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HomeMy WebLinkAboutDevcon Construction - Insurance Certificate (2)ACOROa CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDfYYYY) F4/26/2016 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. THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Brian Watts Arthur J. Gallagher & Co. Insurance Brokers of CA., Inc. LIC #0726293 _NAME: PHONE FAX U,,. 408 - 973 -9500 . 408 - 257 -2985 EMAIL , brian_watts@ajg.com One Almaden Blvd.Suite 960 INSURER(S) AFFORDING COVERAGE NAIC # San Jose CA 95113 INSURER A: Liberty Mutual Fire Insurance Com a 23035 INSURED DEVCCON -01 INSURER B: Allied World Assurance Co (U.S.) In 19489 Devcon Construction Incorporated INSURER c:American Fire and Casuals Company 24066 Mil Gibraltar Drive Milpitas, CA 95035 INSURER D:AIG S eciaKy Insurance Company 26883 — INSURER E: Travelers Property Casualty Co of A 25674 $10,000 INSURER F: Arch Specialty Insurance Company 21199 COVERAGES CERTIFICATE NUMBER: 286455936 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF M/DD/YYYY POLICY EXP MIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y TB2661066455026 1 4/30/2016 4/30/2017 EACH OCCURRENCE $1,000,000 CLAIMS -MADE E OCCUR DAMAGE TO RENT PREMISES Ea occurrence $300,000 MEDEXP (Any one person) $10,000 PERSONAL & ADV INJURY $1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 P POLICY PE 7 LOC PRODUCTS - COMP /OP AGG s2,000,000 $ OTHER: A AUTOMOBILE LIABILITY Y Y AS2661066455036 4/30/2016 4/3012017 I- D INGLE LIMIT Ea accident $1,000,000 X BODILY INJURY (Per person) $ ANYpAUTO AU�OS NED AUTODULED BODILY INJURY (Per accident) E HIRED AUTOS X NON -OWNED AUTOS X Per accident $ X $ Comp:$1,000 X Coll:$1,000 B C X UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE 03075003 ECA1756083777 4/30/2016 4/30/2016 4/30/2017 4130/2017 EACH OCCURRENCE $30,000,000 AGGREGATE $30,000,000 DED I X I RETENTION $ 10,000 $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? N /A Y WA266DO66455016 4/30/2016 4/30/2017 X ATUTE 107H - ST E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYE $1,000,000 (Mandatory in NH) If es, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $1,000,000 D F E Pollution Liability Professional Liability Rented /Leased Equipment CP01421304 4/30/2015 CPP004978904 4/3011016 QT6305429B804TIL16 4/30/2016 4/30/2017 4/30/2017 4/30/2017 Each Loss/Agg 5,000,000 Per Claim /Agg 5,000,000 Per Any One item 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: New Trellis Lighting. Additional Insured(GL and Auto and Waiver of Subrogation GL, AUTO & WC): City of Gilroy Project or Job #: Job #D13 -538 %,r-M 1 1r 1V M 1 G rIULUr-K I.AIYI.tLLA 1 IUIV City of Gilroy 7351 Rosanna Street Gilroy CA 95020 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ® 1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Named Insured: Devcon Construction, Incorporated Policy Number: TB2661066455026 Policy Term: 04/30/2016 to 04/30/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ ITCAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SECTION 11 - WHO IS AN INSURED is amended to include as an insured any person or organization for whom you have agreed in writing to provide liability insurance. But. The insurance provided by this amendment: 1. Applies only to "bodily injury" or "property damage" arising out of (a) "your work" or (b) premises or other property owned by or rented to you; 2. Applies only to coverage and minimum limits of insurance required by the written agreement, but in no event exceeds either the scope of coverage or the limits of insurance provided by this policy; and 3. Does not apply to any person or organization for whom you have procured separate liability insurance while such insurance is in effect. regardless of whether the scope of coverage or limits of insurance of this policy exceed those of such other insurance or whether such other insurance is valid and collectible. The following provisions also apply: 1. Where the applicable written agreement requires the insured to provide liability insurance on a primary, excess, contingent, or any other basis, this policy will apply solely on the basis required by such written agreement and Item 4 Other Insurance of SECTION IV of this policy will not apply. 2 Where the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Item 4. Other Insurance of SECTION IV of this policy will govern. 3 This endorsement shall not apply to any person or organization for any "bodily injury" or "property damage" I any other additional insured endorsement on this policy applies to that person or organization with regard to the "bodily injury" or "property damage". 4. If any other additional insured endorsement applies to any person or organization and you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for that additional insured, this policy will apply solely on the basis required by such written agreement and Item 4. Other Insurance of SECTION IV of this policy will not apply, regardless of whether the person or organization has available other valid and collectible insurance. If the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Item 4. Other Insurance of SECTION IV of this policy will govern LN 20 01 06 05 Named Insured: Devcon Construction, Incorporated Policy Number: TB2661066455026 Policy Term: 04/30/2016 to 04/30/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE AMENDMENT — SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Person or Organization: All persons or organizations with whom you have entered into a written contract or 1 agreement, prior to an 'occurrence" or offense, to provide additional insured status. i If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for any person or organization shown in the Schedule of this endorsement that qualifies as an additional insured on this policy, this policy will apply solely on the basis required by such written agreement and Paragraph 4. Other Insurance of Section IV - Conditions will not apply. If the applicable written agreement does not specify on what basis the liability insurance will apply, the provisions of Paragraph 4. Other Insurance of Section IV - Conditions will govern. However, this insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured by attachment of an endorsement to another policy providing coverage for the same "occurrence ", claim or "suit ". LC 24 20 02 13 O 2013 Liberty Mutual Insurance All rights reserved. Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Named Insured: Devcon Construction, Incorporated Policy Number: TB2661066455026 Policy Term: 04/30/2016 to 04/30/2017 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 PP.ODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Secti n IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule below 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 below. SCHEDULE Name Of Person Or Organization. Any person or organization with whom you have agreed in writing to waive any right of recovery prior to a loss Information required to complete this Schedule. if not shown above, will be shown in the Declarations. CG 24 04 05 09 9 Insurance Services Office, Inc., 2008 Page I of 1 Named Insured: Devcon Construction, Incorporated Policy Number: AS2661066455036 Policy Term: 04/30/2016 to 04/30/2017 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 FOPM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement identifies person(si or organtzabon(sl 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 SCHEDULE 114ame Of Person(s) Or Organization(s): Any person or organization whom you have agreed in writing to add as an additional insured, but only to coverage and minimum limits of insurance required by the written agreement, and in no event to exceed either the scope of coverage or the limits of insurance provided in this policy, rmation required to complete this SchedUe, 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 Page 1 of 1 Named Insured: Devcon Construction, Incorporated Policy Number: AS2661066455036 COMMERCIAL AUTO Policy Term: 04/30/2016 to 04/30/2017 CA 04 44 10 13 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: 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 the endorsement. SCHEDULE N Person(s) Or Organization(s): 'Any person or organization for whom you Perform work under a written !contract if the contract requires you to obtain this agreement from us, but ,only if the contract is executed prior tuthe injury or damage occuring. Premium: $ INCL Information required to complete this Schedule. if not shown above, wdl be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others 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 "accident' or the "loss" under a contract with that person or organization. CA 04 44 10 13 4.) Insurance Services Office, Inc.. 2011 Pag 1 of 1 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSENENT - CALIFORNIA 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 2% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Where required by contract or written agreement prior to loss and allowed by law. Job Description Issued by Liberty Mutual Fire Insurance Company 1658E For attachment to Policy No. WA266DO66455016 Effect;vQ gate 04/30/2016 Premium $ issued to Devcon Construction Incorporated WC 04 03 06 Page 1 of 1 ED: 44/1984 Named Insured: Devcon Construction, Incorporated Policy Number: QT6305429B804TIL16 Policy Term: 04/30/2016 to 04/30/2017 COMMERCIAL INLAND MARINE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET LOSS PAYEES This endorsement modifies insurance provided under the IM PAK COVERAGE FORM. The following is added to Section E - ADDITIONAL COVERAGE CONDITIONS: Loss Payable Provision In the event of a Covered Cause of Loss to Covered Property in which both you and a Loss Payee share an insurable interest, we wilt: a. Adjust the loss or damage with you; and a� a o= m— o� o� b. Pay any claim for loss or damage jointly to you and the Loss Payee as your interests may ap- pear. This endorsement applies to all Covered Property for which a Loss Payee is on file with us or your insur- ance agent or insurance broker. CM T5 60 01 10 ® 2009 The Travelers Indemnify Company Page 1 of 1 Includes copyrighted material of insurance Services Ofte, Inc. with its permission. 004051 Named Insured: Devcon Construction, Incorporated Policy No.: TB2661066455026 Policy Term: 04/30/2016 to 04/30/2017 IL 02 70 09 12 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY)COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT - RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART A. Paragraphs 2.. 3. and 5. of the Cancellation Common Policy Condition are replaced by the following: 2. All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less, and is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named Insured. at the mailing address shown in the policy, and to the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least a. 10 days before the effective date of cancellation 0 we cancel for: (1) Nonpayment of premium; or (2) Discovery of fraud by: (a) Any insured or his or her representative in obtaining this insurance: or (b) You or your representative in pursuing a claim under this policy. b. 30 days before the effective date of cancellation if we cancel for any other reason. 3. All Policies In Effect For More Than 60 Days a. If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon the occurrence, after the effective date of the policy, of one or more of the following: (1) Nonpayment of premium, including payment due on a prior policy we issued and due during the current policy term covering the same risks. (2) Discovery of fraud or material misrepresentation by: (a) Any insured or his or her representative in obtaining this insurance: or (b) You or your representative in pursuing a claim under this policy. (3) A judgment by a court or an administrative tribunal that you have violated a California or Federal law, having as one of its necessary elements an act which materially increases any of the risks insured against. IL 02 70 09 12 ® Insurance Services Office, Inc., 2012 Page 1 of 4 Named Insured: Devcon Construction, Incorporated Policy No.: TB2661066455026 Policy Term: 04/30/2016 to 04/30/2017 (4) Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards. by you or your representative, which materially increase any of the risks insured against. (5) Failure by you or your representative to implement reasonable loss control requirements, agreed to by you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially increases any of the risks insured against. (6) A determination by the Commissioner of Insurance that the: (a) Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial integrity or solvency; or (b) Continuation of the policy coverage would: (1) Place us in violation of California law or the laws of the state where we are domiciled; or (ii) Threaten our solvency. (7) A change by you or your representative in the activities or property of the commercial or industrial enterprise, which results in a materially added, increased or changed risk, unless the added, increased or changed risk is included in the policy. b. We will mail or deliver advance written notice of cancellation, stating the reason for cancellation, to the first Named Insured. at the mailing address shown in the policy. and to the producer of record, at least: (1) 10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud; or (2) 30 days before the effective date of cancellation if we cancel for any other reason listed in Paragraph 3.a. 8. The following provision is added to the Cancellation Common Policy Condkion: 7. Residential Property This provision applies to coverage on real property which is used predominantly for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household personal property in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part — Farm Property — Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a. If such coverage has been in effect for 60 days or less, and is not a renewal of coverage we previously issued, we may cancel this coverage for any reason, except as provided in b. and c. below. b. We may not cancel this policy solely because the first Named Insured has: (1) Accepted an offer. of earthquake coverage; or (2) Cancelled or did not renew a policy issued by the California Earthquake Authority (CEA) that included an earthquake policy premium surcharge. However, we shall cancel this policy if the first Named Insured has accepted a new or renewal policy issued by the CEA that includes an earthquake policy premium surcharge but fails to pay the earthquake policy premium surcharge authorized by the CEA. c. We may not cancel such coverage solely because corrosive soil conditions exist on the premises. This restriction (c.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1) Commercial Property Coverage Part — Causes Of Loss — Special Form; or (2) Farm Coverage Part — Causes Of Loss Form — Farm Property, Paragraph D. Covered Causes Of Loss — Special. Page 2 of 4 ® Insurance Services Office. Inc., 2012 IL 02 70 0912 Named Insured: Devcon Construction, Incorporated Policy No.: TB2661066455026 Policy Term: 04/30/2016 to 04/30/2017 C. The following is added and supersedes any (2) The Commissioner of Insurance finds provisions to the contrary: that the exposure to potential losses will Nonrenewal threaten our solvency or place us in a hazardous condition. A hazardous 1. Subject to the provisions of Paragraphs C.Z. condition includes. but is not limited to, a and C.3. below, if we elect not to renew this condition in which we make claims policy, we will mail or deliver written notice, payments for losses resulting from an stating the reason for nonrenewal, to the first earthquake that occurred within the Named Insured shown in the Declarations. and preceding two years and that required a to the producer of record, at least 60 days, but reduction in policyholder surplus of at not more than 120 days. before the expiration least 25% for payment of those claims; or anniversary date. or We will mail or deliver our notice to the first (3) We have: Named Insured, and to the producer of record, at the mailing address shown in the policy. (a} Lost or experienced a substantial reduction in the availability or scope 2. Residential Property of reinsurance coverage: or This provision applies to coverage on real (b) Experienced a substantial increase in property used predominantly for residential the premium charged for purposes and consisting of not more than four reinsurance coverage of our dwelling nits, and to coverage on tenants' g g residential property insurance household property contained in a residential policies: and unit, if such coverage is written under one of the following: the Commissioner has approved a plan Commercial Property Coverage Part for the nonrenewals that is fair and equitable, and that is responsive to the F Farm Coverage Part —Farm Property —Farm changes in our reinsurance position. Dwellings. Appurtenant Structures And Household Personal Property Coverage Form c. We will not refuse to renew such coverage solely because the first Named Insured has a. We may elect not to renew such coverage cancelled or did not renew a policy. issued for any reason, except as provided in b., C. by the California Earthquake Authority, that and d. below. included an earthquake policy premium b. We will not refuse to renew such coverage surcharge. solely because the first Named Insured has d. We will not refuse to renew such coverage accepted an offer of earthquake coverage. solely because corrosive soil conditions However, the following applies only to exist on the premises. This restriction (d.) insurers who are associate participating applies only if coverage is subject to one of insurers as established by Cal. Ins. Code the following, which exclude loss or damage Section 10089.16. We may elect not to caused by or resulting from corrosive soil renew such coverage after the first Named conditions: Insured has accepted an offer of 1 ()Commercial Property Coverage Part — earthquake coverage, if one or more of the Causes Of Loss— Special Form; or following reasons applies: (2) Farm Coverage Part — Causes Of Loss (1) The nonrenewal is based on sound Form — Farm Property. Paragraph D. underwriting principles that relate to the Covered Causes Of Loss — Special. coverages provided by this policy and that are consistent with the approved 3• We are not required to send notice of rating plan and related documents filed nonrenewal in the following situations: with the Department of Insurance as a. If the transfer or renewal of a policy, without required by existing law: any changes in terms. conditions or rates, is between us and a member of our insurance group. IL 02 70 09 12 0 Insurance Services Office, Inc., 2012 Page 3 of 4 Named Insured: Devcon Construction, Incorporated Policy No.: TB2661066455026 Policy Term: 04/3012016 to 04/30/2017 b. If the policy has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph C.1. c. If you have obtained replacement coverage, or if the first Named Insured has agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. d. If the policy is for a period of no more than 60 days and you are notified at the time of issuance that it will not be renewed. e. If the first Named Insured requests a change in the terms or conditions or risks covered by the policy within 60 days of the end of the policy period. f. If we have made a written offer to the first Named Insured, in accordance with the timeframes shown in Paragraph CA., to renew the policy under changed terms or conditions or at an increased premium rate, when the increase exceeds 25 %. Page 4 of 4 0 Insurance Services Office, Inc., 2012 IL 02 70 0912 Named Insured: Devcon Construction, Incorporated Policy No.: AS2661066455036 Policy Term: 04/30/2016 to 04/30/2017 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION ENDORSEMENT 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. We will not cancel this policy or make changes that reduce the insurance afforded by this policy until written notice of cancellation or reduction has been mailed or delivered to those listed in the schedule below at least; a) 10 days before the effective date of cancellation, if we cancel for non - payment of premium; or b) 90 days before the effective date of the cancellation or reduction if we cancel or reduce the insurance afforded by this policy for any other reason. NAME Devcon Construction, Inc. ADDRESS 690 Gibraltar Drive Milpitas, CA 95035 -6317 Policy No: AS2661066455035 Issued By: Liberty Mutual Fire Insurance Co. Effective Date: 04/30/2016 Expiration Date: 04/30/2017 Sales Office: AM 02 0106 10 Copyright 2010, Liberty Mutual Group of Companies. All rights reserved. Page 1 of 1 Named Insured: Devcon Construction, Incorporated Policy No.: WA266D066455016 Policy Term: 04/30/2016 to 04/30/2017 CALIFORNIA CANCELLATION ENDORSEMENT This endorsement applies only to the insurance provided by the policy because California is shown in Item 3.A. of the Information Page. The cancellation condition in Part Six (Conditions) of the policy is replaced by these conditions: Cancellation 1. You may cancel this policy. You must mail or deliver advance written notice to us stating when the cancellation is to take effect. 2. We may cancel this policy for one or more of the following reasons: a. Non - payment of premium; b. Failure to report payroll; c. Failure to permit us to audit payroll as required by the terms of this policy or of a previous policy issued by us; d. Failure to pay any additional premium resulting from an audit of payroll required by the terms of this policy or any previous policy issued by us; e. Material misrepresentation made by you or your agent; f. Failure to cooperate with us in the investigation of a claim; g. Failure to comply with Federal or State safety orders; h. Failure to comply with written recommendations of our designated loss control representatives; i. The occurrence of a material change in the ownership of your business; j. The occurrence of any change in your business or operations that materially increases the hazard for frequency or severity of loss; k. The occurrence of any change in your business or operation that requires additional or different classification for premium calculation; I. The occurrence of any change in your business or operation which contemplates an activity excluded by our reinsurance treaties. WC 04 06 01 A Page 1 of 2 Ed. 12/01/1993 Named Insured: Devcon Construction, Incorporated Policy No.: WA266DO66455016 Policy Term: 04/30/2016 to 04/30/2017 3. If we cancel your policy for any of the reasons listed in (a) through (f), we will give you 10 days advance written notice, stating when the cancellation is to take effect. Mailing that notice to you at your mailing address shown in Item 1 of the Information Page will be sufficient to prove notice. If we cancel your policy for any of the reasons listed in Items (g) through (1), we will give you 30 days advance written notice; however, we agree that in the event of cancellation and reissuance of a policy effective upon a material change in ownership or operations, notice will not be provided. 4. The policy period will end on the day and hour stated in the cancellation notice. Issued by Liberty Mutual Fire Insurance Company 16586 For attachment to Policy No. WA266DO66455016 Effective Date Premium $ Issued to Devcon Construction, Inc. WC 04 06 01 A Page 2 of 2 Ed. 12/01/1993