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HomeMy WebLinkAboutCal-West - Insurance CertificateCALWELIGI ACRD ® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 10/1/2018 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 have ADDITIONAL INSURED provisions or 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 Commercial Lines - (628) 201 -9001 USI Insurance Services National, Inc. - CA Lic#: OD08408 201 Mission St, 11th Floor San Francisco, CA 94105 CONTACT NAME: PHONE FAX 610.537.2393 (A/C No Ext): (A/C, No): E -MAIL Re nests usi.COm ADDRESS: Certq INSURER(S) AFFORDING COVERAGE NAIC dl INSURER A: Zurich American Insurance Co 16535 INSURED Cal -West Lighting & Signal Maintenance PO Box 612035 San Jose CA 95161 INSURER B : Allied World National Assurance Co. 10690 INSURER C : 10/1/2019 INSURER D : S 1,000,000 INSURER E : CLAIMS -MADE INSURER F OCCUR COVERAGES CERTIFICATE NUMBER: 13522145 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY X GLA931895807 10/1/2018 10/1/2019 EACH OCCURRENCE S 1,000,000 CLAIMS -MADE X OCCUR DAMAGE PREMISES ( SES (Ea occurrence) S 300,000 MED EXP (Any one person) S 10,000 GEN'L PERSONAL 8 ADV INJURY S 1,000,000 AGGREGATE POLICY OTHER: X LIMIT APPLIES jECT X PER: LOC GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMP /OP AGG S 2,000,000 S A AUTOMOBILE X - X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY X SCHEDULED AUTOS NON -OWNED AUTOS ONLY X GLA931895807 10/1/2018 10/1/2019 {Ea COMBINEDaccident) SINGLE LIMIT 5 1,000,000 BODILY INJURY (Per person) 5 BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) 5 5 UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE S AGGREGATE 5 DED RETENTION S A AND EMPLOYERS' YEAS' LI A LIABILITY AND EMPLOYERS' LIABILITY Y / N OFFIC R MEMBER XCLUDED ?ECUTIVE I N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WC931895907 10/1/2018 10/1/2019 X STATUTE ERH El EACH ACCIDENT 1,000,000 5 E DISEASE - EA EMPLOYEE 5 1,000,000 E.L. DISEASE - POLICY LIMIT 5 1,000,000 B Pollution Liability 03104146 11/01/2017 11/01/2018 $1,000,000 Each Pollution Condition $1,000,000 Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CA20481013,U -GL- 1175 -F CW (04/13) Re: Traffic Signal Maintenance Services in the City of Gilroy City of Gilroy, its employees, officers, officials and volunteers is named as additional insured as respects general liability and automobile liability per endorsements attached. CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 -6141 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 ACORD 25 (2016/03) The ACORD name and ogo are registered marks of ACORD © 1988-2015 ACORD CORPORATION. All rights reserved. i IMI i Il i Dli liv i u ili ' CYB O 1 A02/000043102/06/O/0/0/0' Client Code: CALWELIG1 SID: 13522145 Certificate of Insurance (Con't) OTHER Coverage INSR TYPE OF INSURANCE ADDL WVD POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE LIMIT LTR INSR SUBR (MM /DD/YY) (MM /DD/YY) B Professional Liability 03104146 11/01/2017 11/01/2018 $2,000,000 Each Act, Error, or Omission $2,000,000 Aggregate Certificate of Insurance -Con't mop ui lvii „lv d IIV CYB 01 A02I000043r03/061010I0/0' Additional Insured — Automatic — Owners, Lessees Or Contractors ZURICH Policy No. I Eff. Date of Pol. 1GLA931895801 10/1/18 Exp. Date of Pol. Eff. Date of End. Producer No. Add'I. Prem Return Prem. 10/1/19 I 10 /1 /18 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: CAL —WEST LIGHTING & SIGNAL MAINTENANCE Address (including ZIP Code): PO BOX 612035 SAN JOSE CA 95161 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 additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations or "your work" as included in the "products- completed operations hazard ", which is the subject of the written contract or written agreement. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage ", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. Includes copyr ghted mate ial of nsurance Services Off ce Inc., wi h its pe mission. uui 11111 i 1011 ui 1011 110 w d u 0011 i m U -GL- 1175 -F CW (04/13) Page 1 of 2 C. 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. D. For the purposes of the coverage provided by this endorsement: 1. The following is added to the Other Insurance Condition of Section IV — Commercial General Liability Conditions: Primary and Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional 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 a written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. E. 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. F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; 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. All other terms and conditions of this policy remain unchanged. Includes copyr ghted mate is of nsurance Services Offce Inc., w h its pe mission. w i ID III i IDII IIII DII I I II U-GL- 1175 -F CW (04/13) Page 2 of 2 cYe01 A02/000643/05/O6/O /0/6/6' POLICY NUMBER: GLA931895807 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER 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" for Covered Autos Liability Coverage 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 on the inception date of the policy unless another date is indicated below. Named Insured: Cal -West Lighting and Signal Maintenance, Inc. Endorsement Effective Date 10/1/18 SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR 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. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II - Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 DII i 'DII i illifi e ui Page 1 of 1 •CYBO1A02/000043i06/06 0r0ro 0' 280706 A� ®® CERTIFICATE OF LIABILITY INSURANCE DATE 1 /15 /2017 Y) 11/15/2017 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 have ADDITIONAL INSURED provisions or 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 Construction & Real Estate Practice Wells Fargo Insurance Services USA, Inc. - CA Lic#: OD08408 45 Fremont Street, Suite 800 San Francisco, CA 94105 -2259 CONTACT NAME: PNON o F No): (866) 358 -1487 E-MAIL nests wellsfar o.COm ADDRESS CertRe Q C g INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Zurich American Insurance Co 16535 INSURED Cal -West Lighting & Signal Maintenance PO Box 612035 INSURER B: Allied World National Assurance CO. 10690 INSURER C :. $ 1,000,000 INSURER D PREMISES Ea occur ence ) INSURER E: MED EXP (Any one person) San Jose CA 95161 INSURER F: COVERAGES CERTIFICATE NUMBER: 12449482 REVISION NUMRER- See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL USR POLICY NUMBER POLICY EFF h9=D/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR X GLA931895806 10/1/2017 10/1/2018 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occur ence ) $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY X❑ ECT LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY X GLA931895806 10/1/2017 10/1/2018 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) I $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X PROPERTY DAMAGE Per accident $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE ID I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORMARTNER /EXECUTIVE Y / N OFFICER /MEMBER EXCLUDED? C NIA WC931895906 10/1/2017 10/1/2018 X STATUTE ERH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Pollution Liability 03104146 11101=17 11/01/2018 $1,000,000 Each Pollution Condition $1,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) U -GL- 1175 -F CW (04/13),CA20481013 Re: Traffic Signal Maintenance Services in the City of Gilroy City of Gilroy, its employees, officers, officials and volunteers is named as additional insured as respects general liability and automobile liability per endorsements attached. ... '. _ . City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 Rosanna Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 -6141 AUTHORIZED REPRESENTATIVE 9( - -411�- I ne AL.Urcu name ana logo are registered marks of ACORD ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111 CID:280706 SID:12449482 Certificate of Insurance (Con't) OTHER Coverage INSR TYPE OF INSURANCE ADDL WVD POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE LTR INSR SUBR (MM /DD/YY) (MM /DD/YY) LIMIT Professional Liability 03104146 11/01/2017 11/01/2018 $2,000,000 Each Act, Error, or Omission $2,000,000 Aggregate Additional Insured -- Automatic -- Owners, Lessees Or Contractors ZURICHm Policy No. I Eff . Date of Pol. Exp. Dale of Pol. Elf. Date of End. Producer No. AddT Prom Return Prem. GLA931895806 10/1/17 10/1/18 10/1/17 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: CAL —WEST LIGHTING & SIGNAL MAINTENANCE Address (Including ZIP Code): PO BOX 612035 SAN JOSE CA 95161 This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. Section Il — Who is An Insured is amended to include as an additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization is an additional insured only with respect to liability for "bodily injury", 'property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations or "your work" as included in the 'products- completed operations hazard ", which is the subject of the written contract or written agreement. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury", 'property damage" or 'personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the "bodily injury" or 'property damage ", or the offense which caused the 'personal and advertising injury", Involved the rendering of or the failure to render any professional architectural, engineering or surveying services. U -GL- 1175 -F CW (04/13) Page 1 of 2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. C. 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. M 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. D. For the purposes of the coverage provided by this endorsement: 1. The following is added to the Other Insurance Condition of Section IV -- Commercial General Liability Conditions: Primary and Nonoontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional Insured provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional 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 a written contract or written agreement to provide coverage to the additional Insured on a primary and non- contributory basis. E. 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. F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; 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. All other terms and conditions of this policy remain unchanged. U- GL- 1175 -F CW (04/13) Includes copyrlghted material of Insurance Services Office, Inc., with Its permission. Page 2of2 1111111111111111111111111 Hill 1111111111111111111111 Hill Hill Hill 11111 Hill 111111 Hill 1111111111 -CY...0005OWS/060010/ POLICY NUMBER: GLA931895806 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER 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" for Covered Autos Liability Coverage 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 on the Inception date of the policy unless another date Is indicated below. Named Insured: Cal —SJest Lighting and Signal Maintenance, Inc. Endorsement Effective Date: 10/1/17 SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR 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. I Information required to complete this Schedule, if not shown above will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section If — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 0 Insurance Services Office, Inc., 2011 Page 1 of 1 Zbutub A� ®r CERTIFICATE ®F LIABILITY INSURANCE DATE 17 10/2/2017 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 have ADDITIONAL INSURED provisions or 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 Construction & Real Estate Practice Wells Fargo Insurance Services USA, Inc - CA Llc# OD08408 45 Fremont Street, Suite 800 San Francisco, CA 94105 -2259 CONTAC NAME: PHONE FAX cM c�€xt No (866) 358 -1487 E CertRe ADDRESS- quests @wellsfargo com INSURER(S) AFFORDING COVERAGE NAIC # INSURER Zurich American Insurance Co 16535 INSURED Cal -West Lighting & Signal Maintenance PO BOX 612035 INSURER B Allied World National Assurance Co 10690 INSURER C: 10/1/2018 EACH OCCURRENCE S 1,000,000 INSURER D CLAIMS -MADE %� OCCUR INSURER E. San Jose CA 95161 INSURER F COVERAGES CERTIFICATE NUMBER- 12325245 PP% /ICIn61 u1 IU92CO• Qnn KnI- , THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDL INSD SUER POLICY NUMBER POLICY MM DID/YEYYY MMlDDY LIMITS A X — COMMERCIAL GENERAL LIABILITY X GLA931895806 10/1/2017 10/1/2018 EACH OCCURRENCE S 1,000,000 CLAIMS -MADE %� OCCUR A A RENTED PREMISES Ea occurrence S 300,000 MED EXP (Any one person) S 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY EX ❑X ECT LOC PRODUCTS - COMP /OP AGG S 2,000,000 $ OTHER A AUTOMOBILE LIABILITY X GLA931895806 10/1/2017 M.1NE g 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X PER DAMAGE Per accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAB CLAIMS -MADE DIED RETENTIONS S A AND EMPS COMPENSATION AND EMPLOYERS' LIABILITY YERS' LI A ILIT WC931895906 10/1/2017 10/1/2018 X STATUTE ERH Y / N ANYPROPRIETOR /PARTNER /EXECUTIVE E L EACH ACCIDENT S 1,000,000 OFFICER/MEMBEREXCLUDED? C N/ A E L DISEASE - EA EMPLOYEE S 1,000,000 (Mandatory in NH) If yes. describe under E L DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below I B Pollution Liability 03104146 11/01/2016 11/01/2017 $1,000,000 Each Pollution Condlbon $1 000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CA20481013,U- GL- 1175 -F CW (04/13) Re. Traffic Signal Maintenance Services In the City of Gilroy City of Gilroy, Its officers, and employees Is named as additional Insured as respects general liability and automobile liability per endorsements attached City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 -6141 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 I 1 iv m%,vtcv name ana logo are reglsterea marKS of ACORD ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) I IIIIIII III IIIIIII IIII VIII IIIIII IIII VIII VIII VIII VIII VIII VIII VIII VIII VIII IIII IIII 'C YBa3Aa2/00174610210610/0/0/0• D 280706 SID:12325245 ,Certificate. of"lnsurance.,(,Con't) OTHER Coverage INSR TYPE OF INSURANCE ADDL WVD POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE LIMIT LTR INSR SUBR (MM/DD/YY) (MM /DD/YY) B Professional LiabiI4 03104146 11/01/2016 11/01/2017 $2,000,000 Each Act, Error, or Omisslo-n .$2,000,000 Aggregate ; i I r - - CertiflcatWoflnsurance -Con't IIWIVNI�IIIIN� '�IIIAIIInII�II�IY�I�IYhIhN ..�,.�... Aft Additional Insured -- Automatic -- Owners, Lessees Or ZURICHO Contractors Policy No. I Eff bate of Pol. I Exp. Date of Pol. I Elf. Dale of End. I Producer No I Add'I Prem I Return Prem IGLA931895806110/1/17 110 /1/18 1 10/1/17 1 1 1 THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: CAL —WEST LIGHTING & SIGNAL MAINTENANCE Address (including ZIP Code): PO BOX 612035 SAN JOSE CA 95161 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 additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations or "your work" as included in the "products - completed operations hazard ", which is the subject of the written contract or written agreement. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusion applies- This insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage ", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. U-GL- 1175 -F CW (04/13) Includes ccpyrighfed material of Insurance Services Office, Inc., with its permission. Page 1 of 2 'CYB03A0900 7 7a6104106 /0 /O /OIO' C. 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 She additional insured is a Named Insured if the written contract or written agreement requires that this coverage be primary and non - contributory. D. For the purposes of the coverage provided by this endorsement: 1. The following Is added to the Other Insurance Condition of Section IV — Commercial General Liability Conditions: Primary and Noncontributory insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured provided that - a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional 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 a written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. E. 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. F. With respect to the insurance afforded to the additional Insureds under this endorsement, the following is added to Section III —Limits, Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: I. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; 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 All other terms and conditions of this policy remain unchanged. U -GL- 1175 -F CW (04/13) Includes copy0ghled material of Insurance Services Office, Inc., with Its permission Page 2of2 i1111iuuNUUUiiiuiAisuuiiiniimmumAiumiiuMniin m02f00176/05(06/0/010/0. POLICY NUMBER: GLA931895806 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED-INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO_ DEALERS COVERAGE FORM _Sl1SINESS AUTO COVERAGE FORM MOTOR CARRIER 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" for Covered Autos Liability Coverage 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 on the inception date of the,policy unless another date is Indicated below. Namedlnsiured: Cal -West Lighting and Signal Maintenance, Inc. Endorsement Effective Date: 10/1/17 SCHEDULE Name Of Person(s) Or Organization(s): ANY PERSON OR ORGANIZATION TO WHOM OR 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. Information required_to complete this Schedule if not shown above will be shown in the Declarations Each person -or organization shown in the Schedule is an °insured_° for Covered Autos Liability Coverage, but only -to the, extent that person or organization qualifies as an "insured" .under the Who Is An Insured provision contained in Paragraph-A.1. of Section 41 Covered Autos Liability Coverage in the 'Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section 'I = Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 •crao3novooi�asrosrosroroioio- 280706 A� R ®® CERTIFICATE OF LIABILITY INSURANCE DAT11 /q 016 Y' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or 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 Construction & Real Estate Practice Wells Fargo Insurance Services USA, Inc. - CA Lic#: OD08408 CONTACT NAME: PHONE FAX ac No : (866) 358 -1487 E-MAJL tR er ness wellsfar ADDRESS: Ct o.COm G g INSURER(S) AFFORDING COVERAGE NAIC # 959 Skyway Road INSURER A: Zurich American Insurance Co 16535 San Carlos, CA 94070 INSURED INSURER B: Allied World National Assurance Co. 10690 Cal -West Lighting & Signal Maintenance INSURER C: $ 300,000 PO Box 612035 INSURER D $ 10,000 INSURER E; INSURER F; San Jose CA 95161 COVERAGES CERTIFICATE NUMBER: 11083486 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MWDD/YYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X GLA931895805 10/1/2016 10/1/2017 EACH OCCURRENCE $ 1,000,000 PREMISES Ea occurrence) $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY FX PE LOC PRODUCTS - COMPIOP AGG $ 2,000;000 $ OTHER: A AUTOMOBILE LIABILITY X GLA931895805 10/1/2016 10/1/2017 EOacci nSINGLELIMIT $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ x PROPERTY DAMAGE Per accident) $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLALIAB EACH OCCURRENCE $ HOCCUR AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER /EXECUTIVE YIN OFFICER/MEMBEREXCLUDED? N. (Mandatory in NH) NIA WC931895905 10/1/2016 10!112017 X STATUTE ERH E.L. EACH ACCIDENT 1,000;000 $ E.L. DISEASE - EA EMPLOYEE — $ 1,000,000 H yes, describe under .DESCRIPTION OF OPERATIONS. below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Pollution Liability 03104146 11/01/2016 11/01/2017 $1,000,000 Each Pollution Condition $1,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) CA20481013,U -GL- 1175 -F CW (04/13) Re: Traffic Signal Maintenance Services in the City of Gilroy City of Gilroy, its officers, and employees is named as additional insured as respects general liability and automobile liability per endorsements attached. 1rtK I IFI{.A I t MULLItK 1- A1Y%,tLLA I IUN City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna Street ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 -6141 AUTHORIZED REPRESENTATIVE 9t 00, The ACORD name and logo are registered marks of ACORD ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) 1111111111111111111111 VIII 1111111111 VIII VIII VIII 11111 VIII VIII VIII VIII VIII 1111 IIII •CYB01A04/000262/02/0610r0r0/o- CID:280706 SID:11083486 Certificate of Insurance (Con't) OTHER Coverage INSR TYPE OF INSURANCE ADDL WVD POLICY NUMBER EFFECTIVE DATE EXPIRATION DATE LIMIT LTR INSR SUBR (MM /DD/YY) (MM /DD/YY) B Professional Liability 03104146 11/01/2016 11/01/2017 $2,000,000 Each Act, Error, or Omission $2,000,000 Aggregate III111I111111U1111II1111111111111II11111IUY11111A11111111IA1111 ..4/000..3/0610/010. POLICY NUMBER: GLA931895805 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER 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" for Covered Autos Liability Coverage 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 on the inception date of the policy unless another date is indicated below. Named Insured: Cal -West Lighting & Signal Maintenance Endorsement Effective Date: 10/1/2016 SCHEDULE Name Of Person(s) Or Organization(s): Re: Traffic Signal Maintenance Services in the City of Gilroy City of Gilroy, its officers, and employees is named as additional insured as respects automobile liability. Information required to complete this Schedule, If not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 0 Insurance Services Office, Inc., 2011 Page 1 of 1 'CY801 A04l000282/04 /O6 /0 /0lOJO' Additional Insured - Automatic - Owners, Lessees Or Contractors ZURICH Policy No. J Eff. Date of Pol. I Exp. Date of Pol. I Eff. Dated End. I Producer No. Add'1. Prom Return Prem. GLA931895805 10/1 /2016 110/1/2017 110/112016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: CAL —WEST LIGHTING & SIGNAL MAINTENANCE Address (including ZIP Code): PO sox 612035 SAN JOSE CA 95161. 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 additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization Is an additional Insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations or "your work" as included in the "products - completed operations hazard ", which is the subject of the written contract or written agreement. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional Insured. 8. Nth respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing In the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage ", or the offense which caused the "personal and advertising injury", involved the rendering of or the fallure to render any professional architectural, engineering or surveying services. U -0LA 175-F CW (04/13) Includes copyrighted material of Insurance Services Office, fnc., with Its permisdon. Page i of 2 'CYS01 A60I000262/05/OB/O/DIQ70' C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV — Commercial General Liability Conditbns: 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 Narned Insured if the written contract or written agreement requires that this coverage be primary and non - contributory. D. For the purposes of the coverage provided by this endorsement: 1. The following is added to the Other insurance Condition of Section IV— Cornr>erdal General LiablMy Conditions: Primary and Noncontributory insurance This insurance is primary to and will not seek. contribution from any other insurance available to an additional insured provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. 2. The following paragraph is added to Paragraph 4.b. of the Other Insurance Condition of Section IV— Commercial General Liability Cond- itions: 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 a written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. E. 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. F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1, required by the written contract or written agreement referenced In Paragraph A. of this endorsement; 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. All other terms and conditions of this policy remain unchanged. U -GLA 175-F OW (04/13) Page 2of2 Includes copyrighted material of Insurance Services Office, Inc., with its permission. 280706 CERTIFICATE OF LIABILITY INSURANCE DAT 10 /4/2D/YYYY) 10/4/2016 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 have ADDITIONAL INSURED provisions or 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 Construction & Real Estate Practice Wells Fargo Insurance Services USA, Inc. - CA Lic#: OD08408 959 Skyway Road CONTACT NAME. PHONE FAX (866)358 -1487 No t : AIC No E-MAIL e nests wellsfar ADDRESS: CertR o.com q @ 9 INSURERS AFFORDING COVERAGE NAIC # San Carlos, CA 94070 INSURERA: Zurich American Insurance Co 16535 INSURED Cal -West Lighting & Signal Maintenance INSURER B: Westchester Surplus Lines Ins. Co. 10172 INSURERC: PO Box 612035 INSURER D INSURER E; $ 10,000 San Jose CA 95161 INSURER F: COVERAGES CERTIFICATE NUMBER: 10955633 REVISION NUMBER: See below THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MWDD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X GLA931895805 10/1/2016 10/1/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE To PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 _ PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FX ECT [X] LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 S OTHER: A AUTOMOBILE LIABILITY X 10/1/2016 10/1/2017 BINED NGLELIMIT COaccident) $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X PROPERTY DAMAGE Per accident $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR /PARTNER /EXECUTIVE Y / N OFFICER/MEMSEREXCLUDED? N. N/A WC931895905 10/1/2016 10/1/2017 X STATUTE ERH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Pollution & Professional G27512562002 10/01/2015 11/01/2016 $1,000,000 Per Occurence $2,000,000 Per Aggregate DESCRIPTION OF OPERATIONS f LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) CA20481013,U- GL- 1175 -F CW (04/13) Re: Traffic Signal Maintenance Services in the City of Gilroy City of Gilroy, its officers, and employees is named as additional insured as respects general liability and automobile liability per endorsements attached. ILviC City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna Street ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 -6141 AUTHORIZED REPRESENTATIVE 10 If I ne A(;UKLJ name and logo are registered marks of ACORD ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) 111111111111111111 IIII VIII 111111 IIII 11111 VIII VIII VIII VIII VIII VIII VIII VIII 11111111 roreotnaaioot2ssrovosroioioio POLICY NUMBER: GLA931895805 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER 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" for Covered Autos Liability Coverage 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 on the inception date of the policy unless another date is indicated below. Named Insured: Cal -West Lighting & Signal Maintenance Endorsement Effective Date: 1011/2016 SCHEDULE Name Of Person(s) Or Organizatlon(s): Re: Traffic Signal Maintenance Services in the City of Gilroy City of Gilroy, its officers, and employees is named as additional insured as respects automobile liability. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form.. CA 20 48 10 13 0 Insurance Services Office, Inc., 2011 Page 1 of 1 Additional Insured -- Automatic -- Owners, Lessees Or Contractors 4 ZURICH Policy No. i Eff. Date of Pol. I Ex p. Date or Poi. I Eff. Date of End. I Producer No. Addl Prom Return Prem. IGLA931895805110/l/2016 10/1/2017 110/1J2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: CAL —WEST LIGHTING & SIGNAL MAINTENANCE Address (including ZIP Code): PO BOX 612035 SAN JOSE CA 95161 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 additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization Is an additional Insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations or "your work" as included in the "products - completed operations hazard ", which Is the subject of the written contract or written agreement. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional Insured. B. With respect to the insurance afforded to these additional Insureds, the following additional exclusion applies: This insurance does not apply to: "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services including: a. The preparing, approving or failing to prepare or approve maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the 'occurrence" which caused the 'bodily injury" or "property damage ", or the offense which caused the 'personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. U-GL-1 175-F CW (04/13) Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 1 of 2 •CYBOtA0M001263 /04 /OSIOIO /0 /0' C. The following is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV — Commercial General Liability ConditIonw. 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. D. For the purposes of the coverage provided by this endorsement: 1. The following is added to the Other Insurance Condition of Section W— Commercial General LisbW Conditions: Primary and Noncontributory insurance This insurance is primary to and will not seek_ contribution from any other insurance available to an additional insured provided that: a. The additional insured Is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional 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 a written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. E. 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. F. With respect to the insurance afforded to the additional insureds under this endorsement, the following is added to Section III — Llmlts Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. required by the written contract or written agreement referenced in Paragraph A. of this endorsement; 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. All other terms and conditions of this policy remain unchanged. U-GL- 1175 -F OW (04118) Page 2 of 2 includes copyrighted material of insurance Services Office, Inc., with its permission. 1111111111111111111 IN 1111111111111111111111111111111111111111111111111111111111111111111 CYB01AW00125X05/0B/0/010/0r A ®® CERTIFICATE OF LIABILITY INSURANCE DATE /2/20 ,rrYr) 10/2/2055 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED, the pollcy(les) must be endorsed. If SUBROGATION IS WANED, 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 Construction & Real Estate Practice CONTACT NAME: PHON o FAX N.): (866) 358 -1487 Wells Fargo Insurance Services USA, Inc. - CA Lic#: OD08408 959 Skyway Road ADDRESS: CertRequests @wellsfargo.com INSURER(S) AFFORDING COVERAGE NAIC A San Carlos, CA 94070 INSURER A: Zurich American Insurance Co 16535 INSURED Cal -West Lighting & Signal Maintenance INSURER B: Westchester Surplus Lines Ins. Co. 10172 INSURER C DAMAGE TO RENTED PREMISES Ea occurrence PO Box 612035 INSURER D MED EXP (Any one person) INSURER E: San Jose CA 95161 INSURER F: COVERAGES CERTIFICATE NUMBER: 9648968 REVISION NUMBER: See below 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 ADOL SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY ) POLICY EXP (MMfDDNYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X GLA931895804 10/1/2015 10/1/2016 EACH OCCURRENCE $ 1,000.000 DAMAGE TO RENTED PREMISES Ea occurrence $ 300,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEWL AGGREGATE LIMIT APPLIES PER: POLICY II JECT Fx] LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITY X GLA931895804 10/1/2015 10/1/2016 COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X X NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS MADE .DED_ I RETENTION$ 1 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? a NIA WC931895904 10/1/2015 1011/2016 X STATUTE ERH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $. 1,000,000 B Pollution & Professional G27512562002 10/01/2015 10101/2016 $1,000,000 PerOccurence $2,000,000 Per Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required) CA20480299,U- GL- 1175 -F CW (04/13) Re: Traffic Signal Maintenance Services in the City of Gilroy City of Gilroy, its officers, and employees is named as additional insured as respects general liability and automobile liability per endorsements attached. City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 -6141 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 name and logo are registered marks of ACORD @ 1988 -2014 ACORD CORPORATION. All rights reserved. ACO1W 25 (201,4101) 11111111 1 111111111111 IN 11111111111 Hill 11111111111 loll 111111 IN IN 11111111 •cvtlolAOZroos�zs/ovoyaaao• 0 Additional Insured -- Automatic - Owners, Lessees Or ZURICH* Contractors Policy No. J Eff. Date of Pd. I Exp. Date of Pd. I Eff. Dale of End.'- i Producer No. I Add'I. Prom Return Prom. GLA93189580 10/1/15 1 10/1/16 1 10/1/15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Named Insured: CAL —WEST LIGHTING & SIGNAL MAINTENANCE Address (including ZIP Code): PO BOX 612035 SAN JOSE CA 95161 This endorsement modifies Insurance provided under the: Commercial General Liability Coverage Part A. Section If — Who Is An Insured is amended to include as an additional insured any person or organization whom you are required to add as an additional insured on this policy under a written contract or written agreement. Such person or organization Is an additional Insured only with respect to liability for "bodily Injury", "property damage" or "personal and advertising Injury" caused, In whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, In the performance of your ongoing operations or "your work' as Included in the 'products - completed operations hazard ", which Is the subject of the written contract or written agreement. However, the insurance afforded to such additional insured: 1. Only applies to the extent permitted by law; and 2. Will not be broader than that which you are required by the written contract or written agreement to provide for such additional insured. IL With respect to the insurance afforded to these additional insureds, the following additional exclusion applies: This Insurance does not apply to: "Bodily Injury", "property damage" or "personal and advertising Injury" arising out of the rendering of, or failure to render, any professional architectural, engineering or surveying services Including: a. The preparing, approving or falling to prepare or approve naps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, Inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily Injury" or "property damage ", or the offense which caused the "personal and advertising injury", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. Includes copyrighted material of Inwranoe Services office, Inc., wpb Its permisslcn. ■Ifldtll��Irtl111Yi1 U-GL- 1175 -F CW (04/13) Page 1 of 2 'CVB01 A07/"037T5/03I05/0/O/WO' C. The following Is added to Paragraph 2. Duties In The Event Of Occurrence, Offense, Claim Or Suit of Section IV — Conunerclal General Liability Condftlons: 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 9 the written contract or written agreement requires that this coverage be primary and non - contributory. D. For the purposes of the coverage provided by this endorsement: 1. The following is added to the Other Insurance Condition of Section IV — Corn nerole Gerleeal Lilabllfty Conditions: Primary and Noncontributory Insurance This Insurance Is primary to and will not seek contribution from any other insurance available to an additional insured provided that: a. The additional insured is a Named Insured under such other insurance; and b. You are required by written contract or written agreement that this insurance be primary and not seek contribution from any other insurance available to the additional insured. 2 The following paragraph is added to Paragraph 4.b6 of the Other insurance Condition of Section IV— Commarclal 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 "sult ". 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 a written contract or written agreement to provide coverage to the additional insured on a primary and non- contributory basis. E. 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. F. With respect to the Insurance afforded to the additional insureds under this endorsement, the following Is added to Section iII — Limits Of Insurance: The most we will pay on behalf of the additional insured Is the amount of Insurance: 1. Required by the written contract or written agreement referenced in Paragraph A. of this endorsement; or 2. Available under the applicable Limits of Insurance shown in the Declarations, whichever is less. This endorsement shall not increase the applicable Umits of Insurance shown In the Declarations. Ail other terms and conditions of this policy remain unchanged. U- GL- 11 17&FCW (04113) Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc., with Its permission. I8�r1�Y1Y11�11YY1111 _�...� POLICY NUMBER: GLA931895804 COMMERCIAL AUTO CA 20 48 02 88 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 modi- fied 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 on the Inception date of the policy unless another date is Indicated below. October 1, 2015 Insured: Inc. required by written contract SCHEDULE (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 organisation qualifies as an 'Insured" under the. Who Is An Insured Provision contained In Section U of the Coverage Form. Copyright, Hawaii Insurance Bureau, Inc., 1999 Includes copyrighted material of the Insurance Services Office, Inc., with its permission CA 1028 (2 -99) CA 20 48 02 88 Copyright, Insurance Services Office, Inc., 1989 Page 1 of 1 IN Ii1BrIlIVd,lllllill ._.___