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HomeMy WebLinkAboutTwo Brothers Cathodic - Insurance Certificate `a Allstate. You're in good hands. CICWA021011 CERTIFICATE OF INSURANCE This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms,exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder. Named Insured: CITY OF GILROY TWO BROTHERS CATHODIC SERVICE ITS OFFICERS,OFFICIALS AND 5361 HILLTOP RD EMPLOYEES AS ADDITIONAL INSURED GARDEN VALLEY CA 95633-9501 7351 ROSANNA ST GILROY, CA USA 950206141 - ------------------------------------------------------------ Automobile Liability Insurer Name:Allstate Insurance Company Policy Number: 048751653 1 --Any Auto 2-Owned Autos Only 3-Owned Priv.Pass.Autos Only 4--Owned Autos Other Than Priv. 5-Owned Autos Subject to 6-Owned Autos Subject to a Compulsory UM Law Pass.Autos Only No Fault x 7--Specifically Described Autos 8-Hired Autos Only 9-Nonowned Autos Only Policy Effective Date: 11-16-2018 Policy Expiration Date: 11-16-2019 Limits of $2,000, 000 Combined Single Limit(each accident) Insurance: BI Per Person BI Per Accident PD Per Accident Description of Operations/Locations/Vehicles/Endorsements/Special Provisions Interested Party Type: Additional Insured - Municipality THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES)MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer: BACIOCCO BROS INS Authorized Representative: Date: 09-02-18 : Includes copyrighted material of Insurance Services Office, Inc., with its permission j"�.'���-. P BU114R-3 CI CW A02 10 11 Allstate Insurance Company Page 1 of 1 Additional Insured Copy ())Allstate. You're in good hands. POLICY NUMBER: 048751653 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POUCY. 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: TWO BROTHERS CATHODIC SERVICE Endorsement Effective Date: 1 1-16-2 018 SCHEDULE Name Of Person(s) Or Organization(s): CITY OF GILROY ITS OFFICERS,OFFICIALS AND EMPLOYEES AS ADDITIONAL INSURED 7351 ROSANNA ST GILROY, CA USA 950206141 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. BU114R-3 CA 20 48 10 13 ©Insurance Services Office, Inc., 2011 Page 1 of 1 Additional Insured Copy TWOBROT -02 MMURCHISON CERTIFICATE OF LIABILITY INSURANCE COVERAGES CERTIFICATE NUMBER: REVIS!0N NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DATE 01 /31 /2018Y) 01 /31 /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 Cumbre Insurance .Services, LLC 4065 Mother Lode Drive Suite CONTACT Alaina Shortes- Bosold NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E -MAIL alaina @cumbreins.com ADDRESS: Shingle Springs, CA 95682 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Colony Insurance Company 39993 101 GL 0005336 -03 INSURED INSURER B: National Union Fire Insurance Company of Pittsburgh, Pa. 19445 INSURER C: Two Brothers Cathodic Services, Inc. INSURER D: 5361 Hilltop Road Garden Valley, CA 95633 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVIS!0N 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 IN SD SUBR WVD POLICY NUMBER POLICY EFF M /DD NYNI POLICY EXP (MM/DDNYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [X ] OCCUR X 101 GL 0005336 -03 02/03/2018 02/03/2019 EACH OCCURRENCE $ 1,000,000 DAMASETO a RENTED nce $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY 1 PE0 F—] LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPcE.R DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY B X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE $ EXCESS LIAR CLAIMS -MADE EBU 021521317 02103/2018 02/03/2019 DED RETENTION $ $ 3,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under N /A E.L. DISEASE - EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Gilroy, its officers, officials and employees are named as an additional insured RE: Work performed by the insured when under contract. 10 days notice of cancellation for non - payment of premium. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy, its officers officials and employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Allstate. You're in good hands. CERTIFICATE OF INSURANCE Cl CW A02 10 11 This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the berms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder. Named Insured: CITY OF GILROY TWO BROTHERS CATHODIC SERVICE ITS OFFICERS, OFFICIALS AND 5361 HILLTOP RD EMPLOYEES AS ADDITIONAL INSURED GARDEN VALLEY CA 95633 -9501 7351 ROSANNA ST GILROY, CA USA 950206141 Automobile Uability Insurer Name: Allstate Insurance Company Pol' Number. 048751653 1 --Any Auto 2 - Owned Autos Only 3 - Owned Priv. Pass. Autos Only F 4 -- Owned Autos Other Than Priv. Pass. Autos Only 5 - Owned Autos Subject to No Fault 6 - Owned Autos Subject to a Compulsory UM Law X 17 -- Specifically Described Autos 1 18 - Hired Autos Only 9 - Nonowned Autos Only Policy Effective Date: 11-16-2017 1 Policy Expiration Date: 11 -16 - 2 018 Limits of $2,000,000 Combined Single Limit (each accident) Insurance. BI Per Person I BI Per Accident PD Per Accident Description of O rations /Locations /Vehicles /Endorsements /S cial Provisions Interested Party Type: Additional Insured - Municipality THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer. BACIOCCO BROS INS Authorized Representative: Date: 09 -04 -17 N BU114R -3 CI CW A02 10 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission Allstate Insurance Company Additional Insured Copy Page 1 of 1 Allstate. You're in good hands. POLICY NUMBER: 048751653 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: TWO BROTHERS CATHODIC SERVICE Endorsement Effective Date: 11-16-2017 SCHEDULE Name Of Person(s) Or Organization(s): CITY OF GILROY ITS OFFICERS,OFFICIALS AND EMPLOYEES AS ADDITIONAL INSURED 7351 ROSANNA ST GILROY, CA USA 950206141 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. r, BU114R -3 CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Additional Insured Copy Page 1 of 1 ACOI�O® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 2/1/2017 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 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 endorseme s . PRODUCER CONTACT Sarah Cookie NAME: Cumbre Insurance Services, LLC PHONE (530) 677 -8755 (C N0 A/C E -MAIL AD DRESS: cookies @dlins.com Formerly Mother Lode Ina Svcs P.O. Box 1310 INSURE S AFFORDING COVERAGE NAIC 0 INSURERA-Colony Insurance Cc EACH OCCURRENCE Cameron Park CA 95682 INSURED INSURER B :Burns S Wilcox Ins.. Services 100,000 $ r INSURERC: MED EXP (Any one person) Hamann, Dale, DBA: Two Brothers Cathodic Ser. Inc. 5361 Hilltop Road INSURER 0: X INSURER E: 101 GL 0005336 -03 2/3/2017 Garden Valley CA 95633 INSURER F: COVERAGES CFRTIFICOTF NIIMRFR•2017-20IR ocinalnu ui1ueco. 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.REOUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT 1NITH 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City f ty Gilroy, its Officers Officials and employees POLICY NUMBER POLICY EFF POLICY EXP 011301YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE T RENTED PREMISES Eeoccurrence) 100,000 $ r MED EXP (Any one person) $ 5,000 X 101 GL 0005336 -03 2/3/2017 2/3/2018 PERSONAL S ADV INJURY $ 1,000,000 GEN•L AGGREGATE LIMIT APPLIES PER: POLICY E] PET LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY 1 Ea% daMI $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident)' $ HIRED AUTOS AUTOS PROPERTY DAMAGE (Per accident) $ $ X UMBRELLA UAB OCCUR - EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3 000 000 B EXCESS LIAR - CLAIMS -MADE DIED _. RETENTION $ EBU 021521317 2/3/2017 2/3/2018 WORKERS'COMPENSATION AND EMPLOYERS' LIABILITY YIN N ANY PROPRIETOR/PARTNER/EXECUI OFFICER/MEMBER EXCLUDED? NIA PER 0TH - U ER E.L. EACH ACCIDENT - $ - E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERAnONS I LOCATIONS I VEHICLES (ACORD 101, Addldonal Remarks Schedule, maybe attached M more space Is required) City of Gilroy, its officers, officials and employees are named as an additional insured, per the attached endorsement RE: Work performed by the insured when under contract. 10 days notice of cancellation for non - payment of premium. I.CK I I FICA I, C' NULULK 9`AM/-CI1 Anf1L1 (408)846 -0288 daldridge @ci.gilroy.ca.us - SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City f ty Gilroy, its Officers Officials and employees THE :EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE Sarah Cookie /SARAH_S ACORD 25 (2014101) INRQ75 mnienn 9 1958 -ZU14 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 101 GL 0005336 -03 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL. INSURED - OWNERS, LESSEES OR CONTRACTORS - BLANKET COVERAGE INCLUDING PRIMARY / NON - CONTRIBUTORY AND WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) Additional Insured): Locations of Covered Operations: All persons or organizations as required by a written contract or agreement with the named insured. Locations as required by a written contract or agreement with the named insured. A. SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. 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 for the additional insured(s) at the location(s) designated above. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations at Work "bodily injury" or "property damage" occurring after: 1. all work, including materials, parts or equipment fumished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization. Negligence of Additional Insured "bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional insured(s). U156A -0313 Includes copyrighted material of ISO Properties, Inc., Page 1 of 2 with its permission. 101 GL 000533e -03 C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is amended and the following added: The insurance afforded by this Coverage Part for the additional insured required by a written contract or agreement with the named insured is primary insurance and we will not seek contribution from any other insurance available to that additional insured. D. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of Recovery Against Others To Us is amended and the following added: We waive any rights of recovery we may have against any person or organization because of payments we make for injury or damage resulting from your ongoing operations or `Your work" done under a contract with that person or organization and included in the "products- completed operations hazard" if: a. you agreed to such waiver; b. the waiver is included as part of a written contract or lease; and c. such written contractor lease was executed prior to any loss to which this insurance applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U1 56A -0313 Includes copyrighted material of ISO Properties, Inc., Page 2 of 2 with Its permission. Allstate. You're in good hands. CERTIFICATE OF INSURANCE Cl CW A02 10 11 This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder. Named Insured: CITY OF GILROY TWO BROTHERS CATHODIC SERVICE ITS OFFICERS, OFFICIALS AND 5361 HILLTOP RD EMPLOYEES AS ADDITIONAL INSURED GARDEN VALLEY CA 95633 -9501 7351 ROSANNA ST GILROY, CA USA 950206141 Automobile Liability Insurer Name: Allstate Insurance Company Poli Number: 048751653 1 --Any Auto 2 - Owned Autos Only 3 - Owned Priv. Pass. Autos Only 4 -- Owned Autos Other Than Priv. Pass. Autos Only 5 - Owned Autos Subject to No Fault 6 - Owned Autos Subject to a Compulsory UM Law X 7 -- Specifically Described Autos 8 - Hired Autos Only 9 - Nonowned Autos Only Policy Effective Date : 11-16-2016 1 Policy Expiration Date: 11-16-2017 Limits of $2 , 000,000 Combined Single Limit (each accident) Insurance. BI Per Person f BI Per Accident i PD Per Accident Description of Operations/Locations/Vehicles/Endorsements/Special Provisions Interested Party Type: Additional Insured - Municipality THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer. BACIOCCO BROS INS Authorized Representative: Date: 09 -02 -16 Iffl0.e. BU114R -3 Cl CW A02 10 11 Includes copyrighted material of Insurance Services Office, Inc., with its permission Allstate Insurance Company Additional Insured Copy Page 1 of 1 Allstate... You're in good hands. POLICY NUMBER: 048751653 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: TWO BROTHERS CATHODIC SERVICE Endorsement Effective Date: 11-16-2016 SCHEDULE Name Of Person(s) Or Organization(s): CITY OF GILROY ITS OFFICERS,OFFICIALS AND EMPLOYEES AS ADDITIONAL INSURED 7351 ROSANNA ST GILROY, CA USA 950206141 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. U -, 4 -, BU114R -3 CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Additional Insured Copy Page 1 of 1 AC R°® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 2/1/2017 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 poiicy(ies) must be endorsed. If SUBROGATION 1S 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 'Cumbre Insurance Services, LLC `Formerly Mother Lode Ins Svcs P.O. BOX 1310 Cameron Park CA 95682 CONTACT Sarah Cookie NAME: PHONE (530)677 -8755 1FAX (530)677 -0314 1C, ll E-MAIL SS: cookies@dline.cam ADDRE INSURER(S) AFFORDING COVERAGE NAIC R INSURER A:C010MY Insurance Cc LIMITS INSURED Hamann, Dale, DBA: Two Brothers Cathodic Ser. Inc. 5361 Hilltop Road Garden- Valley CIL 95633 INSURER B :Burns & Wilcox Ins. Services COMMERCIAL GENERAL LIABILITY INSURER C: INSURER D: INSURER E EACH OCCURRENCE INSURER F: A COVERAGES CERTIFICATE NUMBER:2017 -2018 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 officials and employees ACCORDANCE WITH THE POLICY PROVISIONS. POLICY NUMBER POLICY EFF POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 A CLAIMS MADE OCCUR PREMISES SES Ea occurrence $ 100, 000 MED EXP (Any one person) $ 5,000 X 101 GL 0005336 -03 2/3/2017 2/3/2018 PERSONAL & ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 7 JET 'F1 LOC PRODUCTS- COMP/OP AGG $ 2, 000, 000 $ OTHER: AUTOMOBILE LIABILITY COMBINED ING LIM Ea accdent $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ NON -OWNED HIRED AUTOS AUTOS $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE $ 3,000,000 B EXCESS LIAB CLAIMS -MADE Dim I I RETENTION $ EBD 021521317 2/3/20.17 2/3/2018 WORKERS-COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE W STATUTE ER E.L. EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A E.L. DISEASE -'EA EMPLOYE $ (Mandatory In NH) If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTIONOF OPERATIONS /LOCATIONS /VEHICLES (ACORD 107, AddlBOnal Remarks Schedule, may be attached H more space Is required) City of Gilroy, its officers, officials and employees are named as an additional insured, per the attached endorsement RE: Work performed by the insured when under contract. 10 days notice of cancellation for non- payment of premium. CERTIFICATE HOLDER CANCELLATION (408)846 -0288 daldridge@ci.gilroy.ca.us SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy, its Officers THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED. IN officials and employees ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna. Street AUTHORQEDREPRESENTATIVE Gilroy, CA 95020 Sarah Cookie /SARAH ACORD 25'(2014/01) INS025 pouoi) ®1988- 2014,ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Two Brothers Cathodic Ser. Inc. Two Brothers Cathodic Ser. Inc. Two Brothers Cathodic Ser. 'Inc. Two Brothers Cathodic Ser. Inc. Two Brothers Cathodic Ser. Inc. Two Brothers Cathodic Ser. Inc. Two Brothers Cathodic Ser. Inc. Additional Named Insureds Doing Business As Doing Business As Doing Business As Doing Business As Doing Business As Doing Business As Doing Business As OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC 101 GL 0005338 -03 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Addfional Insured Person(s) or Organization(s) (Additional Insured): Location(s) of Covered Operations: CITY OF GILROY, ITS OFFICER, OFFICIALS PER WRITTEN CONTRACT WITH THE AND EMPLOYEES NAMED INSURED 7351 ROSANNA STREET Gilroy, CA 95020 It is further agreed that this insurance shall be Primary and Non - Contributory but only in the event of a Named Insured's sole negligence. A. SECTION 11 WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule for whom you are perfomvng operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. 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: I. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "Bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations at Work "Bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of'your work' out of which the injury or damage arises has been put to its intended use by any person or organization. Negligence of Additional Insured "Bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional U156 -0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of with its permission. 101 GL 0006336 -03 insured(s). ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U156 -0310 Includes copyrighted material of ISO Properties, Inc., Page 2 of 2 with its permission. 101 GL 0005336 -03 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE ame of Additiorial Insured Person(s) or Organization(s) Additional Insured): Locations of Covered Operations:- _ All persons or organizations as required by a written Locations as required by a written contractor contract or agreement with the named insured. agreement with the named insured. A. SECTION 11— WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. 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 for the additional insured(s) at the locations) designated above. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations at Work "bodily injury" or "property damage" occurring after: 1. all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. that portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization. Negligence of Additional Insured "bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional insured(s). U156A -0313 Includes copyrighted material of ISO Properties, Inc., Page 1 of 2 with its permission. 101 GL 0005336.03 C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is amended and the following added: The insurance afforded by this Coverage Part for the additional insured required by a written contract or agreement with the named insured is primary insurance and we will not seek contribution from any other insurance available to that additional insured. D. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of Recovery Against Others To Us is amended and the following added: We waive any rights of recovery we may have against any person or organization because of payments we make for injury or damage resulting from your ongoing operations or "your work` done under a contract with that person or organization and included in the "products- completed operations hazard" if: a. you agreed to such waiver; b. the waiver is included as part of a written contract or lease; and c. such written contractor lease was executed prior to any loss to which this insurance applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U156A -0313 Includes copyrighted material of ISO Properties, Inc., Page 2 of 2 with its permission.