPRJESPER PItflOU is-clamor PAC3C' $ 4,000,000 X FCIJC Y i Lim $ B At ramorz JA91nY Y N BA-4277X735 02/01/2012 02/01/2013 (63°C6431€DecOdennSINGLE UMT +$ 1,000,000 X ANYAUF0 BODILY INJURY(Re'per cn) $ BCOILY INJURY(Fkiraccident) $ AUTCS AUTOS NZN-GAIsED PROPERTY'1303/AGE X R®Anus X AIMS (RN accident) - $ A X A'JAB —CCC R N N OBF-9108859-00 05/01/2011 0501/2012 6143-I OOa.r $ 1,000,000 EXCESS UAS X cusas-neAcE AO3REG TE _ $ 1,000,000 CEO X FZETBVTICN$ 5000 $ C WORKERS COMPENSATION TIITY Y 4030618609 0510//2011 05(01/2012 X uMis ANY PRCPRIETCRPARTNEREXECLITNE EX ,lip YN NIA EL EACH AOOICB�FT $ 1,000,000 OFRCENMENEIBR(3/tinclinsy Inrill EL DISEASE-EAE PLOrI£$ 1,000,000 If yyeeae.�daavibe uida 069GTaPrICPICF(PERATIC tenni EL DISEASE-PCIJCYUMT $ 1,000,000 D Professional Liab. N N IJA694960 05/01/2011 05/01/2012 CM React 5/1/2001 1,000,000 OESCIIPfION OF OFERATIOdS/LOCATIONS/'EHCLES(Mach AcaRD 101,Addition Rennes Schedule,if mss specs is rewind) The Instzer shall give additional insured thirty(30)days advance witten notice by the insurer prior to cancellation of the Policy Upon nonpayment of parkin,10 days notice of cancellation applies. M California Operations Additional Insured(See CG20 equivalent attached) City of Gilroy (continued on ACORD 101 Adcitiortal Remarks Schedule) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BECANCELLED Btu City of Gilroy THE BCPIRAII NN DATE TH EF EOF,NOTICE WU_BE oEuvei®IN Community Development ACOOROANICE VMTH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy,CA 95020 AU1FICir®REPRESBIfA1re Zat(0 (118) ©1988-2010 ACORD CORPORATION. All rights reserved ACORD 25(2010/05) The ACORD name and logo are registered merles of ACORD Rinted by 118 an February 09,2012 at 11:13AM AGENCY CUSTOMER ID: 80231737 LOC#: Accwri- ADDMONAL RIEMARKS SCEEDULE page 2 of 2 AGENCY MANED INSURED Professional Insmance Associate:03e=Insurance Agency Goodwin Consulting Group Inc. \Actor Irzylc PCUCY NUMBER CARRIER mac CCOE EFFECTIVE DATE ACCIMONAL RE1W11413 MIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM nuvest 25 Fpm TITLE: Certificate of Liability Inswance (continued from Description of Operations) Location:555 University Avenue,Suite 280,Sacran-erto,CA 95825 ACORD 101(2)08/01) 02008 ACORD CORPORATION. All rights reserved The ACCRD name and l000 are reciistered marks of ACORD Printed lay 118 cn February 09,2012 at 11:13,4M i POLICY NUMBER _ OBF 9108859-00 ,o^ kaHnanover k Insurance c.mup. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT - CONTRACTORS This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM (1) Owners or other interests from 1. Additional Insured by Contract, whom land has been leased Agreement or Permit which takes place after the Under Section 11 — Liability C Who is An lease fof that land expires;or Insured,Paragraph 6.is added as follows: (2) Managers or lessors of 5. Any person or organization with whom premises if: you agreed, because of a written (a) The occurrence takes place contract,written agreement or permit to after you cease to be a provide insurance, is an insured, but tenant in that premises;or only with respect to: (b) The'bodily injury','property a. 'Your work' for the additional damage or 'personal and insured(s)at the location designated advertising injury'arises out in the contract,agreement or permit; of structural tural alterations,new « construction or demolition operations performed by or b. Facilities owned or used by you. on behalf of the manager or This Insurance applies on a primary lessor. basis if that is required by the written contract,written agreement or permit. This provision does not apply: a. Unless the written contract or written agreement has been executed or permit has been issued prior to the 'bodily injury,'property damage'or 'personal and advertising injury'; b. To any person or organization included as an insured by an endorsement Issued by us and made part of this Policy, c. To any lessor of equipment: (1)After the equipment lease expires;or (2)If the 'bodily injury, 'property damage or 'personal and advertising injury arises out of the sole negligence of the lessor, or d. To any: includes copyrighted material of Insurance Services Office.Inc.1997.2001 391-1107(7102) Page I of I m 1 � im¢1 .- EA m E c g gIi ;i m o W b v m Q g O c , o, n( 5 c • (7 V e 0 a i It ® C X o= a �or,� mr-,� ° rs�o p �- eE toAi ��c s 1 Oarc') f �Z a a Eg . g�ev2E' z.. I P3 a Z m 158v •W ; o3, mo a. 2 w� #= n_ a� 1 1111 8 s 551 1 1 g h 131 E611152!g Z •E 8 IFS i t E n° Em g Z as =nm i� voo $ /1 m c ` m = E :elf m 1 # c Zs ae S 2 m Y m `c. m.Es a .r m CirNA (Ed. 1 1197) POLICY NUMBER 4 30618609 WORKERS'COMPENSATION AND EMPLOYERS'UABIUTY INSURANCE POUCY BLANKET WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS This endorsement changes the pobcy to which it is attached. It is agreed that Part One Workers'Compensation Insurance G.Recovery From Others and Part Two Employers' Liability Insurance H.Recovery From Others are emended by adding the following: We will not enforce our right to recover against persona or organizations.(This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) GOODWIN CONSULTING GROUP INC. EMIRI I .. Q G-19160-B Page 1 of 1 (Ed. 11/97) CAT4370808 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO 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 modified by the endorsement. The following is added to the Section ll—Liability Coverage, Paragraph A.1.Who Is An Insured Provision: Any person or organization that you are required to include as additional insured on the Coverage Form in a written contract or agreement that is signed and executed by you before the "bodily injury"or "property damage" occurs and that is in effect during the policy period is an "insured"for Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. 1 • . Name of Insured Policy Number: BA-4277X735-11 Effective Date: 02/01/2012 GOODWIN CONSULTING GROUP, INC. Processing Date: 02/02/2012 Travelers Insurance Company A i 7 I 'I �tll i II' �I WRL) CERTIFICATE OF LIABILITY INSURANCE DATE 05J08/2011 THIS MRTIFTCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY ANEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE TVVEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AI)THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)crust be endorsed. If SUBROGATION IS WAIVED,subject to the terns and concitions of the policy,certain policies may require an endorserrent A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemerrt(s). PRODUCER NAIVE:cr Zane Pexa Professional Insurance Associates Inc. PHONE FAX PO 60x1266 (NC.No.Ext): 916788-4200 (NC,No):916.788-4204 N San Carlos,CA 94070 ADORESS: zPettainsagen rn cy.co License# 0726 INSURER(S)AFFORDING COVERAGE RC# _ INSURER A: Hanover _ INSURED INSURER B: Travelers _ Goodwin Consulting Group Inc. INSURER C: CNA 555 University Ave STE 280 INSURER D Cooper&McCloskey Inc. Sacramento,CA 95825 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER 80231737-75387 REVISION NUMBER 4 THIS IS TO CERTIFY THAT1F-EFCUOE SCFINSURANCEUSTEDea_cwHAVEBEENISSUED1CJT1-E INSURED NAvE-DABCiEFCR11-EPOLICYPERIOD INDICATE). NOTVNTHSTANDING ANY REQUIREMENT,TERMCR(XNXTICNCFANY OONTRACTCROT7-ERRDOCUMENITW1H RESFECT TOW-I0-I1HIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BYTFEPOLICIES DESCRIBED H TANISSUEUECTTOALLTFETEFays, B<CLUSICNS AND CCNDITTCNS CF SUCH POLICIES UMTS SHOJIN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTTRR TYPE OF INSURANCE �4 YND POLICY NIJNI3Et (6M00/YVY) Ovw/DdYWY) IJMTS A GEERALLIABIUTY Y N OBF-9108859-00 0901/20/1 05/01/2012 EA0-I0CCL $ 2,000,000 DoMAGE RENTED CCNIVE3RCIPL GENERAL LIPB vt UTY PRH (Ea ccarrerce) $ 500,000 CLAMS-MADE OCCUR MED PEXP y(Na s paw ) $ 5,000 PERECNY6L&AI7V INJURY $ 2,000,000 GENERA_AGGREGATE $ 4,000,000 C$4LA3C EGATE UMT APR1ES PER PRCXCTS-O'3xP/OPAOG $ 4,000,000 —)-1( ICY JFECT LOC $ g AUTO11110BILEUABIUTY Y N BA-4277X735-11SEL 02/01/2011 02/01/2012 raBx SINGLE UMT $ ,000,000 X gNJyN ro BCCILY INJURY(Ray person) $ ALLCVMID SCHEDLLEID BCCILY INJURY(Per aoddert) $ AUTC6 _ ALITCG X FIRED AUTOS X puns (I i $ A X UL—IA LLB OCCUR N N OBF-9108859-00 0901/2011 05/01/2012 EACH OCCURRENCE $ 1,000,000 ENDES&LIAB X CLPIrs sooE AGC3REGATE $ 1,000,000 CED XI FEIT3JIICIV$ soon $ C w ®ss aRl CONFENSATION Y 4030618609 05101/2011 0901/2012 X nys Tila alX AND ENFLOYERS LIABILITY ANY PROPRIETCRIPARTISEREXECUME CFa BQOUOL")? 11 N/A EL CH $ 1,000,000 (PAaidatary in EL OISBASE-EA ENFLCNEE$ 1,000,000 IL as av CF CPEZATICNSbeow EL t)BEP -FCUGYUMT $ 1,000,000 D Professional Uab. N N IJA694980 05+01/2011 0901/20/2 pains-Made 1,000,000 DESCRIPTION of OPERATIONS/LOCAT1CNS/VEHICLES(Attach ACORD 101,Additional Karats Schedule,if rrore spare is required) The Insurer shall give adcitional insured thirty(30)days advance written notice by the insurer prior to cancellation of the policy Upon nonpayment of prerriurn,10 days notice of cancellation applies. All California Operations Additional Insured:(See CG20 equivalent attached) City of Gilroy Job Location:Deer Park CFD CERTIFICATE HOLDER CANCELLATION SHOW)ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE City of Gilroy T1-E EXPIRATION DATE THEREOF,NOTICE MALL BE DELIVERED IN Corrrrunity Development Department ACCORDANCE WTH THE POUCY PROVISIONS 7351 Rosanna Street Gilroy,CA 95020 AUTHORIZED REIiRESVrrAnvE/—� (118) ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Pirtm!by 118 ai M3y 09,2011 at 09:35W POLICY' NUMBER _ OBF 9108859-00 he Hanover Insurance Group.. THIS ENDORSEMENT CHANGES THE'POLICY.'PLEASE READ IT CAREFULLY. ADDITIONAL INSURED BY CONTRACT, AGREEMENT OR PERMIT ® CONTRACTORS This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM (1) Owners or other interests from 1. Additional Insured by Contract, whom and has been leased Agreement or Permit which takes place after the lease for that land expires; or • Under Section II — Liability C Who Is An Insured, Paragraph 5. is added as follows: (2) Managers or lessors of 5. Any person or organization with whom premises if: you agreed, because of a written (a) The occurrence takes place contract, written agreement or permit to after you cease to be a provide insurance, is an insured, but • tenant in that premises; or only with respect to: (b) The "bodily injury", "property a. "Your work" for the additional damage" or "personal and insured(s)at the location designated advertising injury" arises out in the contract, agreement or permit; of structural alterations, new or construction or demolition operations performed by or b. Facilities owned or used by you. on behalf of the manager or This insurance applies on a primary lessor. basis if that is required by the written contract, written agreement or permit. This provision does not apply: a. Unless the written contract or written agreement has been executed or permit has been issued prior to the "bodily injury" , "property damage"or "personal and advertising injury"; b. To any person or organization included as an insured by an endorsement issued by us and made part of this Policy; c. To any lessor of equipment: (1)After the equipment lease expires; or (2)If the "bodily injury", "property damage" or "personal and advertising injury" arises out of the sole negligence of the lessor; or d. To any: Includes copyrighted material of Insurance Services Office, Inc. 1997,2001 391-1107(7/02) Page 1 of 1 ADDITIONAL mown ninonUC6VWNT COMMEfCIAL AUTO This endorsement changes your Auto Liability Protection. How Coverage Is Changed W anyone who drives a covered auto with your permission or with the permission of The following is added to the Who Is one of your employees or agents. But Protected Under This Agreement section of this doesn't include the person or your Auto Liability Protection. This change organization naroed below, or ovie of i.heir broadens coverage. employees or agents. The person or organization named below, for We'll mail the additional insured notice of whom you are doing work, is protected. But any cancellation of this policy. If the only for bodily injury or property damage cancellation is by us, we'll give ten days that results from the ownership, notice to the additional insured. maintenance, use, loading or unloading of a covered auto by: Other Terms • you; • an employee of yours; or All other terms of your policy remain the same. Person or Organization: • • • Name of Insured Policy Numher BA-4277X735-1 1 Effective Date 2/1 /1 1 GOODWIN CONSULTING GROUP,INC. Processing Date 2/1 /2011 A0265 Ed. 0-03 Printed in U.S.A. Endorsement ©St.Paul Fire and Marine Insurance Co. 2003 All Flights Reserved Page 1 of 1 Policy Number: Date Entered: 03/17/2011 "a`C.)R°® CERTIFICATE OF LIABILITY INSURANCE 3/17/2011 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 Bill Douglas Kouris Insurance Agency Inc PHONE FAX - 10345 Danichris Way a/ No.Eat): (916)508-0974 (p,/C No): (916)685-9571 Elk Grove, CA 95757 ADDRESS:bdkouris @aol.com INSURER(S)AFFORDING COVERAGE NAIL# INSURER A:Hartford INSURED Goodwin Consulting Group, Inc. INSURER B:Gemini. Insurance Company INSURER C: 555 University Avenue, Suite 280 INSURERD: Sacramento, CA 95825 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP W /W LIMITS LTR INSR VD POLICY NUMBER (MM/DD/YYYY) (MM/DDYY) GENERAL LIABILITY EACH OCCURRENCE $2,000,000 A XSOMMERCIAL GENERAL LIABILITY 57SBARH8616SC 5/18/2009 5/18/2011 DAMAGE TO RENTED PREMISES(Eaoccurrence) $300,000 CLAIMS-MADE ® OCCUR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY _ $2,000,000 GENERAL AGGREGATE $4,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $4 r 000,000 POLICY PRO- JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 2,000,000 (Ea accident) $ A ANY AUTO 57SBARH8616SC 5/18/2009 5/18/2011 BODILYINJURY(Perperson) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS NON-O PROPERTY DAMAGE $ NUTOS ED (Per accident) X HIRED AUTOS AUTOS A UMBRELLA LIAB OCCUR EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE 57SBARH8616SC 5/18/2009 5/18/2011 AGGREGATE $1,000,000 DED RETENTION$ $ WORKERS COMPENSATION WC TU - OTH- AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? n N/A State Fund (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ Retro Date 5/1/2001 Each Occurence 1,000,000 B Professional Liab VCPL060135 5/1/2010 5/1/2011 Aggregate 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,it more space is required) Upon nonpayment of premium, 10 days notice of cancellation applies. All California Operations Additional Insured: (See CG20 equivalent attached) City of Gilroy Job Location: Deer Park CFD CERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Community Development Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE }( ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD 'roducod using Forms Boss Plus software.www,FormsBoss.com;Impressive Publishing 800-208-1977 POLICY NUMBER: 57SBARH8616SC COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 57SBARH8616SC COMMERCIAL AUTOMOBILE LIABILITY 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 (a)COMMERCIAL GENERAL LIABILITY COVERAGE (b)COMMERCIAL AUTOMOBILE LIABILITY SCHEDULE Name of Additional Insured Person(s)or Organization: Location(s)of Covered Operations City of Gilroy Deer Park CFD (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 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. 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. 2. "Bodily injury"or"property damage"occurring after a. All work,including materials,parts or equipment fumished 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. In respect to the named additional insured(s),this insurance is primary insurance. Any other insurance maintained by the above-named additional insured(s)is excess and not contributing insurance with the insurance required hereunder. Additional Insured Parties:City of Gilroy as additional insureds. CG 20 33 07 04 Copyright,ISO Properties,Inc.,2004