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HomeMy WebLinkAboutDon Chapin Co. - Insurance CertificateCERTIFICATE OF LIABILITY INSURANCE 12/03/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFCATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY•AMEND, EXTEND OR ALTER THE COVERAGE.AFFORDED BY THE POLICIES BELOW. T'IUS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ismNG INSURER(St AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER - IMPORTANT: If the certificate holder Is An ADDITIONAL INSURED . the Po ey(te$) li ' must be endorsed. H SUBROGATION 6S WARNED, subject to the terms and conditions of .the policy, certain policies may require an endorsement A stateawd on this certificate does not confer rights to to certificate holder In lieu of such endorsement(s). pRODUCER LIC S 056172 1 -831- 724 =3841 MIACT washerry i Radson PHONE FAX 575 Auto Coat Drive � P. O. Hoz 2690 0L0 9674277 -04 10/01/1 Wats=viIle, CA 95076 90RIREW AFFORDING COVERAGE NAACO INSLMM A: ZMXCB A!IBRICIN INS.CO - _ 16535 a�ED abURERB: STARE ZaID i LIAB CO -- 36518- TER R DON CRAPIN COMPANY INC. -- - NED EXP Oft ow $ 5,_000_ eLS!lRER c s 1,000,000 WSURERD: 560 CRAZY am CANYON ROAD sXRIRERE: SALINAS. CA 93907 LE" [A[iF_ \" &2129766 eea U UK. M D. THIS'IS10 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT M---T" RESPECT_ TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE D CE AFFORD BY THE POLICIES DESCRIBED HERON is SJECT UB TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID.CLAIMS. RBR TYPE OF DISURANCE POUCr POL1C7 OFF POIJCY Om Lam - 8 GENHtIIL LtABnJY _. Z % 0L0 9674277 -04 10/01/1 20702/15 3 1, 000, 0.00 = CMaffRC1ALG89MLUABRRY CLNtASMPME a OCCUR E Contractual Liability -- - NED EXP Oft ow $306'.000 $ 5,_000_ PERSONAL .A AOV VQURY s 1,000,000 GENERAL AGGREGATE 32 .000,000 GENL AGGREGATE UMT APPLIES PER: PROMCTS•.CONPIOPAGO 32.. cool 000 - POLLY z PRO. LOC A Z E BAP 9674279 -0 LIMIT 1,000,000 Z ANY AUTO 8001LY INJURY (Per pecan) S ALL AUTOS AUTO eOORY wuki (Pet —won S mm ALROS E � ED f X Coatrao _ H WEXCESS =REL'LA LIAR S OCCUR 1000021295 10 /0 1 /1 10/01/15 EACH ,OCCURRENCE 1510,000,000 AGGREGATE S 10,000,000 UA13 CLAIMS -UAOE DED RETENTIONS_ Follows Fozm S A"El70001 LIALIT E7W1.0_.'YERS'LIABR.IIY ANY PROr!WETORIPARTNERUE)MCM4 YIN a�FT�AgMgI EEXCLUDED? Q wUw A WC 9674280 -06 10 /01 /1 10/01/15 Y gTATUc -' . Ei EACH ACDENT ! O S1,000.000 � ,FA BMLOYEi $ 1.000.000 0 m� E1. M6Aw • POLICY uM1r', S1-1166.060 OF OPERATIONS below DESCRIPT= OF OPERATIONS Y WCATIOM I VMiCLES IAesoh AOORD un..Ad@sand a.— seh.hb, a. w+b naati9di RE: PROJECT NO. 15 -7I0-216, SIM STREET nIPROVII l=.S. LED TRAIL LIMMING, LED UPGBAM AND FMM OPTICS REPAffi CITY OF GILHOY, ITS EXACTED a APPOINTED OFFICERS, OFFICIALS, EMPLOYERS AND VOLDSTLERRS ARE INCLUDED AS ADDITIONAL INSURED PER TER ATTACHED ECDORSBNSNTS. aL PER ISO FORM 000001 04/13; AL PER ISO FORM 60001 10/13 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF GILROY THE EXPIRATION DATE tMEREOE; NOTICE WILL BE DELNERED IN ACCORDANCE WITH THE POLICY PROVISIONS. RISK MANAGER 7351 ROSAM STREET ALnHORZEDREPRESIMATIVE GILROY, G 95020 I TJS1► @19W201 AGORO Z5 (2010M5) The ACORD name and logo are registered marks of ACORD mgarcia 42129764 TION. All rights reserved. SUPPLEMENT TO CERTIFICATE OF INSURANCE 11/1 QA'FE 7/2014 Additional Insured — Automatic — Owners, Lessees Or Contractors 9 ZURICH Polity No Eff Dale of Pot Exp Date or Pol Eff Date of End Producer No Addl Prem Return Prem. GLO9674277 -d4 10/01/2014 10/0112015 1010112014 JMcShenry a uiudso City Of Gilroy, its Elected & Appointed Officers, Officials. Employees and Volunteers THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. The Don Chapin Company Inc. t landset Engineers, inc i Named Insured. Toms Site Serv,cmTom`s Septic Constnxtwon Address (including ZIP Code): 560 Crazy Horse Canyon Road. Saunas, CA 93907 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A- Section 11— Who Is An Insured is amended to include as an insured any person or organization who you are required to add as an additional insured on this policy under a written contract or written agreement. However, if you have entered into a construction contract or construction agreement with an additional insured person or organization, the insurance afforded to such additional insured only applies to the extent permitted by law. B. The insurance provided to the additional insured person or organization applies only to "bodily injury", "property damage' or "personal and advertising injury" covered under Section I — Coverage A — Bodily Injury And Property Damage Liability and Section I — Coverage B — Personal And Advertising Injury Liability, 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, and resulting directly from your ongoing operations or "your work" as included in the "products - completed operations hazard ", which is the subject of the written contract or written agreement. C. However, regar6ess of the provisions of Paragraphs A. and B. above: 1. We will not extend any insurance coverage to any additional insured person or organization: a. That is not provided to you in this policy: or b. That is any broader coverage than you are required to provide to the additional insured person or organizat c- in the written contract or written agreement; and 2. We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of: a. The Limits of Insurance provided to you in this policy, or b. The Limits of Insurance you are required to provide in the written contract or written agreement. D. The insurance provided to the additional insured person or organization does not apply to "Bodily injury". "property damage" or "personal and advertising injury" arising out of the rendering or failure to render any professional architectural, engineering or surveying services including. 1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports surveys. field orders, change orders or drawings and specifications; and 2. Supervisory inspection architectural or engineering activities u- GL- 1175 -E CW (04112) Page 1 of 2 Includes copyrighteC material of Insurance Services Office, Inc with its perrriss.on E. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV — Comrnercial General liability Conditions: The additional insured must see to it that 1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim; 2. We receive written notice of a claim or" suit" as soon as practicable; and 3. A request for defense and Indemnity of the claim or "suit will promptly be brought against any policy Issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the written contract or written agreement requires that this coverage be primary and non - contributory. F. For the coverage provided by this endorsement 1. The following paragraph is added to Paragraph 4.a. of the Other Insurance Condition of Section IV — Commercial General Iability Conditions: This insurance is primary insurance as respects our coverage to the additional insured person or organization, where the written contract or written agreement requires that this insurance be primary and non - contributory with respect to any other policy upon which the additional insured is a Named Insured. In that event. we will not seek contribution from any other such insurance policy available to the additional insured 'on which the additional insured person or organization is a Named Insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV— Commercial General Liability Conditions: This Insurance is excess over Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy ' providing coverage for the same "occurrence ", offense, claim or "suit". This provision does not apply to any policy in which the additional insured is a Named Insured on such' other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. G. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. All other terms and conditions of this policy remain unchanged. U-GL- 1175 -E CW (04112) Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc_, with its permission. POLICY NUMBER: GLOW4277 -04 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 PROOUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any Person or Organization that requires You to waive your Rights of Recovery, in a written contract or agreement with the Named Insured that Is executed prior to the acci- dent. or toss: City Of Gilroy, Its Elected & Appointed Officers, Officials, Employees and volunteers Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph S. 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 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 Wolters I kmw Financial Services I Uniform FwnsT° POLICY NUMBER: GLO9674277 -04 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): A General Aggregate Limit applies to each construction project. where the Named Insured Is performing operations, however, a General Aggregate Limit does not apply to any construction project where the Named Insured Is performing operations that are insured under a wrap up or any other consolidated or similar insurance program. City Of Gilroy, Its Elected & Appointed Officers, Officials, Employees and Volunteers Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A For all sums which the insured becomes legally obligated to pay as damages caused by 'occur rences° under Section l — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, ex- cept damages because of 'bodily injury" or "property damage' included in the "products - completed operations hazard ", and for medi- cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits ". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they.reduce any other Designated Con- struction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Construction Pmject Gen- eral Aggregate Limit CG 25 03 05 09 C Insurance Services Office, Inc., 2008 Page 1 of 2 Worters l0uwer Financial Services I Uniform Forms"' B. For all sums which the insured becomes legally obligated to pay as damages caused by "occur - rences' under Section I — Coverage A, and for all medical expenses' caused by accidents under Section 1 Coverage C, which cannot be at- tributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages . or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products- completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit C. When coverage for liability arising out of the 'products- completed operations hazard" is pro- vided, any payments for damages because of *bodily injury" or "property damage° included in the 'products- completed operations hazard' will reduce the Products - completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit: D. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans; blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject- E. The provisions of Section M — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stfpulated. Page 2 of 2 O Insurance Services Office, Inc., 2008 CG 25 03 05 09 Notification to Others of Cancellation, Nonrenewal or Reduction of Insurance 0 ZURICH Policy No I Eff Date of Pol Ex, Date of Pol Eff Date of End Producer No Addl Prem Return Pre - GLO9674277 -04 1 10/0112014 10/01/2015 10/01/2014 Mcs�nva��aso� THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the Commercial General Liability Coverage Part Liquor Liability Coverage Part Products /Completed Operations Liability Coverage Part A. If we cancel or non -renew this Coverage Part(s) by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non - renewal: 1. To the name and address corresponding to each person or organization shown in the Schedule below: and 2. At least 10 days prior to the effective date of the cancellation or non - renewal, as advised in our notice to the first Named Insured. or the longer number of days notice 4 indicated in the Schedule below. B. If we cancel this Coverage Part(s) by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least'10 days prior to the effective date of such cancellation_ C. If coverage afforded by this Coverage Part(s) is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims, we will mail or deliver notice of such reduction or restriction: 1. To the name and address corresponding to each person or organization shown in the Schedule below: and 2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Persons) I Organization(s): Number of Days Notice: Any person or organization to whom you are required by written contract or agreement to mail prior written notice of cancellation, non - renewal, and /or reduction in coverage All other terms and conditions of this policy remain unchanged 30 U- GL- 1447 -A Cw (05,'10) Page t of t InGudes copyrighted material of insurance Services Office, Inc. Tenth its permission �V Starr Indemnity & Liability Company Dallas, TX 1- 866 -519 -2522 POLICY NUMBER: 1000021295 EXCESS LIABILITY POLICY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES This endorsement modifies insurance provided under the following: EXCESS LIABILITY POLICY FORM Effective Date of Change: 11!10/2014 at 12:01 A.M. Change Endorsement No.: 1 Named Insured: THE DON CHAPIN COMPANY, INC. The following item(s): ❑ Insureds Name Policy Number ❑ Effective/Expiration Date ❑ Payment Plan ❑ Additional Interested Parties: ❑ LimitslExposures ❑ Covered Property/Located Description ❑ Rates is (are) changed to read {See Additional Page(s)j: ❑ Insureds Mailing Address ❑ Company ❑ Insureds Legal StatusiBusiness of Insured Premium Determination 0 Coverage Forms and Endorsements ❑ Self - Insured Retention ❑ Classification/Class Codes ❑ Underlying Insurance The above amendments result in a change in the premium as follows: XS-103 1 (0AM Copyright ® C. V. Starr & Company and Starrindemnity & Liability Company. Ail rights reserved Page 1 of 3 includes copyrighted material of 180 Properties, Inc.. used r&h Its permission. : 'Starr Indemnity & liability Company Dallas, TX 1- 866 - 519 -2522 © NO CHANGES [] TO BE ADJUSTED AT AUDIT Endorsement Effective: 11/10/2014 Named Insured: THE DON CHAPIN COMPANY, INC. ADDITIONAL PREMIUM RETURN PREMIUM S g Countersigned By: 791: It is hereby agreed that the fd lowing is Added - The City of Gilroy, Its elected & appointed Officers, Officials, Empi yeas and Volunteers as Additional Insured as respects: Project No. 15- PW:216, Sbcth Street Improvements. LED trail lighting, LED upgrades and Fiber Optic Repair. All other terms and conditions of this policy remain unchanged. XS-103 (111108) Copyright ® C. V. Starr & Company and D dty Starr Indemr & Liability Company. All rights rmrved.f�dge 2 Of 3 Includes copyrighted material of 180 Propartres, Inc.. used with its permission. Signed for the Company as of the Effective Date above: Charles H. Dangelo, °President Nehemiah E. Ginsburg, General Counsel XS403 (1Qli>SQ CopogM ® QV. stag s Company arm Starr 4mamidty & L- RY cwwwgr. Ail rights MSwVwL e 8 of S Includes copyrighted material of 1St) Properties, Inc-. treed with Its pwmisslam POLICY NO.: SAP 9674279 -04 ZURICH AMERICAN INS. CO. COMMERCIAL AUTO CA 2048 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement the provisions of the Coverage Form apply unless modified by this endorsement This endorsement identifies persons) or organizations) who are 'insureds" under the Who Is an Insured Provision of the Coverage Form This endorsement does not after coverage provided in the Coverage Form This endorsement changes the policy effective an the inception date of the policy unless another date is indicated below Endorsement Effective: 10/1,2014 Countersigned By: Authorized Representative SCHEDULE Name of Person(s) or Organization(s): Any person or organization to whom or to which you are required to provide additional insured status or additional insured status on a primary, mm-contributory basis, in a written contract or written agreement executed prior to loss, except where such contract or agreement is prohibited by law. City Of Gilroy, Its Elected & Appointed Officers. Officials. E=ployees and volunteers (If no entry appears above information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement ) Each person or organization shown in the Schedule is an "insured- for Liability Coverage but only to the extent that person or organization qualifies as an 'insured' under the Who Is an Insured Provision contained in Section If of the Coverage Form CA 20 48 02 99 Copyright Insurance Services Office, Inc 1998 Page I of 1 POLICY NUMBER-. SAP 9674279 -04 COMMERCIAL AUTO CA 04 44 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the foiiowing BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: The Don Chapin Company Inc. / Landset Engineers. Inc. ! Tom's Site Serviceslrom's Septic Construction Endorsement Effective Date: 10/01/2014 SCHEDULE Name(s) Of Person(s) Or Organization(s): ALL PERSONS AND /OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY. ty Of Gilroy, Its Elected 6 Appointed Officers, Officials, Employees and Volunteers I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Oth- ers To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "ac- cident" or the "loss" under a contract with that person or organization. CA 04 44 03 10 u, Insurance Services Office Inc., 2009 Page 1 of 1 Wolters Kluwer Financial Services I Uniform Forms"" Notification to Others of Cancellation, Nonrenewal or Reduction of Insurance 09 ZURICH Policy No I Ea Date -- Pol Ex, Date of Pol Eft Date of End Producer No I Addl P-e,, Returr Pre,, BAP 9674279 -04 1 10101/2014 10101,2015 10/01/2014 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial Automobile Coverage Part A. If we cancel or non -renew this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mall or deliver a copy of such written notice of cancellation or non - renewal: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the cancellation or non - renewal. as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this Coverage Part by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this Coverage Part is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims, we will mail or deliver notice of such reduction or restriction: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A. B. or C. of this endorsement is mailed. proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s) / Number of Days Notice: Organization (s): _ Any person or organization to whom you are 30 required by written contract or agreement to mail prior written notice of cancellation, non - renewal, andlor reduction in coverage All other terms and conditions of this policy remain unchanged U -CA -811 A CVV (05j10 Page lo'1 Includes copyrgr)ted material of Insurance Services Office. Inc., with its permission WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA This endorsement changes ti'e policy to which it r; attached effective on the inception date of the policy unless a different date is indicated below The followng "attaching clause" need be completed only when this endorsement is ;ssued subsequent to oreparation of the policy ) This Endorsement is effective on 10/1/2014 Policy No. WC 9674280 -06 Premium (if any) S at 12:01 A.M. standard time. forms a part Endorsement No of the ZURICH AMERICAN INSURANCE COMPANY Authorized Representative We have the right to recover our payments from anyone liable for an injury covered by this policy We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule The additional premium for this endorsement shall be 0 0% of the California workers' compensation premium otherwise due on such remureration. Schedule Person or Organization ALL PERSONS AND /OR ORGANIZATIONS THAT REQUIRE BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND I OR ORGANIZATION. City Of Gilroy, Its Elected & Appointed Officers, Officials, r- =lovees and Volunteers WC 25214-84) WC 04 03 06 (Ed 464) Job Description ALL CALIFORNIA OPERATIONS Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 NOTIFICATION TO OTHERS OF CANCELLATION, NONRENEWAL OR REDUCTION OF INSURANCE ENDORSEMENT This endorsement is used to add the following to Part Six of the policy. PART SIX CONDITIONS A. If we cancel or non -renew this policy by written notice to you for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non - renewal to the name and address corresponding to each person or organization shown in the Schedule below. Notification to such person or organization will be provided at least 10 days prior to the effective date of the cancellation or non - renewal, as advised in our notice to you, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this policy by written notice to you for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation C. If coverage afforded by this policy is reduced or restricted, except for any reduction of Limits of Liability due to payment of claims, we will mail or deliver notice of such reduction or restriction to the name and address corresponding to each person or organization shown in the Schedule below. Notification to such person or organization will be provided at least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below D_ If notice as described in Paragraphs A. B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice SCHEDULE Name and Address of Other Person(s) / Number of Days Notice: Organization(s): Any person or organization to whom you are 30 required by written contract or agreement to mail prior written notice of cancellation, non - renewal, andior reduction in coverage All other tears and conditions of this policy remain unchanged. This endorsement c-.arges the pc cy to which it is attached and is effective on the date issued un!ess otherwise stated (The information. below is required only when this endorsement is issued subsequent to preparation of the polity.) Endorsement Effective 101111014 Po cy No. WC 9674280 -06 Endorsement No Insured orem,Lm S Insurance Company Zurich American Ins. Co WC 99 06 34 (Ed 05-10,1 tnctuoes copyrighted materat of Nat ;onat Council or Comaensatior Irsurance Inc with its perrrissaor . Page 1 of 1 ,4k °® CERTIFICATE OF LIABILITY INSURANCE �� ofiliwaftym 12/03/2024 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER. 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 eertifroate holder is an ADDITIONAL INSURED, the policAles) must be. endorsed N SUBROGATION IS WAIVED, st set io the tonne 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). _ vR000CBt LIC 90056172 1- 831 - 724 -3841 _ LARfS _ NCSherrjr i Nndson PHONE FAX 575 Auto Canter Drive maw P. 0. Bo= 2690 Wats=viIle, CA 95076 IMMAERM AFFORDING COVERAGE NAIC0 pMURERA :AXRRICAN ZURICE INS CO 40142 00E106:RCLAL GENERAL LIABILITY 08SUREa TIM D= CHAPIN CCUPANY INC. .MSURD3t e MED.DP am PW50M MSLRERL : INSIRERO: 560 CRAZY HORSE CANYON ROAD MSUREItE: SAr.rtm.a, CA 93907 tNSURER F: - S - .. Jt COVERAGES CFRTIGIP -ATF NIIMRFD- 42242645 DL%AetAY'eIItYDOD• THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED -.BELOW HAVE BEEN ISSUED TO THE INSURED NAME AHOVE"FOR THE POLICY PERIOD iNDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDffION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICItS'DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POUCIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DOR LTR _ - TYPE OF VMRANCE POlJCY MUtlaBt POLICY EFF ...� W _ LARfS _ GE kERAL UASRJDY EACH _' - - = 00E106:RCLAL GENERAL LIABILITY MED.DP am PW50M 5 CLAIMSMADE F7 OCCUR PERSONAL A ADV INJURY S - .. Jt _ GENERAL AGGREGATE $ GENL AGGREGATE LIMR APPLIES PER: PRODUCTS - COMPIOP AGO t POLICY '�' F7 Loc s AUTOMOBLE LIABILITY COMBINED SINGLE LIMIT e ANY AUTO BOOILY MIDDY (par pen=) S ALL AUTOS SCHEDULED OS G=Lr N AIRY (Per amwevTq s - autos R NON4)WNED MIED AUTOS PROPERTY Ow,IAOE s . s UMBRELLA LU18 OCCUR EACH OCCURRENCE 'S EXCESS UAa CUJUI S -MADE I AGGREGATE S .DEM - _..RETENTIONS S YVORI CNSATIdI AND ESkLOY6ir u AaL" YIN APIY PROVRIETOR?A OFRI EXCLUDED? a NIA WC STAN- OT}F _ El. EACH ACCIDENT S E.L. DISEASE - EAEuPL MO Oftndulwy yeyC daiaft� IraWer E.L DISEASE - POLICY LWT — S - N OF OPERATIONS baum. _ A 'Risk Policy BR07249784 12/03/14 22103/15 Limit 805,726 1BUildd.r-8 Ded. 5,000 DE n& OF GFEAATIONS I LOCATIONS I VEMCLES Oa...h ACORD 101. Aral Remarks SelmGdo, x mam s0aeo is nau600 JOB: PROJECT NO. 15 -PW -216, SIXTH STREET n pRovm=TS, LED TRAIL LIGHTING, LED UPWADES AND VIM OPTICS REPAIR CONTRACT VALUE: $805,726 CITY OF GILROY, ITS ELECTED 4 APPOINTED OFFICERS, OPPICIALS, Z%PLOYBRS AND VOLIINTEBRS ARE MAD® LOSS PAYEE. vntw^ • � t.wn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF GILROY THE EX1qRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVI§IONS. RISE MAMCIER 7351 ROSANA STREET AUTHORIZEDREPRwExTATIVE GILROY, CA 95020 USA 0 1988.2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD agarcia 42242645 SUPPLEMENT TO CERTIFICATE OF INSURANCE I DATE lZ/03/2014 Form 4388FU (Rev. May 1, 1942) LENDERS LOSS PAYABLE ENDORSEMENT S.F. FORM 1. Loss or damage, if any, under this poricy shall be paid to City of Gilroy , its elected & appointed officers, officials, employees and volunteers its successors and assigns, hereinafter referred to -as "the Lendef, in whatever form or capacity its interests may appear and whether said interest be vested in said Lender in its individual or in its disclosed or undis- closed fiduciary or representative capacity, or otherwise, or vested in a nominee or trustee of said Lender. 2. The insurance under this policy, or any rider or endorsement attached thereto, as to the interest only of the Lender, its successors and assigns, shall not be invalidated nor suspended: (a) by any error, omission, or change respecting the ownership, description, possession, or location of the subject of the insurance or the in- terest therein, or the title thereto; (b) by the commencement of foreclosure proceedings or the giving of notice of sale of any of the property covered by this policy by virtue of any mortgage or trust deed; (c) by any breach of warranty, act, omission, neglect, or non-compliance with any of the provisions of this policy,'including any and all riders now or hereafter attached thereto, by the named insured, the borrower, mortgagor, trustor, vendee, owner, tenant, warehouseman. custodian, occupant, or by the agents of either or any of them or by the happening of any event permitted by them or either of them, or their agents, or which they failed to pre- vent, whether occurring before or after the attachment of this endorsement, or whether, before. or after a loss, which under the provisions of this policy of insurance or of any rider or endorsement attached thereto would invalidate or suspend the insurance as to the named insured, excluding herefrom, however, any acts or omis- sions of the Lender while exercising active control and management of the property. 3. In the event of failure of the insured to pay any premium or additional premium which shall be or become due under the terms of this policy or on account of any change in occupancy or increase in hazard not permitted by this policy, this Company agrees to give written notice to the Lender of such non - payment of premium after sixty (60) days from and within one hundred and twenty (120) days after due date of such premium and it is a condition of the continuance of the rights of the Lender hereunder that the Lender when so notified in writing by this Company of the falure of the insured to pay such premium shall pay or cause to be paid the premium- due within ten (10) days following receipt of the Company's demand in writing therefor. If the Lender shall de- dine to pay said premium or additional premium, the rights of the Lender under this Lender's Loss Payable Endorsement shall not be terminated before ten (10) days after receipt of said written notice by the Lender. 4. Whenever this Company shall pay to the Lender any sum for loss or damage under this policy and shall claim that as to the insured no Lability therefor exists, this Company, at its option, may pay to the Lender the whole principal sum and interest and other indebtedness due or to become due from the insured, whether secured or unsecured, (with refund of all interest not accrued), and this Company, to the extent of such payment, shall thereupon receive a full assignment and transfer, without recourse, of the debt and all rights 'and securities held as collateral thereto. 5. If there be any other insurance upon the within described property, this Company shall be liable under this policy as to the Lender for the proportion of such loss or damage that the sum hereby insured bears to the en- tire insurance of similar character on said property under policies held by, payable to and expressly consented to by the Lender. Any Contribution Clause included in any Fallen Building Clause Waiver or any Extended Coverage Endorsement attached to this contract of insurance is hereby nul1ifed, and also any Contribution Clause in any other endorsement or rider attached to this contract of insurance is hereby nullified except Con- tribution Clauses for the compliance with which the insured has received reduction in the rate charged or has received extension of the coverage to include hazards other than fire and compliance with such Contribution Clause is made a part of the consideration for insuring such other hazards. The Lender upon the payment to it of the full amount of its claim, will subrogate this Company (pro rata with all other insurers contributing to said payment) to all of the Lender's rights of contribution under said other insurance. 6. This Company reserves the right to cancel this policy at any time, as provided by its terns, but in such case this policy shall continue in force for the benefit of the Lender for ten (10) days after written notice of such can- cellation is received by the Lender and shall then cease. Page 1 of 2 Fore 438BFU (Rev. May 1, 1942) S.F. FORM (Cont'd) 7. This policy shall remain in full force and. effect as to the interest of the Lender for a period of ten (10) days after its expiration unless an. acceptable policy in renewal thereof with loss thereunder payable to the Lender in accordance with the terns of this Lender's Loss Payable Endorsement, shall have been issued by some in- surance company and accepted by the Lender. 8. Should legal title to and beneficial ownership of any of the property covered under this policy become vested in the Lender or its. agents, insurance under this policy shall continue for the term thereof for the benek. of the Lender but, in such event, any privileges granted by this Lender's Loss Payable Endorsement which are not also granted the insured under the terms and conditions of this policy and/or under other riders or endorse- ments attached thereto shall not apply to the insurance hereunder as respects such property. 9. All notices herein provided to be given by the Company to the Lender in connection with this policy and this Lenders toss Payable Endorsement shall be mailed to or delivered to the Lender at its office or branch at or, if none be specified, at its head office it Attached to Polity No.'. ER07249784 of American Zurich.lnsurance.Companv Issued to The Don Chapin Company, Inc. Agency at Approved: Board of Fire Underwriters of the Pacific, California Bankers' Association, Committee on Insurance. Page 2 of 2 12/03/2014 Agent. CERTIFICATE OF LIABILITY INSURANCE 712/03/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY -AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LIC #0056172 1- 831 - 724 -3841 Mc Sherry & Hudson CONTACT PHONE I FAX, No E ADDRESS: 575 Auto Center Drive P. O. Box 2690 X X Watsonville, CA 95076 INSURERS AFFORDING COVERAGE NAIC0 INSURER A: ZURICH AMERICAN INS CO 16535 INSURED INSURER B: STARR IND & LIAB CO_ 38318 THE DON CHAPIN COMPANY INC. - INSURER C: MED EXP (Any one person) INSURER 0: PERSONAL B AOV INJURY 560 CRAZY HORSE CANYON ROAD INSURER E: X Contractual Liability SALINAS, CA 93907 INSURER F: CDVFRAGFS CFRTIFICATF NLIMRFR- 42129764 RFVISInN NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR. LTR TYPE OF INSURANCE SUBR POLICY NUMBER POLICY EFF DD POLICY EXP MIDD LIMITS A GENERAL LIABILITY X X GLO 9674277 -04 10 /01 /1 10/01/15 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FYI OCCUR PREMI (Ea occurrence) $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL B AOV INJURY $ 11000,000 X Contractual Liability GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS • COMPIOP AGG $ 2,000,000 POLICY PRO- X LOC $ A AUTOMOBILELIABILRY X X BAP 9674279 -04 10701F14 10/01/15 COMBINED SINGLE LIMIT a a dent 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X NON-OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE cad $ $ X Contractua B UMBRELLA I" X OCCUR 1000021295 10 /01 /1 10/01/15 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 X EXCESS LIAB CLAIMS -MADE DIED RETENTION$ Follows Form $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? D (Mandatory in NH) N /A X WC 9674280 -06 10/01/1 10/01/15 X WCSTATU- .OTH. E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, descri be under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Addltlonal Remarks Schedule. If mom space is required) RE: PROJECT NO. 15 -PW -216, SIXTH STREET IMPROVEMENTS, LED TRAIL LIGHTING, LED UPGRADES AND FIBER OPTICS REPAIR CITY OF GILROY, ITS ELECTED 6r APPOINTED OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED PER THE ATTACHRD ENDORSEMENTS. GL PER ISO FORM CG0001 04/13; AL PER ISO FORM CA0001 10/13 v.CK I Iri%.A I C r1VL.LJCK tiAINUtLLA I JUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF GILROY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. RISK MANAGER 7351 ROSANA STREET AUTHORIZED REPRESENTATIVE GILROY, CA 95020 O��Y USA C 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD mgarcia 42129764 I DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 11,17/2014 NAME OF INSURED: = DON CHAPIN COMPANY INC. PP (10100) a Additional Insured — Automatic — Owners, Lessees Or ZURICH Contractors Policy No. Eff. Date of Pol. Exp. Date of Pol. I Eff. Date of End. I Producer No AddT Prem Return Prem. GLO9674277 -04 10/01/2014 10/01/2015 1 10/01/2014 IMcSherry & Hudsoril City Of Gilroy, Its Elected & Appointed Officers, Officials, Employees and Volunteers THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: The Don Chapin Company Inc. I Landset Engineers, Inc. I Tom's Site ServiceslTorn s Septic Construction Address (including ZIP Code): 560 Crary Horse Canyon Road, Salinas, CA 93907 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section II — Who Is An Insured is amended to include as an insured any person or organization who you are required to add as an additional insured on this policy under a written contract or written agreement. However, if you have entered into a construction contract or construction agreement with an additional insured person or organization, the insurance afforded to such additional insured only applies to the extent permitted by law. B. The insurance provided to the additional insured person or organization applies only to "bodily injury", "property damage" or "personal and advertising injury" covered under Section I — Coverage A — Bodily Injury And Property Damage Liability and Section I — Coverage B — Personal And Advertising Injury Liability, 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, and resulting directly from your ongoing operations or "your work" as included in the "products- completed operations hazard ", which is the subject of the written contract or written agreement_ C. However, regardless of the provisions of Paragraphs A. and B. above: 1. We will not extend any insurance coverage to any additional insured person or organization: a. That is not provided to you in this policy; or b. That is any broader coverage than you are required to provide to the additional insured person or organization in the written contract or written agreement; and 2. We will not provide Limits of Insurance to any additional insured person or organization that exceed the lower of: a. The Limits of Insurance provided to you in this policy; or b. The Limits of Insurance you are required to provide in the written contract or written agreement. D. The insurance provided to the additional insured person or organization does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering or failure to render any professional architectural, engineering or surveying services including: 1. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; and 2. Supervisory, inspection, architectural or engineering activities. U- GL- 1175 -E CW (04/12) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. E. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV — Commercial General Liability Conditions: The additional insured must see to it that: 1. We are notified as soon as practicable of an "occurrence" or offense that may result in a claim; 2. We receive written notice of a claim or "suit" as soon as practicable; and 3. A request for defense and indemnity of the claim or "suit" will promptly be brought against any policy issued by another insurer under which the additional insured may be an insured in any capacity. This provision does not apply to insurance on which the additional insured is a Named Insured, if the written contract or written agreement requires that this coverage be primary and non - contributory. F. For the coverage provided by this endorsement: 1. The following paragraph is added to Paragraph 4.a. of the Other Insurance Condition of Section IV — Commercial General Liability Conditions: This insurance is primary insurance as respects our coverage to the additional insured person or organization, where the written contract or written agreement requires that this insurance be primary and non - contributory with respect to any other policy upon which the additional insured is a Named Insured. In that event, we will not seek contribution from any other such insurance policy available to the additional insured on which the additional insured person or organization is a Named Insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV— Commercial General Liability Conditions: This insurance is excess over Any of the other insurance, whether primary, excess, contingent or on any other basis, available to an additional insured, in which the additional insured on our policy is also covered as an additional insured on another policy providing coverage for the same "occurrence ", offense, claim or "suit'. This provision does not apply to any policy in which the additional insured is a Named Insured on such other policy and where our policy is required by written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. G. This endorsement does not apply to an additional insured which has been added to this policy by an endorsement showing the additional insured in a Schedule of additional insureds, and which endorsement applies specifically to that identified additional insured. All other terms and conditions of this policy remain unchanged. U- GL- 1175 -E CW (04/12) Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. POLICY NUMBER: GL09674277 -04 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: Any Person or Organization that requires You to waive your Rights of Recovery, in a written contract or agreement with the Named Insured that is executed prior to the acci- dent or loss. City Of Gilroy, Its Elected & Appointed Officers, officials, Employees and Volunteers I 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 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 Wolters Kluwer Financial Services I Uniform Forms''" POLICY NUMBER: GL09674277 -04 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following; COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): A General Aggregate Limit applies to each construction project, where the Named Insured is performing operations, however, a General Aggregate Limit does not apply to any construction project where the Named Insured Is performing operations that are insured under a wrap up or any other consolidated or similar insurance program. City Of Gilroy, Its Elected & Appointed officers, Officials, Employees and Volunteers Information required to complete this Schedule, if not shown above, will be shown in the Declarations A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, ex- cept damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard ", and for medi- cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits ". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Construction Project Gen- eral Aggregate Limit. CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 Wofters Kluwer Financial Services I Uniform FormsT"" B. For all sums which the insured becomes legally C. obligated to pay as damages caused by "occur- rences" under Section I — Coverage A, and for all medical expenses, caused by accidents under Section I - Coverage C, which cannot be at- tributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical D. expenses shall reduce the amount available under the General Aggregate Limit or the Products - completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. When coverage for liability arising out of the "products- completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard" will reduce the Products - completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated_ Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 9 Notification to Others of Cancellation, Nonrenewal ZURICH or Reduction of Insurance Policy No. Eff. Date of Pol. Exp. Date of Pol. Eff. Date of End. Producer No. Add'1. Prem Return Prem. GL09674277 -04 1 10/01/2014 10/01/2015 10/01/2014 -she"" "On THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part Liquor Liability Coverage Part Products /Completed Operations Liability Coverage Part A. If we cancel or non -renew this Coverage Part(s) by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non - renewal: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the cancellation or non - renewal, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this Coverage Part(s) by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this Coverage Part(s) is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims, we will mail or deliver notice of such reduction or restriction: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Persons) / Organization(s): Number of Days Notice: Any person or organization to whom you are 30 required by written contract or agreement to mail prior written notice of cancellation, non - renewal, and /or reduction in coverage All other terms and conditions of this policy remain unchanged. U- GL- 1447 -A CW (05110) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. *Starr Indemnity & Liability Company Dallas, TX 1- 866 - 519 -2522 POLICY NUMBER: 1000021295 EXCESS LIABILITY POLICY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGES This endorsement modifies insurance provided under the following: EXCESS LIABILITY POLICY FORM Effective Date of Change: 11110/2014 at 12:01 A.M. Change Endorsement No.: 1 Named Insured: THE DON CHAPIN COMPANY, INC. The following dem(s): ❑ Insureds Name ❑ Policy Number ❑ Effective/Expirabon Date ❑ Payment Plan ❑ Additional Interested Parties: ❑ Limits/Exposures ❑ Covered Property/Located Description ❑ Rates is (are) changed to read {See Additional Page(s)j: ❑ Insureds Mailing Address ❑ Company ❑ Insureds Legal Status/Business of Insured Premium Determination ZCoverage Forms and Endorsements ❑ Self- Insured Retention ❑ Classification/Class Codes ❑ Underlying Insurance The above amendments result in a change in the premium as follows: XS -103 (10/08) Page 1 of 3 Copyright ® C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved Includes copyrighted material of ISO Properties, Inc., used with Its permission- ' -r ` Starr Indemnity & Liability Company Dallas, TX 1- 866 - 519 -2522 ❑1 NO CHANGES [—] TO BEADJUSTED AT AUDIT Endorsement Effective: 11/10/2014 Named Insured: THE DON CHAPIN COMPANY, INC. ADDITIONAL PREMIUM RETURN PREMIUM S $ Countersigned By: (Authorized Represe I POLICY CHANGES ENDORSEMENT DESCRIPTION It is hereby agreed that the following is Added - The City of Gilroy, Its elected & appointed Officers, Officials, Employees and Volunteers as Additional Insured as respects: Project No. 15 -PW 216, Sixth Street Improvements LED trail lighting, LED upgrades and Fiber Optic Repair. All other terms and conditions of this policy remain unchanged. XS-103 (10108) Page 2 of 3 Copyright ® C. V. Stan- & Company and Starr Indemnity & Liablitty Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with Its permission. l0 N W 0 co E U a� f VJ 9n tm m N L L a� a cL v R � C N1 9 C CN 'C N � E E ti 2 .d t as >m CS � ® e 0 u (xti� V r X POLICY NO.: BAP 9674279 -04 ZURICH AMERICAN INS. CO. COMMERCIAL AUTO CA 2448 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following. BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are 'insureds" under the Who Is an Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective an the inception date of the policy unless another date is indicated below Endorsement Effective: 10!1;2014 Countersigned By: Authorized Representative SCHEDULE Name of Person(s) or Organization(s): Any person or organization to whom or to which you are required to provide additional insured status or additional insured status on a primary, non - contributory basis, in a written contract or written agreement executed prior to loss, except where such contract or agreement is prohibited by law. City Of Gilroy, Its Elected & Appointed Officers, Officials, Employees and volunteers (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage but only to the extent that person or organization qualifies as an 'insured" under the Who Is an Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc. 1998 Page 1 of 1 POLICY NUMBER- BAP 9674279 -04 COMMERCIAL AUTO CA 04 44 03 10 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM BUSINESS AUTO PHYSICAL DAMAGE COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modi- fied by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: The Don Chapin Company Inc. / Landset Engineers, Inc. /Tom's Site Services/Tom's Septic Construction Endorsement Effective Date: 10/01/2014 SCHEDULE Name(s) Of Person(s) Or Organization(s): ALL PERSONS AND /OR ORGANIZATIONS THAT ARE REQUIRED BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAIVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY. ty Of Gilroy, Its Elected & Appointed Officers, Officials, Employees and volunteers I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Oth- ers To Us Condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "ac- cident" or the "loss" under a contract with that person or organization. CA 04 44 03 10 © Insurance Services Office, Inc., 2009 Page 1 of 1 Wolters Kluwer Financial Services I Uniform Formsm" Notification to Others of Cancellation, Nonrenewal or Reduction of Insurance ZURICH Policy No. Eff Date of Pol. Exp. Date of Pol Eff. Date of End. Producer No. Add'I. Prem Return Prem. BAP 9674279 -04 1 10/01/2014 10101/2015 10/0112014 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the: Commercial Automobile Coverage Part A. If we cancel or non -renew this Coverage Part by written notice to the first Named Insured for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non - renewal: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the cancellation or non - renewal, as advised in our notice to the first Named Insured, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this Coverage Part by written notice to the first Named Insured for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this Coverage Part is reduced or restricted, except for any reduction of Limits of Insurance due to payment of claims, we will mail or deliver notice of such reduction or restriction: 1. To the name and address corresponding to each person or organization shown in the Schedule below; and 2. At least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s) / Organization(s): Number of Days Notice: Any person or organization to whom you are 30 required by written contract or agreement to mail prior written notice of cancellation, non - renewal, and /or reduction in coverage All other terms and conditions of this policy remain unchanged. U -CA -811 -A CW (05/10) Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy.) This Endorsement is effective on 10/112014 Policy No. WC 9674280 -06 Premium (if any) $ at 12:01 A.M. standard time, forms a part Endorsement No. of the ZURICH AMERICAN INSURANCE COMPANY W� Authorized Representative We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 0.0% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization ALL PERSONS AND /OR ORGANIZATIONS THAT REQUIRE BY WRITTEN CONTRACT OR AGREEMENT WITH THE INSURED, EXECUTED PRIOR TO THE ACCIDENT OR LOSS, THAT WAVER OF SUBROGATION BE PROVIDED UNDER THIS POLICY FOR WORK PERFORMED BY YOU FOR THAT PERSON AND / OR ORGANIZATION. City Of Gilroy, Its Elected & Appointed Officers, Officials, Employees and Volunteers WC 252 (4-84) WC 04 03 06 (Ed. 484) Job Description ALL CALIFORNIA OPERATIONS Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 NOTIFICATION TO OTHERS OF CANCELLATION, NONRENEWAL OR REDUCTION OF INSURANCE ENDORSEMENT This endorsement is used to add the following to Part Six of the policy. PART SIX CONDITIONS A. If we cancel or non -renew this policy by written notice to you for any reason other than nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation or non - renewal to the name and address corresponding to each person or organization shown in the Schedule below. Notification to such person or organization will be provided at least 10 days prior to the effective date of the cancellation or non - renewal, as advised in our notice to you, or the longer number of days notice if indicated in the Schedule below. B. If we cancel this policy by written notice to you for nonpayment of premium, we will mail or deliver a copy of such written notice of cancellation to the name and address corresponding to each person or organization shown in the Schedule below at least 10 days prior to the effective date of such cancellation. C. If coverage afforded by this policy is reduced or restricted, except for any reduction of Limits of Liability due to payment of claims, we will mail or deliver notice of such reduction or restriction to the name and address corresponding to each person or organization shown in the Schedule below. Notification to such person or organization will be provided at least 10 days prior to the effective date of the reduction or restriction, or the longer number of days notice if indicated in the Schedule below. D. If notice as described in Paragraphs A., B. or C. of this endorsement is mailed, proof of mailing will be sufficient proof of such notice. SCHEDULE Name and Address of Other Person(s) / Organ ization(s): Number of Days Notice: Any person or organization to whom you are 30 required by written contract or agreement to mail prior written notice of cancellation, non - renewal, and /or reduction in coverage All other terms and conditions of this policy remain unchanged. 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: 10/1/2014 Policy No. WC 9674280 -06 Endorsement No. Insured Premium $ Insurance Company: Zurich American Ins. Co. WC 99 06 34 (Ed. 05 -10) Includes copyrighted material of National Council on Compensation Insurance, Inc. with its permission. Page 1 of 1 �``� °® CERTIFICATE OF LIABILITY INSURANCE DATE 12/03/DD/Y4 12/03/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE_ HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER LIC #0056172 1- 831 - 724 -3841 McSherry & Hudson CONTACT PHONE FAX No): E-MAIL ADDRESS: 575 Auto Center Drive Biz 2690 SP e, W at CA 95076 Watsonv ille, INSURERS AFFORDING COVERAGE NAIC 0 INSURER A:.AMERICAN ZURICH INS CO 40142 INSURED THE DON CHAPIN COMPANY INC. INSURERS : _ INSURER C: $ INSURER D: $ 560 CRAZY HORSE CANYON ROAD INSURER E: SALINAS, CA 93907 INSURER F: COVERAGES CERTIFICATE NUMBER: 42242645 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. IITR TYPE OF INSURANCE INSR SUER POLICY NUMBER MMIDDY EFF MMIDD ExP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMA NT D PREMISES Ea ocarrence $ MED EXP (Any one person) $ CLAIMS-MADE 17 OCCUR PERSONAL 3 AOV INJURY $ y OENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ POLICY PRO• LOC JECT $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea a.dent BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS 80DILY INJURY (Par accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE r accident $ $ UMBRELLA LU18 HCLAIMS-MADE OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR DED _ __ _RETENTION $ $ WORKERS COMPENSATION WC STAN- OTH• AND EMPLOYERS' LWBILn'Y YIN E.L EACH ACCIDENT $ ANY PROPRIETOR/PARTNEWlEXECU TIVE OFFICERIMEMBER EXCLUDED? 57 N/A E.L. DISEASE - EA EMPLOYEE S (Mandatory In NH) It es. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S A Builders Risk Policy 3RO7249784 12/03/1 12/03/15 Limit 805,726 Ded. 5,000 DESCRIPTION OF OPERATIONS I LOCATIONS; VEHICLES (Attach ACORD 101, Additional Remarks Schedule, 11 more space is required) JOB: PROJECT NO. 15 -PY1 -216, SIXTH STREET IMPROVEMENTS, LED TRAIL LIGHTING, LED UPGRADES AND FIBER OPTICE REPAIR CONTRACT VALUE: $805,726 CITY OF GILROY, ITS ELECTED & APPOINTED OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS ARE NAMED LOSS PAYEE. %,arc s 1rit m I c nvwr-m CITY OF GILROY RISK MANAGER 7351 ROSANA STREET GILROY, CA 95020 ACORD 25 (2010/05) mgarcia 42242645 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 USA (J 1965 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SUPPLEMENT TO CERTIFICATE OF INSURANCE I DATE 12/03/2014 THE DON CHAPIN COMPANY INC. burr timul Form 438BFU (Rev. May 1, 1942) LENDERS LOSS PAYABLE ENDORSEMENT S.F. FORM 1. Loss or damage, if any, under this policy shall be paid to City of Gilroy , its elected & appointed officers, officials, employees and volunteers its successors and assigns, hereinafter referred to as "the Lender," in whatever form or capacity its interests may appear and whether said interest be vested in said Lender in its individual or in its disclosed or undis- closed fiduciary or representative capacity, or otherwise, or vested in a nominee or trustee of said Lender. 2. The insurance under this policy, or any rider or endorsement attached thereto, as to the interest only of the Lender, its successors and assigns, shall not be invalidated nor suspended: (a) by any error, omission, or change respecting the ownership, description, possession, or location of the subject of the insurance or the in- terest therein, or the title thereto; (b) by the commencement of foreclosure proceedings or the giving of notice of sale of any of the property covered by this policy by virtue of any mortgage or trust deed; (c) by any breach of warranty, act, omission, neglect, or non -compliance with any of the provisions of this policy, including any and all riders now or hereafter attached thereto, by the named insured, the borrower, mortgagor, trustor, vendee, owner, tenant, warehouseman, custodian, occupant, or by the agents of either or any of them or by the happening of any event permitted by them or either of them, or their agents, or which they failed to pre- vent, whether occurring before or after the attachment of this endorsement, or whether before or after a loss, which under the provisions of this policy of insurance or of any rider or endorsement attached thereto would invalidate or suspend the insurance as to the named insured, excluding herefrom, however, any acts or omis- sions of the Lender while exercising active control and management of the property. 3. In the event of failure of the insured to pay any premium or additional premium which shall be or become due under the terms of this policy or on account of any change in occupancy or increase in hazard not permitted by this policy, this Company agrees to give written notice to the Lender of such non - payment of premium after sixty (60) days from and within one hundred and twenty (120) days after due date of such premium and it is a condition of the continuance of the rights of the Lender hereunder that the Lender when so notified in writing by this Company of the failure of the insured to pay such premium shall pay or cause to be paid the premium due within ten (10) days following receipt of the Company's demand in writing therefor. If the Lender shall de- cline to pay said premium or additional premium, the rights of the Lender under this Lender's Loss Payable Endorsement shall not be terminated before ten (10) days after receipt of said written notice by the Lender. 4. Whenever this Company shall pay to the Lender any sum for loss or damage under this policy and shall claim that as to the insured no liability therefor exists, this Company, at its option, may pay to the Lender the whole principal sum and interest and other indebtedness due or to become due from the insured, whether secured or unsecured, (with refund of all interest not accrued), and this Company, to the extent of such payment, shall thereupon receive a full assignment and transfer, without recourse, of the debt and all rights and securities held as collateral thereto. 5. If there be any other insurance upon the within described property, this Company shall be liable under this policy as to the Lender for the proportion of such loss or damage that the sum hereby insured bears to the en- tire insurance of similar character on said property under policies held by, payable to and expressly consented to by the Lender. Any Contribution Clause included in any Fallen Building Clause Waiver or any Extended Coverage Endorsement attached to this contract of insurance is hereby nullified, and also any Contribution Clause in any other endorsement or rider attached to this contract of insurance is hereby nullified except Con- tribution Clauses for the compliance with which the insured has received reduction in the rate charged or has received extension of the coverage to include hazards other than fire and compliance with such Contribution Clause is made a part of the consideration for insuring such other hazards. The Lender upon the payment to it of the full amount of its claim, will subrogate this Company (pro rata with all other insurers contributing to said payment) to all of the Lender's rights of contribution under said other insurance. 6. This Company reserves the right to cancel this policy at any time, as provided by its terms, but in such case this policy shall continue in force for the benefit of the Lender for ten (10) days after written notice of such can- cellation is received by the Lender and shall then cease. Page 1 of 2 Form 438BFU (Rev. May 1, 1942) S.F. FORM (Cont'd) 7. This policy shall remain in full force and effect as to the interest of the Lender for a period of ten (10) days after its expiration unless an acceptable policy in renewal thereof with loss thereunder payable to the Lender in accordance with the terms of this Lender's Loss Payable Endorsement, shall have been issued by some in- surance company and accepted by the Lender. 8. Should legal title to and beneficial ownership of any of the property covered under this policy become vested in the Lender or its agents, insurance under this policy shall continue for the term thereof for the benefit of the Lender but, in such event, any privileges granted by this Lender's Loss Payable Endorsement which are not also granted the insured under the terms and conditions of this policy and/or under other riders or endorse- ments attached thereto shall not apply to the insurance hereunder as respects such property. 9. All notices herein provided to be given by the Company to the Lender in connection with this policy and this Lender's Loss Payable Endorsement shall be mailed to or delivered to the Lender at its office or branch at 7351 Rosanna Street, Gilroy, CA 95020 or, if none be specified, at its head office at Attached to Policy No. ER07249784 of American Zurich Insurance Company Issued to The Don Chapin Company, Inc. Agency at Date 12/03/2014 Approved: Board of Fire Underwriters of the Pacific, California Bankers' Association, Agent. Committee on Insurance. Page 2 of 2