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HomeMy WebLinkAboutEvans & DeShazo - Insurance CertificateEVANS -1 nc In- Le= �� �� ®• CERTIFICATE OF LIABILITY INSURANCE DATE (UWDDIYYYY) INDICATED NOTWITHSTANDING ANY REQUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS 07131/2017 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 707 -874 -2666 Gene Gaffney Ins Services, Inc P.O. Box 428 5ON AcT fitted Edwards PHONE 707 -874 -2666 Fax (,Q Ne. Eatj (Ak No ):707- 874 -1233 Occidental, CA 95465 Kirsten Edwards mss: rater @ga eyins.eom INSURERUSI AFFORDING COVERAGE NAIC b • 141PZR A: Hartford Casualty Ins. Co. COMMERCIAL GENERAL LIABILITY INSURED Evans & DeShazo, Inc. Attn: Sally Evans INSURER 13: RU Insurance Group INSURER C: 6876 Sebastopol Ave. Sebastopol, CA 95472 INSURER 0: CIAIMSMADE a OCCUR INSURER E • 57SBMBH7623 INSURER F: 04/2012018 17nVFRAn94z 1`CC77CI0%ATC I,11I"Imcn. - - - - -" - -- - Llbzwimij Izad IYI�CR 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 KNSR TYPE OF INSURANCE ADD SUB POLICY NUMBER I POLICY EFF POLICY EXP, LIMITS , X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE is 2,000.000 CIAIMSMADE a OCCUR X 57SBMBH7623 04/20/2017 04/2012018 DAMAGE To RENTED S 1,000,000 t ES Ea oeeurrenrr S 10,000 MED EXP one person) PERSONAL S ADV INJURY S 2,000,000 GEML AGGREGATE LIMB APPLIES PER X � PRO- ❑ GENERAL AGGREGATE S 4,000,000 PRODUCTS - COMPIOP AGG S 4,000,000 POLICY JECT LOC S OTHER A AUTOMOBILE LIABILITY COMBINED SINGLE LI&7T 5 2,000,000 BODILY INJURY M person) $ ANY AUTO OVI ED SCHEDULED 57SBMBH7623 04/2012017 04/20/2018 HX BODILY INJURY Per, — era S AURTEO�S ONLY AUTOS Fper�a�Zr .1AGE Is /N� AUTOS ONLY X AUTOS ONLY IS s UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE S EXCESS 11,08 CW6-i-LV1DE J DED RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY PER OTH- YIN • NY PROPRIETORIPARTNEREXECUTTVE OFFICERM.EUBER EXCLUDED? N I A E L EACH ACCIDENT S (Mandatory In NH) II es, escnbe uncW E L DISEASE - EA EMPLOYEE S E L DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS brim. B Professional Liabi R 08/06/2017 08106/2019 Aggregate 1,000,000 Oecurence 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Scho"a. may be attached I Moro spaeo Is roqulred) Archeaeology. & Historic Preservation Consultants The City of Gilroy, its Officers, Officials, and En toyees are named as Additional Insureds per attached policy form IH�2001185. "'This certificate supercedes the certificate issued 716117 CFRTIFICATF 14r II nFR 0% ^ 1 wtlr.w, At,uRu zD izuibmi) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CI Of Gilroy, City y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. its officers, officals and employees 7351 Rosanna Street AUTHORIZED REPRESENTATIVE , Gilroy, CA 95020 , At,uRu zD izuibmi) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 57 SBM BH7623 THIS ENDORSEMENT CHANGES THE POLICY. ADDITIONAL INSEIRED - STATE /POLITICAL SUBDIViSICN CITY OF GILROY ITS OFFICERS, OFFICIALS, AND E:•IPL07FES 7351 ROSANNA ST GILROY, CA 95020 A PLEASE READ IT CAREFULLY. Form IH 12 00 1185 T SEQ. NO. 003 Printed in U.S.A. Page 001 Process Date: 02/02/17 Expiration Dale: 04120/18 ENDORSEMENT AGREEMENT ADDITIONAL INSURED EMPLOYER 9139842 -17 RENEWAL NA HOME OFFICE SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 1201 AM PACIFIC EFFECTIVE AUGUST 28, 2017 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME EVANS & DE SHAZO, INC. 6876 SEBASTOPOL AVE SEBASTOPOL, CA 95472 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT CITY OF GILROY IS HEREBY NAMED AS AN ADDITIONAL INSURED EMPLOYER ON THIS POLICY BUT ONLY AS RESPECTS EMPLOYEES WHOSE NAMES APPEAR ON THE PAYROLL RECORDS OF EVANS & DE SHAZO, INC. (HEREIN CALLED THE PRIMARY INSURED) WHILE THOSE EMPLOYEES ARE ENGAGED IN WORK UNDER THE SIMULTANEOUS DIRECTION AND CONTROL OF THE PRIMARY INSURED AND THE ADDITIONAL INSURED EMPLOYER. IT IS FURTHER AGREED THAT THE PAYMENT OF THE FULL PREMIUM DUE AND PAYABLE UNDER THIS POLICY SHALL REMAIN THE SOLE RESPONSIBILITY OF THE PRIMARY INSURED. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUGUST 31,/21017 !/mot, !/�4••7i.s^ ,��[N't..K� AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 IREV.7 -2014) 0015 OLD DP 217 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION 9139842 -17 RENEWAL NA HOME OFFICE SAN FRANCISCO PAGE 1 OF 1 ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC EFFECTIVE AUGUST 28, 2017 AT 12.01 A.M. STANDARD TIME OR THE TIME INDICATED AT AND EXPIRING AUGUST 14 , 2018 AT 12.01 A.M. PACIFIC STANDARD TIME EVANS & DE SHAZO, INC. 6876 SEBASTOPOL AVE SEBASTOPOL, CA 95472 ANYTHING IN THIS POLICY TO THE CONTRARY NOTWITHSTANDING, IT IS AGREED THAT THE STATE COMPENSATION INSURANCE FUND WAIVES ANY RIGHT OF SUBROGATION AGAINST, CITY OF GILROY WHICH MIGHT ARISE BY REASON OF ANY PAYMENT UNDER THIS POLICY IN CONNECTION WITH WORK PERFORMED BY, EVANS & DE SHAZO, INC. IT IS FURTHER AGREED THAT THE INSURED SHALL MAINTAIN PAYROLL RECORDS ACCURATELY SEGREGATING THE REMUNERATION OF EMPLOYEES WHILE ENGAGED IN WORK FOR THE ABOVE EMPLOYER. IT IS FURTHER AGREED THAT PREMIUM ON THE EARNINGS OF SUCH EMPLOYEES SHALL BE INCREASED BY 03 %. NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUGUST 31,/2017 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF FORM 10217 IREV.7 -2014) 2570 OLD DP 217 9139842 -17 RENEWAL NA PLEASE KEEP THIS ENDORSEMENT WITH YOUR POLICY Dear Policyholder: These endorsements amend and are part of your policy. Please keep them with your documents for future reference. If you have any questions concerning these endorsements, Please contact your local State Fund office. Form w ®9 Request for Taxpayer Give Form to the (Rev December 2014) Identification Number and Certification requester. Do not Department of the Treasury ury Send tO the IRS. Internal Revenue Service 1 Name (as shown on your Income tax return) Name is required on this line, do not leave this line blank Evans & De Shazo, Inc. N N t71 IC Q c 0 N CL o L 7 o � C N •L C ao d CL to a>' n 2 Business name /disregarded entity name, if different from above 3 Check appropriate box for federal tax classification, check only one of the following seven boxes 4 Exemptions (codes apply only to ❑Individual /sole proprietor or certain entities, not individuals, see p p ❑ C Corporation ❑� S Corporation ❑ Partnership ❑ Trust/estate Instructions on page 3) single- member LLC Exempt payee code (if any) ❑ Limited liability company Enter the tax classification (C =C corporation, S =S corporation, P= partnership) ► Note. For a single- member LLC that Is disregarded, do not check LLC, check the appropriate box in the line above for Exemption from FATCA reporting the tax classification of the single- member owner code (if any) ❑ Other (see Instructions) ► (Applies to accounts m lntalned outside the U S) 5 Address (number, street, and apt or suite no) Requester's name and address (optional) 6876 Sebastopol Avenue 6 City, state, and ZIP code Sebastopol, CA 95472 7 List account number(s) here (optional) Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number backup withholding For individuals, this is generally your social security number ( However, for a resident alien, sole proprietor, or disregarded entity, see the Part I instructions on page 3 For other di page — m — entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN on page 3. or Note. If the account is in more than one name, see the instructions for line 1 and the chart on page 4 for I Employer identification number guidelines on whose number to enter F451 — 1 1 2 1 6 1 8 1 8 1 2 1 8 Under penalties of perjury, I certify that. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me), and 2. 1 am not subject to backup withholding because- (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3 1 am a U S. citizen or other U S person (defined below); and 4 The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but you must provide your correct TIN. See the instructions on page 3. Sign Signature ofj [y( Here U.S. person ► Date ► August 15, 2017 General Instructions Section references are to the Internal Revenue Code unless otherwise noted Future developments Information about developments affecting Form W -9 (such as legislation enacted after we release It) is at www its gov 1fw9 Purpose of Form An individual or entity (Form W -9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer Identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return Examples of information returns include, but are not limited to, the following • Form 1099 -INT (interest earned or paid) • Form 1099 -DIV (dividends, including those from stocks or mutual funds) • Form 1099 -MISC (various types of income, prizes, awards, or gross proceeds) • Form 1099 -B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099 -S (proceeds from real estate transactions) • Form 1099 -K (merchant card and third party network transactions) • Form 1098 (home mortgage Interest), 1098 -E (student loan interest), 1098 -T (tuition) • Form 1099 -C (canceled debt) • Form 1099 -A (acquisition or abandonment of secured property) Use Form W -9 only if you are a U S person (Including a resident alien), to provide your correct TIN If you do not return Form W -9 to the requester with a TIN, you might be subject to backup withholding See What is backup withholding? on page 2 By signing the filled -out form, you 1 Certify that the TIN you are giving is correct (or you are waiting for a number to be issued), 2 Certify that you are not subject to backup withholding, or 3 Claim exemption from backup withholding if you are a U S exempt payee If applicable, you are also certifying that as a U S person, your allocable share of any partnership Income from a U S trade or business is not subject to the withholding tax on foreign partners' share of effectively connected income, and 4 Certify that FATCA code(s) entered on this form (if any) indicating that you are exempt from the FATCA reporting, is correct See What is FATCA reporting9 on page 2 for further information Cat No 10231X Form W -9 (Rev 12 -2014) EVANS -1 / <7'"HL Y CERTIFICATE OF LIABILITY INSURANCE E (MM /DD/YYYY) F�07131/2017 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(les) 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 707 -874 -2666 ,,,ME Kirsten Edwards Gene Gaffney Ins Services, Inc P.O. Box 428 Occidental, CA 95465 Kirsten Edwards PHONE 707- 874 -2666 FAX 707- 874 -1233 (A/c, No, Ext (A/C, No). E -MAIL kirsten@gaffneyins.com ADDRESS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X INSURERS AFFORDING COVERAGE NAIC # INSURER Hartford Casualty Ins. Co. EACH OCCURRENCE $ 2,000,000 INSURED Evans & DeShaZo, Inc. INSURER B RLI Ins_ urance Group $ 1,000,000 Attn: Sally Evans MED EXP (Any one person) $ 10,000 6876 Sebastopol Ave. INSURER C INSURER D Sebastopol, CA 95472 INSURER E: - INSURER F $ 2,000,000 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS INSR LTR TYPE OF INSURANCE ADDL SUB WVD POLICY NUMBER POLICY EFF POLICY EXP 04/20/2018 LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X 57SBMBH7623 04/20/2017 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED occurrence) REM $ 1,000,000 MED EXP (Any one person) $ 10,000 - PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY jPe LOC GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP /OP AGG $ 4,000,000 OTHER A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accdnl) $ 2,000,000 BODILY INJURY Per person)_ $ ANY AUTO OWNED SCHEDULED 57SBMBH7623 04/20/2017 04/20/2018 AUTOS ONLY AUTOS BODILY INJURY Per accident $ X PROPERTY DAMAGE Per accident $ HIRED X NON -O NED AUTOS ONLY AUTOSS ONLY UMBRELLA LIAR HOCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under NIA PER OTH- 1A UTE ER E L EACH ACCIDENT $ E L DISEASE - EA EMPLOYEE $ DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT B Professional Liabi RTP0006077 08/06/2017 08/06/2019 Aggregate 1,000,000 Occurence 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) - Archeaeology 8r Historic Preservation Consultants The City of Gilroy, its Officers, Officials, and Enployees are named as Additional Insureds per attached policy form IH12001185. ** *This certificate supercedes the certificate issued 7/6/17 City of Gilroy, its officers, officals and employees 7351 Rosanna Street Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE '!3,f,. M%,%J LJ Ao kw I0ruo) W 7VU5 -ZUIb AGUKU GUKF'UKA f 10N. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 57 SBM BH7623 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE /POLITICAL SUBDIVISION CITY OF GILROY ITS OFFICERS, OFFICIALS, AND EMPLOYEES 7351 ROSANNA ST GILROY, CA 95020 Form IH 12 00 11 85 T SEQ. NO. 003 Printed in U.S.A. Page 001 Process Date: 02/03/17 Expiration Date: 04/20/18 w EVANS -1 101atMA4 CERTIFICATE OF LIABILITY INSURANCE D 07/06/2017 (MM /2017Y) 07 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 707 -874 -2666 Gene Gaffney Ins Services, Inc P.O. BOX 428 Occidental, CA 95465 Kirsten Edwards CONTACT Kirsten Edwards NAME: PHONE 707- 874 -2666 FAX 707- 874 -1233 (A/C, No, Ext): (A/C, No): EDDRE kirsten@gaffneyins.com X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [X] OCCUR X INSURERS AFFORDING COVERAGE NAIC # INSURER A: Hanford Casualty Ins. Co. 04120/2018 EACH OCCURRENCE INSURED Evans & DeShazo, Inc. INSURER B: RLI Insurance Group DAMAGE TO RENTED SES Attn: Sally Evans 6876 Sebastopol Ave. Sebastopol, CA 95472 INSURER C: _REM MED EXP (Any one person) INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUB POLICY NUMBER POLICY EFF MM/DD POLICY EXP M/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [X] OCCUR X 57SBMBH7623 04/20/2017 04120/2018 EACH OCCURRENCE $ 2'000'000 DAMAGE TO RENTED SES $ 1,000,000 _REM MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: X POLICY 1:1 imef FI LOC GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP /OP AGG $ 4,000,000 OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 BODILY INJURY Per person) ANY AUTO 57SBMBH7623 04/20/2017 04/20/2018 BODILY BODILY INJURY Per accident $ OWNED SCHEDULED AUTEO�S ONLY AUTOS X Perr accisentDAMAGE $ AUTOS ONLY X A�TOS ONL� UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION T PER OTH- AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER/EXECU I IVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under NIA ISTATUT ER E. L: EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below B Professional Liabi RTP0006077 08/0612016 08/06/2017 Aggregate 1,000,000 Occurence 1,000,000 ES RIPTIO OF OP ONS / 1_O "IONS 1 VE CLE (ACOR 01, Additional Remarks Schedule, maybe attached if more space is required) rc eaeo�ogx istoric �°reserva ion onsuJ ants The City of Gilroy, its Officers, Officials, and Enployees are named as Additional Insureds per attached policy form IH12001185. """This certificate supercedes the certificate issued 4/23/17 City of Gilroy, its officers, officals and employees 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2016/03) 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 Kirsten Edwards ©1988 -2015 ACORD CORPORATION_ AlFriahtc rpsarvarl The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 57 SBM BH7623 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE /POLITICAL SUBDIVISION CITY OF GILROY ITS OFFICERS, OFFICIALS, AND EMPLOYEES 7351 ROSANNA ST GILROY, CA 95020 Form IH 12 00 1185 T SEQ. NO. 003 Printed in U.S.A. Page 001 Process Date: 02/03/17 Expiration Date: 04/20/18 i� EVANS -1 OP ID- KF - - -- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 04/2312017 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: It 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 707 -874 -2666 Gene Gaffney Ins Services; Inc P.O. P.O. Box 428' C NTACT Kirsten Edwards PHONE 707 -874 -2666 707-874-1233 A/C, No, Ext : A/C, No : E.M I k irsten ga neyins.C'om . Occidental, CA 95465 Kirsten Edwards COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X INSURERS AFFORDING' COVERAGE NAIC # INSURER A: Hartford Casualty Ins. Co. EACH OCCURRENCE INSURED Evans 8 DeShazo, LLC INSURER B: RLI Insurance Group DAMAGE r0 RENTED Attn: Sally Evans 6876 Sebastopol Ave. Sebastopol, CA 95472 INSURER C: MED EXP (Any one. Person) INSURER D: INSURER E': INSURER F': CrfVFRArZ'FC f_FRTIrie ATF IVI IMRFR• orviciew tj"R wo. 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 LIE TYPE OF INSURANCE ADOL SUIBR POLICY NUMBER POLICY EFF POLICY EXP D LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X 57SBMBH7623 04/20/2017 04/20/2018 EACH OCCURRENCE 2,000,000 DAMAGE r0 RENTED $ 1,000,000 MED EXP (Any one. Person) 1 0,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ j�T LOC GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP /OP AGG 4,000;000 - - OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) 1,000,000 ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 57SBMBH7623 04/2012017 04/20/2018 BODILY INJURY Per erson $ BODILY INJURY (Per accident $ X PROPERTY AMAGE - Peracoident $ HIRREES� X NayoSj AUTOSONLY AUuTO ONL $ LIAB OCCUR EACH OCCURRENCE $ NUMBRELLA AGGREGATE $ EXCESS LIAR CLAIMS -MADE _ - DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OMFFICER/MEMBER EXCLUDED? ( andatory in NMH) If yes, describe under NIA PER OTH- E.L. EACH ACCIDENT $ E.L DISEASE - EA EMPLOYEE $ .E.L. DISEASE - POLICY LIMIT - - $. DESCRIPTION OF OPERATIONS below B Professional Liabi RTP0006077 08/0612016 08/06/2017 Aggregate - - 11000,000 Occurence 1,000,000 ppESppt�IPTO OF OP €P fPONS / J_ �q'IONS / VEKCLE (ACO 01, Atlditional Remarks Schedule, may be allached If more space Is required) Arclleaeology ifr hlistona Preservationonsul>�ants The City of Gilroy, its Officers, Officials, and Enployees are named as Additional Insureds per attached policy form IH12001185. City of Gilroy, its officers, officals and employees 7351 Rosanna Street Gilroy, CA 95020 ACORD 25' (2016103) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Kirsten 01988 -2015 ACORD CORPORXT16frAil rights The ACORD name and logo are registered`marks of ACORD POLICY NUMBER: 57 SBM EH7623 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE /POLITICAL SUBDIVISION CITY OF GILROY ITS OFFICERS, OFFICIALS, AND EMPLOYEES 7351 ROSANNA ST GILROY, CA 95020 Form IH 12 00 1185 T SEQ. NO. 003 Printed in U.S.A. Page 001 Process Date: 02 / 0 3 / 17 Expiration Date: 04/20/18 EVANS -1 OP ID: KE ,a►coMLY CERTIFICATE OF LIABILITY INSURANCE DATE(MWOWYYYY) 07/18/2016 '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: B 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 Gene Gaffney Ins Services, Inc P.O. Box 428 Occidental, CA 95465 Kirsten Edwards CONTACT Kirsten Edwards PHONE .707. 874 -2668 FAX A/c No: 707- 874 -1233 nwLSS:'klrsten affne ins.com COMMERCULL GENERAL LIABILITY CLAIMS-MADE FxI OCCUR X INSURER(S) AFFORDING COVERAGE NAIC a INSURER A: Hartford Casualty Ins. Co. EACH OCCURRENCE ' INSURED Evans & DeShazo, LLC INSURER B: RLI Insurance Group $ 1,000,00 Attn: Stacey De Shazo 6876 Sebastopol Ave. I INSURER C: $ ,10,00 Sebastopol, CA 95472 INSURER D: INSURER E: NSURER F: PERSONAL &ADV INJURY $ 2,000,00 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED'BY PAID CLAIMS. ILTR TYPE OF INSURANCE Jm POLICY NUMBER Man Y EFF MilunoryYYY1 LIMITS A X COMMERCULL GENERAL LIABILITY CLAIMS-MADE FxI OCCUR X I 67SBMBH7623 04120/2016 '0412D/2017 EACH OCCURRENCE $ 2,000,000 PREMISES Ea oocuvence $ 1,000,00 MED EXP (Any one Person) $ ,10,00 PERSONAL &ADV INJURY $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER POLICY ❑ jECT F7 LOC GENERAL AGGREGATE $ 4,000,00 PRODUCTS- COMP /OP AGG $ 4,000,000 $_ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ee accident $ BODILY INJURY (Per Person) $ ANY AUTO, ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS BODILY INJURY Peracoidenq $ E Peraccident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESSLIAB CLAIMS -MADE DED RETENTION$ S WORKERS COMPENSATION AND, EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? NIA STA UTE R - E L EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NW)' under R SCRIPcn0e OF DESCRIPTION OF OPERATION$ below ' EL DISEASE - POLICY LIMIT $ A Professional Liab. RTP0006077 08106/2016 08/06/2017 Aggregate 11000100 Occurence 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be aNaehod N more space Is required) Archeaeology 8: Historic Preservation Consultants The City of Gilroy, its Officers, Officials, and 'Enpptoyyees are named as Additional, Insureds per attached policy form IRM011185. --This certificate supercedes the certificate issued 12/11/15 a City of_Gilroy, its officers, officals and employs". 7351 Rosanna Street Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESEN Kirsten Edwards reserved. ACOHD Z5 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 57 SEM BH7623 r� THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE /POLITICAL SUBDIVISION CITY OF GILROY ITS OFFICERS, OFFICIALS, AND EMPLOYEES 7351 ROSANNA ST GILROY. CA 95020 Form IH 12 00 11 85 T SEQ.,NO. 003 Process Date: 02/04/16 Printed in U.S.A. Page 001 Expiration Date: 04/20/17