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HomeMy WebLinkAboutRolfe Construction - Insurance Certificate® Arc.. CERTIFICATE OF LIABILITY INSURANCE DATE. (MMIDDNYYY) 11/3/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED . REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT:. If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate_ holder in.lieu of such endorsement(s). PRODUCER ONT T. A Cynthia 8anderl n lnterWest Insurance Services License #0801094 P.O. Box 255188 PHONE 916 -609 -8355 F4X 9.16 -979 -7515 EMAIL . csanderlyn @iwins. com INSURERS) AFFORDING COVERAGE NAIC # Sacramento CA 95865 -5188 INSURER A: Colony Insurance Company 39993 INSURED ROLFE -4 INSURER Bliberty Mutual Ins Company 23043 Rolfe Construction INSURER C: First Insurance 10657 3573 Southern Pacific Ave Atwater CA 95301 INsuRERD:Torus National Insurance Co. 25496 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JECOT- FI LOC OTHER: GENERAL AGGREGATE $2,000,000 INSURER E: $2,000,000 - INSURER .F.: $_ B COVFROGFS CFRTIFICOTE NIIMRFR. 851157888 REVISION NUMRFR- 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 I D - - - POLICY NUMBER - POLICYEFF - MM D POLICY EXP MMIDD/Y YY LIMITS_ A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR Y 103GLOO1079200 I 8/15/2015 8/15/2016 EACH OCCURRENCE - $1 ,000,000 PREM S Ea $100,000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JECOT- FI LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OP AGG $2,000,000 $_ B AUTOMOBILE LIABILITY ANY AUTO AUT OWNED SSCCHiEEDULED AUOS HIRED AUTOS X NON-OWNED AUTOS Y BAS56509224 8/15/2015 8/15/2016 Ea accident $ 1,000;000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X p Per accident $ C X UMBRELLA LU1B EXCESS LIAB OCCUR CLAIMS -MADE CAEX000005691901 8/15/2015 8/15/2016 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 DED X [RETENTION $0 $ D WORKERS COMPENSATION EMPLOYERS, LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yyes, describe under DESCRIPTION OF OPERATIONS below NIA 710150083 10/1/2015 10/1/2016 PER 'ER' X STATUTE ER E.L EACH ACCIDENT _ $1,000,000 _ - E.L. DISEASE - EA EMPLOYE ' $1,000,000 E.L. DISEASE -POLICY LIMIT. $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Project: City of Gilroy Joint Trunk Sewer City of Gilroy, its officers, officials and employees are named as additional insured, per the attached endorsements GtK I ItIGA 1 r- MULLJtK GANI;lI I IUN City of Gilroy, Public Works Division 7351 Rosanna St. Giiroy CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE /�w �(�_ ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD 103 GL 0010792 -00 THIS _ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION - COMPLETED OPERATIONS & ONGOING OPERATIONS AS SCHEDULED 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 Operations City of Gilroy, It's Officers, Elected or Appointed City of Gilroy Joint Trunk Sewer Officials, Employees, Agents and Volunteers 7351 Rosanna Street Gilroy, CA 95020 A. Section 11— Who Is An Insured is amended to include the persons) or organization(s) shown in the Schedule (called additional insured), but only with respect to: (1) Liability for "bodily injury" or "property damage" caused, in whole or in part, resulting from "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" when you and such person(s) or organization(s) have agreed in writing in a con- tract or agreement that such person(s) or organization(s) be named as an additional in- sured on your policy. (2) Liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by resulting from: (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(s) at the loca- tion(s) designated above. B. Section IV — Commercial General Liability Conditions, 4. Other Insurance is amended and the following added: If you are required by written contract to provide primary insurance, the insurance afforded by this Coverage Part for the additional insured shown in the Schedule is primary insurance and we will not seek contribution from any other insurance available to that additional insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U462 -0310 Includes copyrighted material of ISO Properties, Inc., 2004 Page 1 of 1 with its permission. 103 GL 0010792 -00 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEE$ OR CONTRACTORS RS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location(s) Of Covered Operations. City of Gilroy, Its Officers, Elected or Appointed City of Gilroy Joint Trunk Sewer Officials, Employees, Agents and Volunteers 7351 Rosanna Street Gilroy, CA 95020 Information required to complete this Schedule; if not shown above, will shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with. respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the .project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That_ portion of 'your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 0 ISO Properties, Inc., 2004 Page 1 of 1 ACORU® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) F l/9/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pol)cy(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 CON TA T Joanne Cadarette InterWest Insurance Services License #0601094 P.O. Box 255188 PHONE g16 -609 -8362 F;A;X 916 -979 -7562 E-MAIL .jcadarette @lwins.com INSURE S AFFORDING COVERAGE NAIC 0 Sacramento CA 95865 -5188 INSURER A: Financial Pacific Ins Company 31453 INSURED ROLFE -6 om an ' INSURERB:TOrus National Insurance Company' 25496 INSURER C: $5,000 Rolfe Construction 3573 Southern Pacific Ave Atwater CA 95301 INSURER D PERSONAL 8 ADV.INJURY $1,000,000 GEML AGGREGATE LIMIT APPLIES PER: POLICY a j�a F-1 LOC OTHER: GENERAL AGGREGATE INSURER E: PRODUCTS - COMP /OPAGG INSURER F: $ COVFRAGFS CFRTIFICATF NLIMRER- 135160320 REVISION NUMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE IN SD WVD POLICY NUMBER POLICY EFF MM DD POLICY EXP MM /DDM'YY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE ❑ OCCUR Contractual Liab Y 60468861 10/3012015 10/30/2016 EACH OCCURRENCE $1,000,000 _ DAMAGE To REN PREMISES Ea d , urns a $100,000 X MED EXP (Any one person) $5,000 X $2.000 Ded. PERSONAL 8 ADV.INJURY $1,000,000 GEML AGGREGATE LIMIT APPLIES PER: POLICY a j�a F-1 LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OPAGG $2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO WNED AUTOSS AUTOSU�D HIRED AUTOS - X 'NON-OWNED AUTOS 60468861 10/30/2015 10/30/2016 Ea accident $1,000,000 BODILYINJURY(Per,person) $ IX BODILY INJURY (Per accident) '$ R DAMAGE Per accident $ A UMBRELLA LIAB EXCESS'LIAB I X OCCUR CLAIMS -MADE 60468861 10/3012015 10/30/2016 EACH OCCURRENCE $5,000,000 X AGGREGATE $5,000,000 DED I X RETENTION$0 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICER/MEMBER EXCLUDED? ❑ (Mandatory inNH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A y 710150083 1011/2015 10/1/2016 X TA E ER - - E.L. EACH ACCIDENT .$1,000,000 - E.L. DISEASE r. EA EMPLOYEE $1;000,000 E.I. DISEASE- POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Re: Joint Trunk Sewer. Additional Insured Status Applies To City Of Gilroy, Its Officers, Elected Or Appointed Officials, Employees, Agents, Volunteers Per Endorsement Attached. Primary Wording, WC Waiver Attached. City of Gilroy, Public Works Division 7351 Rosanna Street Gilroy CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1999 -2014 ACORD CORPORATION_ All riahts reserved ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 60468861 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Locations Of Covered Operations Re: Joint Trunk Sewer City Of Gilroy, Its Officers, Elected Or When this insurance applies, and required Appointed Officials, Employees, Agents, by contract, such insurance is afforded by Volunteers the General Liability policy is primary and any other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip - ment furnished in connection with such work, on the project (other than service, mainte- nance or repairs) to be performed by or on be- half of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 2010 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: 60468861 COMMERCIAL GENERAL LIABIUTY 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 Re: Joint Trunk Sewer City Of Gilroy, Its Officers, Elected Or Appointed Officials, Employees, Agents, When this insurance applies, and required by Volunteers contract, such insurance is afforded by the General Liability policy is primary and any other insurance shall be excess and shall not contribute to the insurance afforded by this endorsement. Information required to complete this Schedule, if not shown above, will be shown in the .Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury' or "property dam- age" caused, in whole or in part, by "your work" at the location designated and described in the sched- ule of this endorsement performed for that additional insured and included in the "products- completed operations hazard ". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 COMMERCIAL GENERAL LIABILITY CG 20 21'.01 96 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - VOLUNTEER WORKERS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART WHO IS AN INSURED (Section II) is amended to include as an insured any persons) who are volun- teW `worker(s) for °you, but only while acting at the direction of, and within the scope of their duties for you. However; none of these volunteer worker(s) are insureds for. 1. ''Bodily injury" or "personal injury": a. To you, to your partners or members (if you area partnership-or joint venture), to your members (if you are a limited liability com- pany), to your other volunteer worker(s) or to "your "employees" arising out of and in the course of their duties for you; b. To the spouse, child, parent, brother or sister of your volunteer worker(s) or your "employees" as a consequence of para- graph 1.a. above; c. For which .there. S, any obligation fo. share damages with or rep_ ay someone .else who n ust pay damages because of the injury described in paragraphs '1.a. or b. above; or d. Arising out of his or her providing or failing to provide professional health care serv- ices. 2. "Property damage" to property: a. Owned, occupied, or used by, b. Rented to, in the care,. custody or control of, or over which physical Control is being exercised for any purpose by you, any of your other volunteer workers, your. "employ_ ees ", any partner or member (if you are a .partnership or joint venture), or any member (if you are a limited liability company). CG 20 21 0196 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 ❑ WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT— CALIFORNIA WC 04 03 06 (Ed. 4 -84) We have the right to recover our payments from anyone liable for an injury covered by this policy: We will`not.enforce our right against the person or organization named in the Schedule., (This agreement ;applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from US.) You riust,maintain payroll records accurately segregating the remuneration of your employees 'while engaged in the work described in the.:Scheidule. Schedule Person or Organization City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 Job Description Joint Trunk Sewer 7351 Rosanna Street Gilroy, CA 95020 This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy -) Endorsement Effective 10/01/15 Policy No. T10150083 Insured Rolfe Construction Company Insurance Company Torus National Insurance Company Countersigned By WC 04 03 06 (Ed. 4 -84) ®1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. Endorsement No. t.8 Policy Effective Date 10/01/15 ROLFE -2 OP ID: RL2 CERTIFICATE OF LIABILITY INSURANCE °ATE'MM` ° °"'Y"' 02/03/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANTi If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subjectla - 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 Lea /Car enter /Kern ' s Insurance 3187 Collins Dr. p_ Merced, CA 95348 Michael J. Carpenter CONTACT enter - (FAX No ac °" o E-,,: 209x384 -0727 E -MAIL ADDRESS: GENERAL LIABILITY INSURERS AFFORDING COVERAGE NAIC # INSURERA:WeSCO_Insurance Company 25011 $ 1,000,000. INSURED Rolfe. Construction INSURER B: Great American Alliance Ins Co 26832 3573 Southern Pacific Avenue Atwater, CA 95301 INSURER C : 01/31/2015 01/31/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,00 INSURER D: $ 5,00 INSURER E': $ 1,000,00 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION;NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADD B .POLICY NUMBER POLICY EFF MM /DD POLICY EXP MM /DD/YYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000. A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR X X WPP1235560 00 01/31/2015 01/31/2016 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE_ $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ _ ZOOM POLICY X PRO- LOC Emp Ben. $ 1,000,00 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,00,00 'X BODILY INJURY (Per person) $ A ANY AUTO X X WPP1235560 00 01/31/2015 01/31/2016 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Peraccident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE PER ACCIDENT $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 5,000,00 B EXCESS LIAB CLAIMS -MADE XS- 3717663 01/31/2015 01/3112016 D X RETENTION $ 10000 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA WC STATU- Ol H- IQELY LIMITS E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) Y yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Rented /Leased WPP1235560 00 01/31/2015 01/31/2016 100,00 Equipment Ded 1,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) City of Gilroy, Its Officers, Elected or Appointed Officials, Employees, Agents and Volunteers are named as Additional Insured with respects to General & Auto Liability per attached forms. Waiver of Subrogation applies to General and Auto Liability. Project: City of Gilroy Joint Trunk Sewer GILRO -3 City of Gilroy Public Works Division 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. WTHORMED REPRESENTATIVE CORPORATION. All rights reserved ACORD 25 (2010/06) The ACORD name and logo are registered marks of ACORD ROLFE -2 OP ID: RL2 ,a►CC7Ap®° CERTIFICATE. OF LIABILITY INSURANCE � --•''� DATE 02 /03 /2015Y) 02/03/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. - - - IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED; subjectao - -: 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' Leap /Carpenter /Kemps Insurance 3187 Collins Dr._. CONTACT Michael J. Ca .. F A/c NO Ell: 209 -384 -0727 A/c No): 209 - 384 -0401 ' E -MAIL ADDRESS: Merced, CA 95348 Michael J. Carpenter X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR X INSURERS AFFORDING COVERAGE NAIC # INSURER A: Colony Insurance Co. 39993 I EACH OCCURRENCE INSURED Rolfe Construction INSURER B: The Ohio Casualty Ins Co 24074 3573 Southern Pacific Avenue Atwater, CA 95301 INSURER C : First Mercury Ins. Co. 10657 $ 5,00 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 P_ AID CLAIMS. INSR LTR TYPE OFINSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM /DD . POLICY EXP MM /DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR X X 103G 0010792 -00 08115/2015 08115/2016 I EACH OCCURRENCE $ 1,000,000. DAMAGE (Ea PREMISES $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV'INJURY $ 1,000,00 GENT AGGREGATE LIMIT APPLIES PER: POLICY P_ 6 LOC GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMPIOP AGG $ 2,000,00 Emp Ben. $ 1',000,00 OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,o0Q,00 B X ANY AUTO X X BAS56509224 08/15/2015 08115/2016 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X NON -OWNED HIRED AUTOS X.J AUTOS PROPERTY DAMAGE Per accident) $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 C X EXCESS LIAB CLAIMS -MADE CA- EX- 0000056919 -01 08/15/2015 08/15/2016 AGGREGATE $ 5,000,00 DED, I X I RETENTION'$ 0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A PER 0TH- STATUTE ER E.L. EACH ACCIDENT $ E.L.' DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yyes, describe under DESCRIPTIONOF OPERATIONS below - E.L.'. DISEASE '- POLICY LIMIT' $ B Rented /Leased BKO56509224 08115/2015 j 08/15/2016 100,00 Epuipment Died 1,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached' If more space is required) City of Gilroy, Its Officers, Elected or Appointed Officials, Employees, Agents and Volunteers are named as Additional Insured with respects to General & Auto Liability per attached forms. Waiver of Subrogation applies to General and Auto Liability. Project. City of Gilroy Joint Trunk Sewer GILRO -3 City of Gilroy Public Works Division 7351 Rosanna St Gilroy, CA 95020 SHOULD ANY OF THE ABOVE' DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Ir: ✓— _ / � i _ . � Vii. � �- ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ROLFE -2 OP ID: RL2 CERTIFICATE -OF LIABILITY INSURANCE °02103`2015' Q2103I2015 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(SL 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 Leap /Ca enter /Kemps Insurance 3187 Collins Dr. � Michael J. Carpenter C No E • 209- 384 -0727 9- 384 -0401 Merced, CA 95348 Michael J. Carpenter EMAIL ADDRESS` INSURER(S) AFFORDING COVERAGE NAIC If INSURERA: Wesco Insurance Company 25011 EACH OCCURRENCE INSURED Rolfe Construction INsuFtfRB: Great American Alliance Ins Co 26632 3573 Southern Pacific Avenue Atwater, CA 95301 INSURER c WPP1235560 00 INSURER D: 01/31/2016 PREMISES Ea occurrence INSURER E MED EXP (Any one person) $ 5,000 WSURERF : $ 1,000,00 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 POLICY NUMBER MMIDD MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX7 OCCUR X X WPP1235560 00 01/31/2015 01/31/2016 PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS- COMPIOP AGG $ 2,000,00 POLICY_ X PRO- LOC Emp Ben. $ 1,000,000 AUrOMOSILELIABILITY COMBINED SINGLE LIMIT Ea accident 1000,00 $ , BODILY INJURY (Per person) $ A ANY AUTO X X PP1235560 00 01/31/2015 01/31/2016 ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X 'NON -OWNED AUTOS JX BODILY INJURY (Per accident $ PROPERTY' DAMAGE PER ACCIDENT $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ 51000 Q00 B EXCESSLWB CLAIMS -MADE XS- 3717663 01/31/2015 01/31/2016 DIED I X I RETENTION $ 10000 $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS LIABILITY y 1 N ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? �, ,NIA TL TS R IMI E.L. EACH ACCIDENT $ E.L. DISEASE - EAEMPLOYEE $ (Mandatory In NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below A Rented /Leased WPP1235560 00 01/31/2015 01/31/2016 100,000 Equipment D 1,000 DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule, If more space Is required) City of Gilroy, Its Officers, Elected or Appointed Officials, Employees, ents and Volunteers are named as Additional Insured with respects to General & Auto Liability per attached forms. Waiver of Subrogation applies to General and Auto Liability. Project: City of Gilroy Joint Trunk Sewer City of Gilroy Public Works Division 7351 Rosanna St. Gilroy, CA 95020 ACORD 25 (2010105) GILRO -3 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE O 1988 -2010 ACORD The ACORD name and logo are registered marks of ACORD riahts reserved POLICY NUMBER: WPP1235560 00 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name. Of Person Or Organization: Blanket as required by written contract. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV —Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products - completed operations hazard ". This waiver applies only to the person or organization shown in the Schedule above. CG 2404 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 ❑ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Policy Number:WPP1235560 00 COMMERICAL AUTOMOBILE BROADENED COVERAGE ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM A. SUBSIDIARIES AND NEWLY ACQUIRED OR FORMED ORGANIZATIONS Paragraph A.I. WHO IS AN INSURED of SECTION II — LIABILITY COVERAGE is amended as follows: The Named Insured shown in the Declarations is amended to include: 1. Any legally incorporated subsidiary in which you own more than 50% of the voting stock on the effective date of the Coverage Form. However, the Named Insured does not include any subsidiary that is an "insured" under any other automobile policy or would bean "insured" under such a policy but for its termination or the exhaustion of its Limit of Insurance. 2. Any organization that is acquired or formed by you and over which you maintain majority ownership. However, the Named Insured does not include any newly formed or acquired organization: a. That is a partnership, joint venture or limited liability company b. That is an "insured" under any other policy, C. That has exhausted its Limit of Insurance under any other policy, or d. 180 days or more after its acquisition or formation by you, unless you have given us notice of the acquisition or formation. Coverage does not apply to "bodily injury" or "property damage" that results from an "accident" that occurred before you formed or acquired the organization B. EMPLOYEES AS INSUREDS Paragraph A. 1. WHO IS AN INSURED of SECTION If — LIABILTY COVERAGE is amended to add: Any "employee" of yours while using covered "auto" you don't own, hire or borrow in your business or your personal affairs. C. LESSORS AS INSUREDS Paragraph A.I. WHO IS AN INSURED of SECTION II — LIABILITY COVERAGE.is amended to add: 1. The lessor of a covered "auto" while the "auto" is leased to you under a written agreement if: The agreement requires you to provide direct primary insurance for the lessor; and b. The "auto" is leased without a driver. CA990143 Page 1 of 7 Ed. 0912 Such a leased "auto" will be considered a covered "auto" you own and not a covered "auto" you hire. D. ADDITIONAL INSURED IF REQUIRED BY CONTRACT Paragraph 1. WHO IS AN INSURED of A. Coverage under SECTION II — LIABILITY COVERAGE is amended to add: 1. Any person or organization with whom or with which you have agreed in writing in a contractor agreement that such person(s) or organization(s) shall be included as an additional insured on your business auto policy. Such person or organization is an "insured ", but only to the extent such person or organization is liable for "bodily injury" or "property damage" caused by the conduct of an "insured" under paragraphs la. or lb. of Who Is An Insured with regard to the ownership, maintenance or use of a "covered" auto. The insurance afforded to any such additional insured applies only if the "bodily injury" or "property damage" occurs: During the policy period, and b. Subsequent to the execution of such written contract, and C. Prior to the expiration of the period of time that the written contract requires such insurance be provided to the additional insured. 2. How Limits Apply If you have agreed in a written contract or written agreement that another person or organization be added as an additional insured on your policy, the most we will pay on behalf of such additional insured is the lesser of: a. The limits of insurance specified in the written contract or written agreement; or b. The Limits of Insurance shown in the Declarations. Such amount shall be a part of and not in addition to Limits of Insurance shown in the Declarations and described in this Section. 3. Additional Insureds Other Insurance If we cover a claim or "suit" under this Coverage Part that may also be covered by other insurance available to an additional insured, such additional insured must submit such claim or "suit" to the other insurer for defense and indemnity. Such insurance as is afforded by this policy or the benefit of the additional insured(s) shall be excess and non - contributory as respect to any claim, loss or liability allegedly arising out of the operations of the Named Insured; however, this insurance will not apply to any claim, loss or liability which is determined to be solely the result of the additional insured's negligence or solely the additional insured's responsibility. 4. Duties In The Event Of Accident, Claim, Suitor Loss If you agreed in a written contract or written agreement that another person or organization be added as an additional insured on your policy, the additional insured shall be required to comply with the provisions in LOSS CONDITIONS 2. DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS of SECTION IV BUSINESS AUTO CONDITIONS, in the same manner as the Named Insured. E. AMENDED FELLOW EMPLOYEE EXCLUSION CA990143 Page 2 of 7 Ed. 0912 Paragraph S. Fellow Employee of SECTION II — LIABILITY COVERAGE does not apply if you have workers: compensation insurance in -force covering all of your "employees ". Coverage is excess over any other collectible insurance. F. HIRED AUTO PHYSICAL DAMAGE COVERAGE The following is added to Paragraph C., Limit of Insurance of SECTION III PHYSICAL DAMAGE COVERAGE: If hired "autos" are covered "autos" for Liability Coverage and if Comprehensive, Specified Causes of Loss, or Collision coverages are provided under this Coverage Forms for any "auto" you own, then the Physical Damage Coverages provided are extended to "autos" you hire or borrow, subject to the following limit. The most we will pay for "loss" to any hired "auto" is: a. $100,000; b. The actual cash value of the damaged or stolen property at the time of the "loss or C. The cost of repairing or replacing the damaged or stolen property, whichever is less, minus a deductible. The deductible will be equal to the largest deductible applicable to any owned "auto" for that coverage. No deductible applies to "loss" caused by fire or lightning. Hired Auto Physical Damage coverage is excess over any other collectible insurance. Subject to the above limit, deductible and excess provisions, we will provide coverage equal to the broadest coverage applicable to, any covered "auto" you own. We will also cover loss of use of the hired "auto" if it results -from an "accident", you are legally liable and the lessor incurs an actual financial loss, subject to a maximum of $1,000 per "accident". This extension of coverage does not apply to any "auto" you hire or borrow from any of your "employees ", partners (if you are a partnership), members (if you are a limited liability company), or members of their households. G. PHYSICAL DAMAGE — ADDITIONAL TEMPORARY TRANSPORTATION EXPENSE COVERAGE Paragraph a. Transportation Expenses of 4. Coverage Extensions under A. Coverage., SECTION 111 PHYSICAL DAMAGE COVERAGE is amended to provide a limit of $SO per day and a maximum limit of $1,000. H. LOAN /LEASE GAP COVERAGE Under SECTION III PHYSICAL DAMAGE COVERAGE, in the event of a total "loss" to a covered "auto ", we will pay your additional legal obligation for any difference between the actual cash value of the "auto" at the time of the "loss" and the "outstanding balance" of the loan /lease. "Outstanding balance" means the amount you owe on the loan /lease at the time of "loss" less any amounts representing taxes; overdue payments; penalties, interest or charges resulting from overdue payments; additional mileage charges; excess wear and tear charges; lease termination fees; security deposits not returned by the lessor; costs for extended warranties, credit life insurance, health, accident or disability insurance purchased with the loan or lease; and carry-over balances from previous loans or leases. I. AIRBAG COVERAGE Under paragraph B. EXCLUSIONS of SECTION III PHYSICAL DAMAGE COVERAGE, the following is added: CA990143 Page 3 of 7 Ed. 0912 The exclusion relating to mechanical breakdown does not apply to the accidental discharge of an airbag. J. ELECTRONIC EQUIPMENT— BROADENED COVERAGE Paragraph B. Exclusions of SECTION III PHYSICAL DAMAGE COVERAGE is amended as follows: 1. Subparagraph 5. of Paragraph B. Exclusions of SECTION III PHYSICAL DAMAGE COVERAGE is replaced by the following: Exclusions 4.c. and 4.d. do not apply to equipment designed to be operated solely by use of the power from the "auto's" electrical system that, at the time of "loss ", is: (1) Permanently installed in or upon the covered "auto "; (2) Removable from a housing unit which is permanently installed in or upon the covered "auto "; (3) An integral part of the same unit housing any electronic equipment described in Paragraphs a. and b. above; or (4) Necessary for the normal operation of the covered "auto' or the monitoring of the covered "auto's" operating system. 2. Paragraph 2. of C. Limit Of Insurance, under SECTION III —PHYSICAL DAMAGE COVEAGE is replaced with the following: $1,500 is the most we will pay for "loss" in any one "accident" to all electronic equipment that reproduces, receives or transmits audio, visual or data signals which, at the time of "loss ", is: Permanently installed in or upon the covered "auto" in a housing, opening or other location that is not normally used by the "auto" manufacturer for the installation of such equipment; 2. Removable from a permanently installed housing unit as described in Paragraph b.(1) above or is an integral part of that equipment; or 3. An integral part of such equipment. 3. The following is added to Paragraph D. Deductible of SECTION 111 — PHYSICAL DAMAGE COVEAGE: For each covered "auto ", should loss be limited to electronic equipment only, our obligation to pay for, repair, return or replace damaged or stolen electronic equipment will be reduced by the applicable deductible shown in the Declarations, or $250, whichever deductible is less. K. GLASS REPAIR —WAIVER OF DEDUCTIBLE Under Paragraph D. DEDUCTIBLE of SECTION III PHYSICAL DAMAGE COVERAGE, the following is added: No deductible applies to glass damage if the glass is repaired rather than replaced. L. EXTRA EXPENSE — BROADENED COVERAGE Under paragraph A. Coverage of SECTION III PHYSICAL DAMAGE COVERAGE, we will pay for the expense of returning a stolen covered "auto" to you. CA990143 Page 4 of 7 Ed. 0912 M. PRIMARYAND NON CONTRIBUTORY IF REQUIRED BY CONTRACT The following is added to Paragraph B.5, Other Insurance, in SECTION IV— BUSINESS AUTO CONDITIONS Only with respect to insurance provided to an additional insured of this endorsement, and required by contract, the following provisions apply: a. Primary Insurance When Required by Contract This insurance is primary if you have agreed in a written contract or written agreement that this insurance be primary. If other insurance is also primary, we will share with all that other insurance by the method described in 5.d., Other Insurance under B. General Conditions of SECTION IV — BUSINESS AUTO CONDTIONS b. Primary And Non- Contributory To Other Insurance When Required By Contract If you have agreed in a written contract or written agreement that this insurance is primary and non- contributory with the additional insured's own insurance, this insurance is primary and we will not seek contribution from that other insurance. Paragraphs a. and b. above do not apply to other insurance, to which the additional insured has been added as an additional insured. When this insurance is excess, we will have no duty to defend the insured against any "suit" if any other insurer has a duty to defend the insured against that "suit ". If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: 1. The total amount that all such other insurance would pay for the loss in the absence of this insurance; and 2. The total of all deductible and self - insured amounts under all that other insurance. We will share the remaining loss, if any, by the method described in 5.d. Other Insurance of B. General Conditions under SECTION IV— BUSINESS AUTO CONDITIONS. N. AUTOS RENTED BY EMPLOYEES Paragraph 5. Other Insurance of B. General Conditions under SECTION IV — BUSINESS AUTO CONDITIONS is amended as follows: If an "employee's" personal insurance also applies on an excess basis to a covered "auto" hired or rented by your "employee" on your behalf and at your direction, this insurance will be primary to the "employee's" personal insurance. O. AMENDED DUTIES IN THE EVENT OF ACCIDENT, CLAIM, SUIT OR LOSS The requirement in A. Loss Conditions, 2. Duties In The Event Of Accident Claim, Suit Or Loss, sub- paragraph a. of SECTION IV BUSINESS AUTO CONDITIONS that you must notify us of an "accident" applies only when the "accident" is known to: CA990143 Page 5 of 7 Ed. 0912 1. You, if you are an individual; 2. A partner, if you are a partnership; 3. A member, if you are a limited liability company; or 4. An executive officer or insurance manager, if you are a corporation. P. UNINTENTIONAL FAILURE TO DISCLOSE HAZARDS Section B. General Conditions of SECTION IV BUSINESS AUTO CONDITIONS is amended as follows: If you unintentionally fail to disclose any hazards existing at the inception date of your policy, we will not deny coverage under this Coverage Form because of such failure. Q. HIRED AUTO — COVERAGE TERRITORY Sub - section 7. Policy Period, Coverage Territory of B. General Conditions, under SECTION IV BUSINESS AUTO CONDITIONS is replaced by the following: a. For short-term hired "autos ", the coverage territory with respect to Liability Coverage is anywhere in the world provided that if the "insured's" responsibility to pay damages for "bodily injury" or "property damage" is determined in a "suit ", the "suit" is brought in the United States of America, the territories and possessions of the United States of America, Puerto Rico or Canada or in a settlement we agree to. R. WAIVER OF SUBROGATION Sub - section S. Transfer Of Rights Of Recovery Against Others To Us of A. Loss Conditions under SECTION IV BUSINESS AUTO CONDITIONS is amended by adding the following: We waive any right of recovery we may have against any person or organization with whom you have a written contract that requires such waiver because of payments we make for damages under this Coverage Form. S. EXTENDED CANCELLATION CONDITION Paragraph 2.b. of the COMMON POLICY CONDITIONS (IL 00 17) cancellation applies except as follows: If we cancel for any reason other than nonpayment of premium, we will mail or deliver to the first Named Insured written notice of cancellation at least 60 days before the effective date of cancellation. T. TWO OR MORE DEDUCTIBLES The following is added to Paragraph D., Deductible, of SECTION III, PHYSICAL DAMAGE COVERAGE If any another policy or policies issued by us provides coverage for the same accident the following applies: a. If the deductible under this Business Auto Coverage Form is the smaller (or smallest) deductible, it will be waived; CA990143 Page 6 of 7 Ed. 0912 b. If the deductible under this Business Auto Coverage Form is not the smaller (or smallest) . deductible, it will be reduced by the amount of the smaller (or smallest) deductible. U. HYBRID PAYMENT COVERAGE The following is added to Paragraph C, Limits of Insurance, of SECTION III, PHYSICAL DAMAGE COVERAGE 1. In the event of a total loss to a "non- hybrid" auto for which Comprehensive, Specified Causes of Loss, or Collision coverages are provided under this Coverage Form, then such Physical Damage Coverages are amended as follows: a. If the auto is replaced with a "hybrid" auto, we will pay an additional 10%, to a maximum of $2,500, of the "non- hybrid" auto's actual cash value or replacement cost, whichever is less. b. The auto must be replaced and a copy of a bill of sale or new lease agreement received by us within 60 calendar days of the date of "loss," C. Regardless of the number of autos damaged in.any one "loss ", the most we will pay under this Hybrid Payment Coverage provision for any one `loss" is $10,000. 2. For the purposes of this HYBRID PAYMENT COVERAGE provision the following definitions apply: "Non- hybrid" auto is defined as an auto that uses only an internal combustion engine to move the auto. "Hybrid" auto is defined as an auto with an internal combustion engine and one or more electric motors; and that uses the internal combustion engine and one or more electric motors to move the auto, or the internal combustion engine to charge one or more electric motors, which move the auto. V. RESULTANT MENTAL ANGUISH INCLUDED The definition of "bodily injury" in SECTION V — DEFINITIONS is replaced with the following: "Bodily injury" means bodily injury, sickness or disease sustained by any person, including mental anguish or death resulting from any of these. W. HIRED "AUTO" REDEFINED The following is added to the Description of Covered Auto Designation Symbols for Symbol 8, Hired "Autos" Only: Any "auto" hired or rented by your "employee" on your behalf and at your direction will be considered. an "auto" you hire. CA990143 Page 7 of 7 Ed. 0912 POLICY NUMBER:WPP1235560 00 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Blanket as required by written contract. Blanket as required by written contract. It is agreed that such insurance as is afforded by this policy for the benefit of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory as respects to any claim, loss or liability, allegedly arising out of the operations of the named insured, provided however that this insurance will not apply to any claim loss or liability which is determined to be solely the additional insured's responsibility Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury ", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: CG 2010 0413 0 Insurance Services Office, Inc., 2012 Page 1 of 3 B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: .1. All work, 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. Page 2 of 3 0 Insurance Services Office, Inc., 2012 . CG 2010 0413 C. With respect to the insurance afforded to these additional insureds, the following is added to Section 111 — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 2010 0413 0 Insurance Services Office, Inc., 2012 Page 3 of 3 13 AG'QRO® CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) 5/13/2015 THIS CERTIFICATE IS ISSUED AS, A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate: does not confer rights to the certificate holder in lieu of such endorsemen s . PRODUCER InterWest Insurance Services License #0601094 P.O. Box 255188 ONTA NAME: PHONE' _ 1C No - - - E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Sacramento CA 95865 -5188 1NSURER.A.: $ PREMISES Ea occurrence IN ROLFE -4 INSURER i $ INSURER C $ Rolfe Construction 3573 Southern Pacific Ave Atwater CA 95301 INSURER D $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ INSURER E : $ INSURER F : AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED FARED AUTOS AUTOS COVERAGES CERTIFICATE NUMBER: 1380435327 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE, FOR THE POLICY PERIOD INDICATED: _ NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH' THIS CERTIFICATE, MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE IN SR WVD POLICY NUMBER MMILDDY/YYYY MM/DD EXP LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 7 OCCUR EACH OCCURRENCE $ PREMISES Ea occurrence $ MED EXP (Any one erson) i $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- LOC PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED FARED AUTOS AUTOS Ea accident BODILY INJURY (Per person) is BODILY INJURY Per accident (Per ._ ) $ PROPERTY DAMAGE Per acc en $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) N yes, describe under DESCRIPTION OF OPERATIONS below NIA Y T10140083 0/1/2014 0/1/2015 X WCSTATU- OTH- TOR M E.L. EACH ACCIDENT $1,000,000 . E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Evidence of Workers Compensation Insurance - Waiver of Subrogation attached a.crt t rrn.N i c nvti City of Gilroy Public Works Division 7351 Rosanna St Gilroy CA 95020 ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD The ACORD name and logo are registered marks of ACORD reserved. WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will hot enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from US.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be _ "_% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description WHERE YOU ARE REQUIRED BY WRITTEN CONTRACT TO OBTAIN THIS AGREEMENT FROM US, PROVIDED THE CONTRACT IS SIGNED AND DATED PRIOR TO THE DATE OF LOSS TO WHICH THIS WAIVER APPLIES. IN NO INSTANCE SHALL THE PROVISIONS AFFORDED BY THIS ENDORSEMENT BENEFIT ANY COMPANY OPERATING AIRCRAFT FOR HIRE. 'The premium charge for this endorsement shall be 2% of the premium developed in the State of California, but not less than $500 policy minimum premium. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/01/14 Policy No. T10140083 Insured Rolfe Construction Company Insurance Company Torus National Insurance Company Countersigned By WC 04 03 06 (Ed. 4 -84) ®1998 by the workers' Compensation Insurance Rating Bureau of California. All rights reserved.. Endorsement No. 13 Policy Effective Date 10/01/14 ROLFE -2 OP ID: RL2 CERTIFICATE OF LIABILITY INSURANCE DATE (MM /66NYYY) 1010v2o14 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 Leap /C 3rQenter /Kem6S l('ssuranc-e 3187 Callrns Dr. _ _ CONTACT: NAME:` Michael J. Carpenter. PHONE FAX N, Ell: 209 - 384 -0727 ac No): 209 -384 -0401 E -MAIL ADDRESS: Merced, CA- 95348. Michael J. Carpenter -- - -.. INSURERS AFFORDING COVERAGE NAIC # INSURER A: Natl Fire Ins of Hartford 20478 A INSURED Rolfe Construction INSURER B: Continental Casual Co. 20443 3573 Southern Pacific Avenue Atwater, CA 95301 INSURER C: American Cas Co of Reading PA 20427 DAMAGE T RENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) INSURER D: PERSONAL & ADV INJURY 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 LTR TYPE OF INSURANCE POLICY NUMBER MM/DDY EFF MM//DD/ YYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_] OCCUR X X 4026892068 01/3112014 01/31/2015 DAMAGE T RENTED PREMISES Ea occurrence $ 100,00 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,060,06 GENERAL AGGREGATE $ 2,000,00 GEN'L °AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,00 POLICY .X- P.RO :r Emp Ben. -.., $ 1,000,00 AUTOMOBILE LIABILITY.. ,. COMBINED SINGLE.LIMIT ;, Ea'accider t -1,000,00( X BODILY INJURY(Pecperson)_ $. B ANY AUTO '': X X.' 4026892085 01/31/2014 '01/31/2015 ALL OWNED SCHEDULED .' AUTOS AUTOS - BODILY INJURY (Per accident) $ X PROPERTY' DAMAGE PER ACCIDENT $ HIRED AUTOS X NON -OWNED AUTOS X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000000 AGGREGATE $ 5,000,00 C EXCESS LWB CLAIMS -MADE 4026892071 0113112014 01/31/2015 DED _X RETENTION$ 10600 $ WORKERS COMPENSATION NSTATU Y_LM_ri7 OTH- ER AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER/EXECUTIVE F7 OFFICER/MEMBER EXCLUDED? NIA 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 $ A Rented /Leased 4026892068 01/31/2014 01/31/2015 100,00 Equipment Ded 1,06 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) *THIS CERTIFICATE REPLACES PREVIOUS CERTIFICATE ISSUED ON 9/26/2014* City of Gilroy, Its Officers, Elected or Appointed Officials, Employees, Agents and Volunteers are named as Additional Insured with respects to General & Auto Liability per attached forms. Waiver of Subrogation applies to General and Auto Liability. GILRO -3 City of Gilroy Public Works Division 7351 Rosanna St. Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD