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HomeMy WebLinkAboutFlowers & Associates - Insurance CertificateFLOWE -2 OP ID: JD ,a►coRO- CERTIFICATE OF LIABILITY INSURANCE DATE 12/09/20 1.6 ,(M9 /20 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLD_ ER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terns and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER California Meridian Ins. 9700 El Camino Real Atascadero, CA 93422 House Account CONTACT NAO E: Jackie Deskin PHONE 805 - 466'3400 FAX 805 - 466'6148 N Ezt : AIC No E-MAIL ADDRESS: 1 ackie californiameridian.com INSURER(S) AFFORDING COVERAGE NAIC / INSURER A: California Automobile Ins. Co. 38342 EACH OCCURRENCE INSURED Flowers &Associates, Inc. INSURER B: National Union Fire Ins Co 1, 19445 201 N. Calle Cesar Chavez #100 MED EXP (Any one person) Santa Barbara, CA 93103 INSURER C: PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:- POLICY ECT- E LOC OTHER: INSURER D:. $ INSURER E.: $ INSURER F: A AUTOMOBILE X COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 THIS IS TO CERTIFY THAT THE POLICIES'OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS 'SUBJECT, TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR ' TYPE OF INSURANCE POLICY NUMBER MWDDIYYYY M POLICY ID/YYYY 'LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS MADE F1 OCCUR EACH OCCURRENCE $ PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:- POLICY ECT- E LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS X BA040000029127 09/01/2016 09/01/2017 Ea acdtleotSINGLE LIMIT $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) .$. X PROPERTY DAMAGE Per accident $ _ —_ _ -- _ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE EBU060476793 09/01/2016 09/01/2017 EACH OCCURRENCE _ $ 5,000,0_0 AGGREGATE $ 5,000,00. DED RETENTION $ $-- WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) �' N yes, describe under DESCRIPTION OF OPERATIONS below N / A I PER — - _ W'-I STATUTE ER E.L. EACH ACCIDENT $ EIL.DISEASE' - EA EMPLOYE _ . $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) City of Gilroy, its officers, officials, and empploy ees are additional insured per attached endorsement CA20480299. RE: W.O. 1445• FY 15 Slurry Seal Pavement Maintenance Design & Inspection Services 2015%2018 City of Gilroy Attn: David Stubchaer, P.E. 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 House Account I ©1988 -2014 ACORD CORPORATION. All riahts reserved ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: BA040000029127 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion 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 indi- cated below. Endorsement Effective: 9/01/16 Countersigned By: Authorized Representative) Named Insured: Flowers & Associates, Inc. SCHEDULE Name of Person(s) or Organization(s): City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section II of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑ ACCPREP CERTIFICATE OF LIABILITY INSURANCE 25/2 NiiI/o °"'"Y' 8/25/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND. CONFERS NO RIGHTS UPON THE CERTIFICATE HOLD_ ER. 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(iss) 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 Dealey, Renton & Associates 199 S: Los Roble es Ave #540 Pasadena; CA 91101 CONTACT NA E• Marie Swaney PHONE 626- 844 -3070 FAX EMAIL Anngiss. mswaney @dealeyrenton.com INSURERS AFFORDING COVERAGE NAIC # LIc #0020739 INSURERA:Hartford Ins. Co of Midwest 37478 9/1/2016 INSURED FLOWEASSO INSURER B :Travelers Property Casu afty Co of A 25674 Flowers &- Associates, Inc. INSURER C :Wesco Insurance Co. 25011 201 North Calle Cesar Chavez, Suite 100 Santa Barbara, CA 93103 INSURER D 805-966-2224 INSURER E: X INSURER F $10,000 rAVFRAGFS rFRTIFIEATF NIIMRFR- 502788224 RFVIminm N[IMRFR- 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, E)(CL_ USIONS 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 MM/DD/YYYY POLICY EXP MWDDNYYY LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y 6801H980764 9/1/2016 9/1/2017 EACH OCCURRENCE $1,000;000 CLAIMS -MADE a( OCCUR O NT r PREMISES '. Ea occurrence $1,000,000 X MED EXP (Anyone person) $10,000 Contractual Liab X XCUlncluded PERSONAL& ADV INJURY $1,000,000. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY H] PRO El LOC PRODUCTS - COMP /OP AGG $2,000,000 bed $0 OTHER: AUTOMOBILE LIABILITY Ea accident $ BODILY. INJURY (Per person) $ ANY AUTO LL OWNED SCHEDULED NON-OWNED P HIRED AUTOS AUTOS I BODILY INJURY (Per accidenQ $ Per accident $ $ UMBRELLA LUlB EACH OCCURRENCE $ HOCCUR AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ A WORKERS COMPENSATION EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE y 72WEGPI0126 9/1/2016 9/1/2017 X sER trr£ OT ER E.L. EACH ACCIDENT $1,000,000 OFFICERIMEMBER EXCLUDED? ❑ N/A E.L. DISEASE - EA' EMPLOYEE $1,000,000 (Mandatary In NH) If yes describe under DESCRIPTION .OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 C Professional Liability Contractor's Pollution Liab Retro Date: 10/1/1977 ITARA125588800 8/26/2016 8/26/2017 $2,000,000 per claim $4,000,000 Annual Aggregate $25,000 Deductible DESCRIPTION OF OPERATIONS I. LOCATIONS I VEHICLES (ACORD 101, Addidonal Remarks Schedule, maybe attached. If more space Is required) Cancellation Notice: 30 day /10 day for non -pay or premium will be Trailed to the certificate holder. AM Best's Rating on all policies above: A/XII or greater. RE: WO #1445, 2015/2016 Pavement Design /Construction -- City of Gilroy, its officials, officers and employees are named as additional insured as respects general liability for claims arising from the operations of the named insured as required per written contract or agreement.. SEE CANCELLATION'SECTION of Certificate for 30 Day Notice of Cancellation /10 Day for Non - Payment of Premium. See Attached... GtK I If-It ;A I t P1ULUr-K UANGtLLA 1 IUN JU UaV v4u%ai I v Uav Tor nonijav OT Drem City of Gilroy, its officials, officers and employees Attn: David Stubchaer 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 @1988 -2014 ACORD ACORD 25 (2014 /01) The ACORD name and logo are registered marks of ACORD AG R AGENCY CUSTOMER ID: FLOWEASSO LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAmeD INSURED Dealey, Renton & Associates Flowers &.Associates, Inc. 201 North Calle Cesar Chavez, Suite 100 Santa Barbara, CA 93103 ___ OOL1 Y NUmifm 805 -966 -2224 CARRIER 71'C CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Coverage afforded the additional insured is primary and non - contributory as respects to general liability coverage. Insurance coverage includes waiver of subrogation per the attached endorsement(s). SEE CANCELLATION SECTION of Certificate for 30 Day Notice of Cancellation /10 Day for Non - Payment of Premium. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Insurance Policy Waiver of Our Right to Recover From Others Endorsement - California WC 04 03 06 If the following information is not complete, refer to the appropriate Schedule attached to the policy. Insured:Flowers & Associates, Inc. Producer: Dealey, Renton & Associates Schedule Person or Organization City of Gilroy, its officials, officers and employees Attn: David Stubchaer 7351 Rosanna. Street Gilroy CA 95020 Additional Premium % We have the right to recover our payments from any- one 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.) #^a4 4-U Authorized Representative WC040306 Policy Number 72WEGP10126 Effective Date 9 / 1 / 2 016 Job Description City of Gilroy, its officials, officers and employees -- RE: WO #1445, 2015/2016 Pavement Design /Construction You mst maintain payroll records accurately segre- gating the remuneration of your employees while en- gaged in the work described in the Schedule. The additional premium for this endorsement shall be the percentage, as shown in the Schedule applicable to this endorsement, of the California. workers' compensation premium otherwise due on such remuneration. POLICY NUMBER: 6801x980764 COMMERICAL GENERAL LIABILITY ISSUE DATE:8/25/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. . ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): City of Gilroy, its officials, officers and employees Attn:.David Stubchaer 7351 Rosanna Street Gilroy CA 95020 PROJECT /LOCATION OF COVERED OPERATIONS: City of Gilroy, its officials, officers and employees -- RR: WO #1445, 2015/2016 Pavement Design /Construction PROVISIONS A The following is added to WHO IS AN INSURED (Section II): The person or organization shown in the Sched- ule above is an additional insured on this Cover- age Part, but only with respect to liability for bod- ily injury", '.property damage" or 'personal injury caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance 'of your ongoing oper- ations;. b. In connection with premises owned by or rented to you; or C. In connection with your work and included within the "products- completed operations hazard." Such person or organization does .not qualify as an additional insured for "bodily injury", "property damage" or "personal injury' for which that Person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: This insurance does not apply to the render- ing of or failure to render any "professional services ". The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in that 'contract or agreement requir- ing insurance" to provide for that additional insured, or the limits shown in the Declarations for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section 111) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a contract or agreement requiring insurance that, for the addi- tional insured shown In the Schedule, the insur- ance provided to that' additional insured under this CG D3 82 09 07 Page 1 © 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office Inc., with its permission COMMERICAL GENERAL LIABILITY Coverage Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring insurance" for such additional insured. But this insurance still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when the additional insured is also an additional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL ,LIABILITY CONDITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" on or for the project, or at the location, shown in the Schedule above, performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insurance" with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement under which you are required to include the person or organization shown in the Schedule as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs, and the "personal injury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. CG D3 82 09 07 Page 2 © 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office Inc., with its permission POLICY NUMBER: BA040000010360 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion 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 indi- sated below. Endorsement Effective: 5/26/2016 Countersigned By: r Authorized Representative) Named Insured: Flowers & Associates, Inc. SCHEDULE Name of Person(s) or Organization(s): City of Gilroy, its officers, officials, and employees 7351 Rosanna Street' Gilroy, CA 95020 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured Provision contained in Section 11 of the Coverage Form. CA 20 48 02 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 ❑ AEORO® CERTIFICATE OF LIABILITY INSURANCE Iii -1-8/25/2016- DATE(MNmomYYl THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS'NO RIGHTS UPON''THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATMELY 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 farms 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 ONTACT Marie Swans Dealey, Renton & Associates 199 S. Los Robles Ave #540 Pasadena, .CA 91101 PHONE 626 844 -3070 FA a1nIL mswane deals renton.com ye° y INSURER(S) AFFORDING COVERAGE NAICN Lie #0020739 INSURER A: Hartford ins. CO Of Midwest 37478 91112017 INSURED FLOWEASSO INSURER B:Travelers Property Casualty CoofA 25674 INSURER C NSISOO Insurance CO. 25011 Flowers &'Associates, Inc. 201 North Calls Cesar Chavez, Suite 100 Santa Barbara, CA 93103 NSURER o ; DAMAGE TO Rein to PR MI' E a--nc 805 - 966.2224 INSURER E MED EXP(Myane person) INSURER F: �CDlvractual L12b COVERAGES CERTIFICATE NUMBER: 502788224 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 MAYBE 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. INSRR TYPE OF INSURANCE IN ADDL SUER w POLICY NUMBER POLICY EFF POLICDY EXP LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y 68011-1980764 911/2016 91112017 EACH OCCURRENCE '$1,OOQ000 CLAIMS-MADE � OCCUR DAMAGE TO Rein to PR MI' E a--nc 57,000.000 X MED EXP(Myane person) $10,000 �CDlvractual L12b X 'XCU'Included PERSONAL B ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY j�C LOC ,PRODUCTS- COMP /OP AGG $2,000,000 Ded $0 OTHER- AUTOMOBILE LIABILITY Ee accident $ BODILY INJURY(Per person) $ MY AUTO p AAUT8rED NUTS Ep HIRED AL TO$ AUTOS BODILY INJURY (PeraccMenO $ er accl0am $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 'AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNEWEXECUTIVE YIN y 72WFGPI0126 9112016 9/1/2017 X T T DER E.L EACH ACCIDENT $11000;000 OFFICER/MEMBER EXCLUDED? (Mandasory In NH) NIA 'E.L DISEASE - EA EMPLOYEE $1,000,000 K yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 C Professional Liability Y 'ARA125588800 8262016 8126/2017 $2,000,000 per Claim,. Contractors Pollution Llab Retro Date: 10/1/1977 $4,000,000 Annual Aggregate $25,000 Deductible DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be aaached K more apace Is required) Cancellation Notice: 30 day /10 day for non -pay or premium will be mailed to the certificate holder. AM Best's Rating on all policies above: A/XII or greater. RE: WO #1445, 2015/2016 Pavement Design /Construction - City of Gilroy, its officials, officers and employees are named as additional insured as respects general liabil'ty for claims arising from the operations of the named Insured as required per written contract or li agreement. SEE CANCELLATION SECTION Of Certificate for 30 Day Notice of Cancellation /10 Day for Non - Payment of Premium. See Attached... CERTIFICATE HOLDER CANCELLATION 30 Day NOC /10 Day for nonpay, of prem City of Gilroy, its officials, officers and employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: David Stubchaer ACCORDANCE WITH THE POLICY PROVISIONS. 7351,Rosanna Street Gilroy CA 95020 AUTHORIZED REPRESENTATIVE 01968.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: FLOWEASSO _ LOC #: A 0120 ADDITIONAL REMARKS SCHEDULE Page 1 of 1— AGENCY 'NAMED INSURED Dealey, Renton & Associates Flowers & Associates, Inc. 201 North Calle Cesar Chavez, Suite 100 POLICY NUMBER Santa Barbara, CA 93103 805966 -2224 CARRIER NAIC CODE EFFECTIVE DATE: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM; FORM NUMBER: 25 FORM TITLE: CERTIFICATE OFiLIABILrry INSURANCE insured is primary and non - contributory as respects to general liability coverage. Insurance coverage .r the attached endorsement(s). of Certificate for 30 Day Notice of Cancellation 110 Day for'Non- Payment of Premium. 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Workers' Compensation and Employers' Liability Insurance Policy Waiver of Our Right to Recover From Others Endorsement - California WC 04 03 06 If the following information is not complete, refer to the appropriate Schedule attached to the policy. Insured:Flowers & Associates, Inc. Producer. Dealey, Renton & Associates Schedule Person or Organization City of Gilroy, its officials, officers and employees Attn: David Stubchaer 7351 Rosanna Street Gilroy CA 95020 Additional Premium % We have the right to recover our payments from any- one 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.) Authorized Representative WC040306 Policy Number 72WEGPI0126 Effective Date 9/1/2016 Job Description City of Gilroy, its officials, officers and employees -- RE: WO #1445, 2015/2016 Pavement Design /Construction You mist maintain payroll records' accurately segre- gating the remuneration of your employees while en- gaged in the work described in the Schedule. The additional premium for this endorsement shall be the percentage, as shown in the Schedule applicable to this endorsement, of the California workers' compensation premium otherwise due on such remuneration. POLICY NUMBER: 6801H980764 COMMERICAL GENERAL LIABILITY ISSUE DATE: 8/25/2016 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSON(S) OR ORGANIZATION(S): City of Gilroy, its officials, officers and employees Attn: David Stubchaer 7351 Rosanna Street Gilroy CA 95020 PROJECT /LOCATION OF COVERED OPERATIONS: City of Gilroy, its officials, officers and employees -- RE: WO #1445, 2015/2016 Pavement ,Design /Construction PROVISIONS A The following is added to WHO IS AN INSURED (Section II): The person or organization shown in the Sched- ule above is an additional insured on this Cover- age Part, but only with respect to liability for bod- ily injury", 'property damage" or 'personal injury caused, in whole or in part, by your acts or omis- sions or the acts or omissions of those acting on your behalf: a. In the performance of your ongoing oper- ations; b. In connection with premises owned by or rented to you; or C. in connection with your work and ,included within the "products - completed operations hazard." Such person or organization does not qualify as an additional insured for "bodily injury", 'property damage" or "personal injury' for which that person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: d. This insurance does not apply to the render- ing of or failure to render any "professional services ". The limits of insurance afforded to the addi- tional insured shall be the limits which you agreed in that 'contract or agreement requir- ing insurance' to provide for that additional insured, or the limits shown in the Declarations for this Coverage Part, whichever are less. This endorsement does not increase the limits of insurance stated in the LIMITS OF INSURANCE (Section III) for this Coverage Part. B. The following is added to Paragraph a. of 4. Other Insurance In COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): However, if you specifically agree in a contract or agreement requiring insurance that, for the addi- tional insured shown in the Schedule, the insur- ance provided to that additional insured under this CG D3 82 09 07 page 1 © 2007 The Travelers Companies, Inc. Includes the copyrighted material of Insurance Services Office Inc., with Its permission COMMERICAL GENERAL LIABILITY Coverage Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have entered into that "contract or agreement requiring Insurance" for such additional insured. But this Insurance still, is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when the additional insured is also an additional insured under any other insurance. C. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us in COMMERCIAL GENERAL LIABILITY CONDITIONS (Section IV): We waive any rights of recovery we may have against the additional insured shown in the Schedule above because of payments we make for 'bodily injury", 'property damage" or "personal injury' arising out of "your work' on or for the project, or at the location, shown in the Schedule above, performed by you, or on your behalf, under a "contract or agreement requiring insurance" with that additional insured. We waive these rights only where you have agreed to do so as part of the "contract or agreement requiring insurance" with that additional insured entered into by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. D. The following definition is added to DEFINITIONS (Section V): "Contract or agreement requiring insurance" means that part of any contract or agreement under which you are required to include the person or organization shown in the Schedule as an additional insured on this Coverage Part, provided that the "bodily injury' and "property damage" occurs, and the "personal Injury" is caused by an offense committed: a. After you have entered into that contract or agreement; b. While that part of the contract or agreement is in effect; and c. Before the end of the policy period. CG D3 82 09 07 Page 2 ® 2007 The Travelers Companies, Ina Includes the copyrighted material of Insurance Services Office Inc., with its permission