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HomeMy WebLinkAboutGolden Bay Construction - Insurance CerticateA� ®® CERTIFICATE OF LIABILITY INSURANCE DATE(MMroDrmrr) 12/31/2014 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate-holder.in_lieu of such endomement(s). PRODUCER McGovern Insurance. 1625 El Camino Real Belmont, CA 94002 CTACT NAME: PHONE 650- 593 -8216 arc rvo : 650 -594 -9130 E -MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC ff 1/1/2015 INSURER A : Navigators Insurance Company 42307 www.jemins.com INSURED Golden Bay Construction Inc. 3826 Depot Road Hayward CA 94545 INSURER B: Travelers Property Casualty Company 25674 INSURER C: Scottsdale Insurance 15580 INSURER D: Everest National Insurance Company 10120 INSURER E: PERSONAL 8 ADV INJURY $ 1,000.000 INSURER F : GENERAL AGGREGATE $ 2,000,000 COVERAGES CERTIFICATE NUMBER: 22896323 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 1= ADDL SUER POLICY NUMBER POLICY DrYYYYYY - MM POLICY V LIMITS _ A �/ COMMERCIAL GENERAL LIABILITY CLAIMS' -MADE ❑✓ .00CUR XCU -Not Excluded �/ SF15CGLO195741C 1/1/2015 1/1/2016 EACH OCCURRENCE _ $ 1,000,000 7-7 DAMAGE TO RENTED PREMISES Ea occurrence $ . 100,000 MED EXP (Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000.000 GEN'L AGGREGATELIMIT APPLIES PER: ✓ POLICY ✓JECT LOC - OTHER:. _ GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2.000,000 $ B AUTOMOBILE LIABILITY ✓ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED ✓ HIRED AUTOS ✓ AUTOS DT- 810- 9D354648 1/1/2015 1/1/2016 EOMBBIINdEDSINGLELIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Peraccident- $ $ C UMBRELLA LIAR EXCESS LIAB ✓ OCCUR CLAIMS -MADE XLS0095373 - 1/1/2015 1/1/2016 EACH OCCURRENCE $ 5000000 AGGREGATE $ 5,000,000 DED I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y OFFICER/MEMBER EXCLUDED? (Mandatory in NH) - If yes, describe under - DESCRIPTION OF OPERATIONS below NIA 7600001373614 -1 10/1/2015 I 10/1/2016- ✓ STATUTE ERH - E.L. EACH ACCIDENT $ 1.,000,000 E.L. DISEASE -.EA EMPLOYE $ 1,000,000 E.L. DISEASE - -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS! LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: All operations within the city of Gilroy under written contract. Additional' Insured: The City of Gilroy -Per attached endorsement. 'CERTIFICATE HOLDER CANCELLATION ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 22696323 CLIENT CODE: GOLDE -1 Joanna Gilbride 12/31/2014 7:13:07 AM (PST) Page 1 of 4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna St ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy CA 95020 AUTHORIZED REPRESENTATIVE Steve Suissa ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD CERT NO.: 22696323 CLIENT CODE: GOLDE -1 Joanna Gilbride 12/31/2014 7:13:07 AM (PST) Page 1 of 4 POLICY NUMBER: SF15CGLO195741C Golden Bay Construction Inc. COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): Location and Description of Completed Operations: Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) Section IL— Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 1 ISO Properties, Inc., 2004 CERT NO.: 22896323 CLIENT CODE: GOLDE -1 Joanna Gilbride 12/31/2014 7:13:07 AM (PST) Page 2 of 4 Page 1 of SF15CGL01.95741C Golden Bay Construction Inc. COMMERCIAL GENERAL LIABILITY CG 20 38 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ R CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11 -- Who Is An Insured Is amended to include as an additional insured: 1, 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; and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described In Paragraph L above. Such person(s) or organizations) is an additional insured only with respect to lialxTity for "bodily injury", "property damage" or "personal and advertising injury' caused, in whoie or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required, by the contract or agreement to provide for such additional 'insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above are completed. CG 20 38 0413 8. 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 d~ or "personal and adverting injury" arhft out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including:. a. The preparing, approvft or failing to prepare or approve, maps, shop drawings. opinions, reports, surveys, field orders, . change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies "even d the claims against any insured allege negfigence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that Insured, if the .occurrence which caused the "bodily injury" or "property damage ". or the offense which caused the "personal and advertising injury', involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. 2. "Bodily injury" or "property damage° occurring after.. a. All work. including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or ® Insurance Services Office, Inc., 2012 CERT NO.: 22896323 CLIENT CODE: GOLDE -1 Joanna Gilbride 12/31/2014 7:13:07 AM (PST) Page 3 of 4 Page 1 of 2 b. That portion of 'your work" out of which the Injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the foaowing is added to Section III — Limits Of Insurance: The most we will pay on behaff of the additional insured is the amount of insurance. 1. Required by the contract or agreement described in Paragraph A.1.; or Page 2 of 2 2. Available under the applicable Umits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Urnits of Insurance shown in the Declarations. ®Insurance Services Office, Inc., 2012 CERT NO.: 22896323 CLIENT CODE: GOLDE -1. Joanna Gilb ;ide 12/31/2014 7:13:Q7 AM (PST) Page 4 of 4 CG 20 38 0415 i 1 ® AcORO CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 1 16-�' 10/2/2014 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 WANED, 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 McGovern Insurance 1625 El Camino Real Belmont, CA 94002 NAME: CONTACT (PA CM 650- 593 -8216 AIC No): 650 - 594 -9130 E -MAIL ADDRESS: INSURE S AFFORDING COVERAGE NAIC # EACH OCCURRENCE INSURER A: Navigators Insurance Company - 42307 www.jemins.com INSURED - INSURERS: Travelers .Property Casualty Company 19046 Golden Bay Construction Inc. 3826 Depot Road Hayward CA 94545 'INSURERC: Scottsdale Insurance 15580 INSURER D : Everest National Insurance Company 10120 INSURER E: GENERAL AGGREGATE . $ 2,000,000 INSURER F: $ 4,000,000 COVERAGES CERTIFICATE NUMBER: 21873917 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. !N3R LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY MMIDDIYYYY .: LIMITS A �/ COMMERCIAL GENERALUABILITY CLAIMS -MADE F✓ OCCUR XCU -Not Fxcluded ✓ SF14CGLO19574 1/1/2014 1/1/2015 EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED PREMISES (Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1 ,000,000 GEN'L AGGREGATE ILIMIT APPLIES PER: ✓ POLICY' 7 JE0 LOC OTHER: GENERAL AGGREGATE . $ 2,000,000 PRODUCTS - COMP /OP AGG $ 4,000,000 $ B AUTOMOBILE LIABILITY ✓ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED ✓ HIRED AUTOS ✓ AUTOS DT- 810- 9D354648 1/1/2014 1/1/2015 Eaaden IN LEUMIT g 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C UMBRELLA LIAB EXCESS LIAB H OCCUR CLAIMS -MADE 1 XLS0091605 1/1 /2014 1/1/2015 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 DIED RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNER /EXECUTIVE Y� OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yyes,.d0 Oe under DESCRIPTIONOF OPERATIONS below NIA 7600001373614 -1 10/1/2014 10/1/2015 �/ STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.LDISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional RemaNs Schedule, may be attached if more space is required) Re: All operations within the city of Gilroy under written contract. Additional Insured: The City of Gilroy -Per attached endorsement. City of Gilroy 7351 Rosanna St Gilroy CA 95020 ACORD 25 (2014/01) GANGtLLA'I IUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVES ` Steve Suissa ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD CERT NO.: 21873917 CLIENT CODE: GOLDE -1 Joanna Gilbride 10/2/2014 10:31:25 AM (PDT) Page 1 of 3 - ------- - - _ _ - - ACORD CERTIFICATE OF LIABILITY INSURANCE OP DDEG GATE(MM/DD/YYYY)l 09/30/08 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOP ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE James E. McGovern, Inc. HOLDER. THIS CERTIFICATE D , EXTEND OR 1625 El Camino Real ALTER THE COVERAGE AFFOIy F ICIES BELOW Belmont CA 94002 Phone: 650-593-8216 Fax:650-594-9130 INSURERS AFFORDING COVERA9€T 0 6 2008 NAIC# INSURED INSURER A: Travelers Property Casualty AIC INSURER B: ENGINEERING Golden Bay Construction, Inc. INSURER C: 3826 Depot Road INSURER D: Hayward CA 94545 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I LTR INSRD DATE(MM!DED/YY)E POLICY T (MMMIDWY) LTR ADIYL TYPE OF INSURANCE POLICY NUMBER LIMITS GENERAL LIABILITY EACH OCCURRENCE $ X COMMERCIAL GENERAL LIABILITY PRE I I tU PREMISES((Ea a oc curence) $ CLAIMS MADE X OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY JEa LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESSIUMBRELLALIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WC Si A[U- OTH WORKERS COMPENSATION AND X TORY LIMITS ER EMPLOYERS'LIABILITY A UB365K869108 10/01/08 10/01/09 E.L.EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1.000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000.000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES!EXCLUSIONS ADDED BY ENDORSEMENT!SPECIAL PROVISIONS Re:Monterey Streetscape Improvement Phase III Except for non-pay which is 10 days. CERTIFICATE HOLDER CANCELLATION GILROYC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30* DAYS WRITTEN City of Gilroy NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL Commercial Development Dept IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 7351 Rosanna Street Gilroy CA 95020 REPRESENTATIVES. ZED REPII�NTA ACORD 25 (2001/08) ©ACORD CORPORATION POLICY NUMBER: SF14CGLO19574 COMMERCIAL GENERAL LIABILITY Golden Bay Construction Inc. CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTOR - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): Location and Description of Completed Operations: Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 ISO Properties, Inc., 2004 Page 1 of 1 CERT NO.: 21873917 CLIENT CODE: GOLDE -1 Joanna Gilbride 10/2/2014 10:31:25 AM (PDT) Page 2 of 3 -• ACORD. CERTIFICATE OEE,I ITY INSURANCE OP ID JG DATE(MM/DD/YYYY) GOLDE-1 12/28/07 PRODUCER _ THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIOI' - JAN 7 2008 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE James E. McGovern, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1625 El Belmont CAa ino02ea1 ENGINEERING ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Phone: 650-593-8216 Fax:650-594-9130 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Property Casualty AIC INSURER B: National Union Fire Insurance Golden Bay Construction, Inc. INSURER C: 3826 Depot Road INSURER D: Hayward CA 94545 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD'L POLICY EFFECTIVE POLICY EXPIRATION LTR INSRL TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 UAMAGE I U NEN I EU A X COMMERCIAL GENERAL LIABILITY C0526D587008 01/01/08 01/01/09 PREMISES(Eaoccurence) $ 50,000 CLAIMS MADE I X OCCUR MED EXP(Any one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GE 'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY PRO- JECT AUTOMOBILE LIABILITY A X ANY AUTO 810526D586908 01/01/08 01/01/09 COMBINED SINGLE LIMIT $ 1 000 000 CO aBINED ccident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ 5,000,000 $ X OCCUR CLAIMS MADE BE4343764 01/01/08 01/01/09 AGGREGATE $ 5,000,000 $ DEDUCTIBLE $ RETENTION $ $ WCSfA?U- OIH- WORKERS COMPENSATION AND X TORY LIMITS ER EMPLOYERS'LIABILITY A UB365K869107 10/01/07 10/01/08 E.L.EACH ACCIDENT $ 1.000.000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1.000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1.000.000 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Re:Monterey Streetscape Improvement Phase III Except for non-pay which is 10 days. CERTIFICATE HOLDER CANCELLATION GILROYC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL MAIL 30* DAYS WRITTEN City of Gilroy NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Commercial Development Dept - RER,'ITS acE•7351 Rosanna Street Gilroy CA 95020 ZED REPIR. NTA1 5`. ":_ ���I ACORD 25 (2001/08) '�' ©ACORD CORPORATION 1 Policy No.: C0526D587008 St. Paul/Travelers Insurance Company Policy Holder: Golden Bay Construction, Inc. CG D2 46 08 05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY BLANKET ADDITIONAL INSURED (CONTRACTORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. WHO IS AN INSURED — (Section II) is amended to include any person or organization that you agree in a "written contract requiring insurance"to include as an additional insured on this Coverage Part, but: a) Only with respect to liability for"bodily injury", "property damage" or"personal injury"; and b) If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of"your work" to which the "written contract requiring insurance" applies. The person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. 2. The insurance provided to the additional insured by this endorsement is limited as follows: a) In the event that the Limits of Insurance of this Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement shall not increase the limits of insurance described in Section III—Limits Of Insurance. b) The insurance provided to the additional insured does not apply to "bodily injury", "property damage" or "personal injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services, including: i. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and ii. Supervisory, inspection, architectural or engineering activities. c) The insurance provided to the additional insured does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products-completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage"that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 3. The insurance provided to the additional insured by this endorsement is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover under this endorsement. However, if the "written contract requiring insurance" specifically requires that this insurance apply on a primary basis or a primary and non-contributory basis, this insurance is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with that "other insurance". But the insurance provided to the additional insured by this endorsement still is excess over any valid and collectible "other insurance", whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under such "other insurance". Page 2 of 2 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: i. How, when and where the "occurrence" or offense took place; ii. The names and addresses of any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or"suit" is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or"suit" and the date received; and ii. Notify us as soon as practicable. The additional insured must see to it that we receive written notice of the claim or "suit" as soon as practicable. c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or"suit", cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. d) The additional insured must tender the defense and indemnity of any claim or"suit"to any provider of"other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insurance provided to the additional insured by this endorsement is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3. above. 5. The following definition is added to SECTION V. —DEFINITIONS: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After the signing and execution of the contract or agreement by you; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. PERSON OR ORGANIZATION City of Gilroy-City Engineer JOB DESCRIPTION: Monterey Streetscape Improvement Phase III CGD2460805 1ST PAUL TRAVELERS POLICY NUMBER: SF14CGLO19574 POLICY HOLDER: Golden Bay Construction Inc. COMMERCIAL GENERAL LIABILITY CG2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modes insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name of Additional Insured Persons) I Locadon(s) Of Covered Operations 'Or Organization(s): Informaition required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section Il - Who Is An Insured is amended to included as an additional insured the persons) or organization(s) shown in the Schedule, but only with respect to liability for - oodlly injury", "property damage* or "personal and advertising injury" caused, In whole or in part, 13y; 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; In the performance of your "ongoing operations" for the additional insured(s) at the location(s) designated above.. B. With respect to the insurance afforded to these additional Insured(s), the following additional exclusions apply This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. AN work, Including materials, parts or equipment furnished In connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional Insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work° out of which the injury or damage arises has been put to its Intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG2010 07 04 c ISO Properties, Inc., 2004 CERT NO.: 21873917 CLIENT CODE: GOLDS -1 Joanna Gilbride 10/2/2014 10.:31:25 AM (PDT) Page 3 of 3 Page 1 of 1 OP ID JG DATE(MM/DDIYYYY) ACORV.. CERTIFICATE OF LIABILITY INSURANCE GOLDS-1 09/26/07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE James E. McGovern, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 1625 El Camino Real ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW Belmont CA 94002 Phone: 650-593-8216 Fax:650-594-9130 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Travelers Indemnity of Conn IND INSURER B: Golden Bay Construction Inc. INSURER C: Johnny Zanette 3826 Depot Road INSURER D: Hayward CA 94545 INSURER E: COVERAGES - THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AMYL - POLICY EFFECTIVE POLICY EXPIRATION LTR INSRD TYPE OF INSURANCE POLICY NUMBER DATE(MM/DD/YY) DATE(MM/DD/YY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ UAMAGt I UREN I tD $ COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurence) $ CLAIMS MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY PRO- JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO EC !VE (Ea accident) ALL OWNED AUTOS V BODILY INJURY $ SCHEDULED AUTOS SEP 2 8 2007 (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) GLNE�R1Nr PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC $ OTHER THAN AUTO ONLY: AGG $ - EXCESS/UMBRELLA LIABILITY , EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND WCSIAfU- OFH- EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVE UB365K869107 10/01/07 10/01/08 E.L.EACH ACCIDENT $ 1000000 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 1000000 If SPEC ALPROVI PROVISIONS E.L.DISEASE-POLICY LIMIT $ 1000000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS Re: Monterey Streetscape Improvement Project, Phase II, and Monterey Operational Improvement Project. Project #03-CDD-117 Waiver of Subrogation is included. Except for non-pay which is 10 days. CERTIFICATE HOLDER CANCELLATION GILROYC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATIOf DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN City of Gilroy NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL City Engineer IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 7351 Rosanna Street Gilroy CA 95020 REPRESENTATIVES. ZED REPf4�NTA� _�-�I ACORD 25 (2001/08) ©ACORD CORPORATION