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HomeMy WebLinkAboutSafety Network Traffic Signs - Insurance CertificateCAPFT -4 OP ID- SM ® CERTIFICATE OF LIABILITY INSURANCE DATE(M2/20 17 03/22/20 7 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 559 - 226 -5191 Imhoff Sunland/PacWestAlliance License # 6632759 2843 N. Maroa /P.O. Box 4579 Fresno, CA 93744 Imhoff Sunland,Ins Serv, Inc. CONTACT Imhoff Sunland Ins Serv, Inc. N M .. PNONE 559 -226 -5191 FAX 559 - 226 -5197 A/c, No, Ext : (Arc, No): EDDRE INSURERS) AFFORDING COVERAGE NAIC# INSURERA:State Comp Insurance Fund 35076 INSURED Safety Network, Inc. - Safety Network Traffic Signs, Inc.; Safety Network Traffic INSURER B: INSURERC: INSURER 0: $ Control Services, Inc. 2310 N. Larkin Ave Fresno, CA 93727 -8644 INSURER E: MED EXP' (Any one person) INSURER F DCUI-Clrlhl NI IMRFR- G.VYCrV \l7 CO vcr".ur,v�,.� nvn, ✓�,�. - -- -- --- - - - -- 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 TYPE OF INSURANCE DDL I SUBR POLICY NUMBER POLICY EFF M D POLICY EXP )o1YYYYI LIMITS LTR COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑, OCCUR EACH OCCURRENCE... $ DAMAGE TO RENTED E ' rence MED EXP' (Any one person) PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: POLICY E] PRO ❑ LOC JECT OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP /OP AGG $ - $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AURTEOS ONLY AUOTNOpS E AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT c BODrILY INJURY Per" rson $ BODILY INJURY Per accident $ Pe08�RdTT nt AMAGE $ UMBRELLA LIAB EXCESS L_ U_ 1B OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I RETENTION '$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE �FFICER/MEMBEREXCLUDED? Vlendatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below - NIA 9094397 -17 04/01/2017 04/01/2018 X PER OTH- E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE 1,000,000 $- E.L. DISEASE - POLICY LIMIT 1,000,000 $ F� &W- I N / y�HICLEg ACORp rke dition ,n � fiche ule % be alts red if more space is required) tC1-Y- YW -.SJU Ke�ula�01 Slfl Invenie3ry aria KeiroereCUVlij/ As$esmen Waiver of'Subroga Ion per form 10217 - attached CITYGI1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of'Gilroy 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE ACORD 25 (2016103) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 0 HOME OFFICE SAN FRANCISCO ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME 1. ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS BROKER COPY REP 04 9094397 -17 RENEWAL NE 3- 13 -74 -07 EFFECTIVE APRIL 1, 2017 AT 12.01 A.M. PAGE 1 OF AND EXPIRING APRIL 1, 2018 AT 12.01 A.M. - SAFETY NETWORK, INC. 2310 N LARKIN AVE FRESNO, CA 93727 WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE. THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER A.WRITTEN.CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00° OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION• ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED ® HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION 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 SA�NFRFRANCISCO: v4 AUTHORIZED REPRESENT IVE SCIF FORM 10217 (REV.7-2014) MARCH 21, 2017 PRESIDENT AND CEO 1 2572 OLD DP 217 SAFET41 OP ID :.SM �..� - CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 1ai2oi2o1s 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 ISS_ UING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must.be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of,the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Imhoff Sunland/PacWestAlliance License # 0632759 2843 N. Marna 1 P.O. Box 4579 Fresno, CA 03744 CONTACT NAME Imhoff Sunland Ins Serv, Inc. PHONE 559-6226-5191 No : 559- 226 -5197 MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC A Imhoff Sunland Ins Serv, Inc. INSUMA:Everest National Insurance Co X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR INSURED Safety Network, Inc; Safety Network Traffic Control INSURER 8: CMU0765 -161 I 06106/2016 06/0612017 Services, Inc; Safety Network INSURERC: Traffic Signs, Inc. 2310 N. Larkin. Ave INSURER D: _ MED EXP (Any one person _100,000 $ 10,000 Fresno, CA.83727.8644 INSURER E: INSURER F : G113VFRAr11FR CFRTIFIr_ATF Ml IMr7F0. 0M%1!0j^K1 4111a110 CO: 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 S_ HOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS:, LT R TYPE OF INSURANCE A D POLICY NUMBER POLICY EFF M EXP � LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR CMU0765 -161 I 06106/2016 06/0612017 EACH OCCURRENCE 3 1,00000 PREMISES O (Ea wence) RERTEtr g MED EXP (Any one person _100,000 $ 10,000 PERSONAL B ADV INJURY _ $ 1,006,00 GEMLAGGREGATE' LIMIT APPLIES PER: X POLICY ❑ ECT F LOC GENERAL AGGREGATE' S 2,060,060 PRODUCTS -COMPIOPAGG $ 2,600,000 TER AUTOMOBILE LIA131LJTY CEOMBIINNEB (SINGLE LIMIT BODILY INJURY (Per person) $ ANY AUTO ALL OWNED AUTOS TO SCHEDULED _ AU HIRED AUTOS NON -OWNED BODILY INJURY (Per accident) $ PROYERTYOAMAGE § _ - - § UMBRELLA LIAB OCCUR EACH OCCURRENCE S AGGREGATE S EXCESS LIAR' CLAIMS -MADE DED RETENTION $ $ _ WORKERSOOMPENSATION AND EMPLOYERS LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y / N OFFICERIMEMBER EXCLUDED? NIA R' T - T T U .L E.L. ACH ACCIDENT - $ E.L. DISEASE = EA EMPLOYEE -- $ (Mandatory In NH) If yes deseritie under DE 1 _ 1 OF OPERATIONS below E.L. DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Romarks SchodUle. may bo attaohod If moro apaco is roqulred) 96- RFP- PW-390 Regulatory Sign Inventory and Retroereflectivlty Assessment ADDITIONAL INSURED gpuer form CG 20 33; PRIMARY &g NONCONTRIBUTORY per form CG OF TRANSforms FARIGHTS OR RECOVERY AGAINST OTHERSrtO US perr form CG 24 04. 30 day Cancellation except 10 days for Non Payment of Premium. CITYGII City of Gilroy, its officers, officials, employees and volunteers- 7351 Rosanna Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE _ EXPIRATION_ DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ITHORIZED REPRESENTATIVE 1988 -2014 ACORD CORPORATION.. All rights reserved ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Policy # CF4GL00765 -161 COMMERCIAL GENERAL LIABILITY _ CQ 20 33 0413 THiS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT'.CAREFULLY. • CONTRA' ADDITIONAL INSOREO ® OWNERS, LESSEES OR TORS AUT'OMA1i'iC To WHEN REQUIRED IN COfVS 'RU►CTION AGREEMENT WITH YOU This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. 8801110n ,11 -• Who Is An Insured is amended to include as an additional Insured any .person or organization 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 ly 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. However, the insurance afforded to such additional Insured: 1. O d and to the extent permitted by law; 2. Will not be broader than that which you are required by the contract or agreement to provide for such additional Insured. 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 hose additional Insureds, the following dddillonal exclusions apply: This insurance does not apply'to: 1. "Bodliy Injury'; `properly dam. age" or "personal and, advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering 'or surveying services, including: a. The preparing, approving, or failing to prepare or-approve, maps; shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, Inspection, architectural or engineering aclivilles,. This exclusion applies, even if the claims, against any Insured allege negligence or other wrongdoing in the supervision, hiring, .employment, training or monitoring of others by that Insured, it the "000urrence" whlch 'caused the " bodiiy Injury" or "Property damage ", or the offense which caused the "personal and advertising Injury ", involved the rendering of or the failure to render any professional architectural, engineering or surveying services. CQ 20 33 0413 0 Insurance Services Office, Inc., 2012 Page i of,2 CG 20 33 04 13 2. `Bodily Injury" or "property damage" occurring after: a. All work, Including materials, parts or equipment furnished In connection with such work, on the project (other than service, maintenance or repairs) to be Fpperformed by or on behalf of the additional at the location of the covered operations has been completed; or b. That portion of "your work" out of which the Injury or damage arises has been put toits Intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a ,principal as a part of the same project. C. With respect to the Insurance afforded to . these additional Insureds, the following is added' to Seollon'fll- Limits Of insurarice: The most we will pay on behalf of the additional Insured Is the amount of Insurance: 1. Required :by the contract or agreement you have 'entered Into with the ,additional insured; 2,. Available under. the applicable Limns of Insurance shown in the Declarations; whichever is less. This endorsement shall not Increase the applicable Limits of Insurance shown in the Declarations, All terms and conditions apply unless modified bythis endorsement. Page 2 of 2 © Insurance Services Office, [no., 2012 CG 20 33 0413 Policy # CF4GL00765 -161 COMMERCIAL GENERAL LIABILITY CG 20 0104 13 THIS ENDORSEMENT CHANGES THE :POLICY, PLEASE READ IT CAREFULLY. PRIMARY AN. . ONCONTRIBUTIORY OTHER INSURANCE COIND TION This endorsement modifies insuranoe provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is ;added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This Insurance Is primary to and will not. seek. contribution from any other Insurance available to an additional insured under your policy provided that: (1) The additional Insured is a Named Insured under such other Insurance; and (2) You have agreed In writing In a contract or agreement that this Insurance would be primary and would not seek contribution from any other Insurance available to the additional Insured. All terms and conditions of this policy apply unless modified by this endorsement. CG 20 0104 113 © Insurance Services Office, Inc., 2012 Page 1 of 1 POLICYNUMBER: CF9GL00765161 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPL.ETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: CITY OF GILROY; ITS OFFICERS, OFFICIALS, EMPLOYEES & VOLUNTEERS 7351 ROSANNA ST, GILROY, CA 95020 The following Is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To_ Us of Section IV — Conditions: We waive any right of recovery we may have against the. person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or 'Your work" done under a contract with that person or organization and Included In the 'products - completed operations hazard ". This waiver applies only to the person or organization shown In the Schedule above. CG 24 04 05 09 © Insurance Services Office, Inc., 200E MUMD Ccar Page 1 of 1 13 1 SAFET -1 OP ID: SM A` 410OR®- CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 10/2012016 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. CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED ,THIS 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 terms and conditions of the'policy, certain policies may require an endorsement. A statement on this.cert ficate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Imhoff Sunland/PacWestAlliance License # 0632759 REACT Imhoff Suniand Ins Serv, Inc. PHONE 559- 226 -5191 AIC Net: 559 -226 -5197 ADDRESS: 2843 N. Maros I P.O. Box 4579 Fresno, CA 93744 INSURE SAFFORDINGCOVERAGE NAICN. Imhoff Suniand Ins Sent, Inc. INSURER A: State COm : Insurance Fund $ INSURED Safety Network, Inc.; Safety Network Traffic Control INSURER 0: MED EXP (Any one personj $ Services, Inc.; Safety Netwok INSURER C : PERSONAL & ADV INJURY INSURER 0: GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT F—] LOC OTHER: Traffic Signs, Inc. 2310 N. Larkin Ave S PRODUCTS - COMP /OP AGG Fresno, CA 93727 -8644 INSURER E: $ INSURER F AUTOMOBILE LIABILITY ANY AUTO ALLOSNED SCHEDULED AUTOS H(REDAUTOS NON OWNED AUTOS CnVPRAr:FS CFRTIFICATF KII IMRF12- RFVLCInm IdI1MRFR- 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 SUB_ JECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. _ - INSR im TYPE OF INSURANCE D a - POLICY NUMBER POLICY EFF MMID POLICY EXP MMIODIYYYY LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS MADE D OCCUR EACH OCCURRENCE $ D ML ES ( ER, o_Nce Kre e S MED EXP (Any one personj $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT F—] LOC OTHER: GENERAL AGGREGATE S PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALLOSNED SCHEDULED AUTOS H(REDAUTOS NON OWNED AUTOS COMBINED SINGLE. LIMIT Eaacddanl $ BODILY INJURY (Per person) S BODILY INJURY (Per accident) $ PROPERTYDAMAGE era 'd _T a 3 UMBRELLA LIAB EXCESS LIAR OCCUR CHUMS -MADE EACH OCCURRENCE $ AGGREGATE S DED_'- _ RETENTION$- $ A WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) II d scribe under D P I OF' OPERATIONS blow NIA 9094397 -16 04/01/2016 I 04/01/2017 X R TH=- PE - E.L. EACH ACCIDENT -•.- $ 1,000,00 E.L. DISEASE - EA EMPLOYEE $ 1,000,00 E.L. DISEASE - POLICY LIMIT — — $ 1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES IACORO 101, Additional Romado Schedule. may be attached If more space is required) 16- RFP -PW -390 Regulatory Sign Inventory and Retroereflectivity Assessment Waiver of Subrogatiion per form 10217 - attached CITYGI1 City of Gilroy 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 7r ®1988.2014 ACORD CORPORATION. All nahts ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD HOME .OFFICE SAN FRANCISCO ALL EFFECTIVE DATES AR E AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BROKER COPY REP 04 9094397 -16 RENEWAL NE 3- 13 -74 -07 PAGE 1 OF 1 EFFECTIVE JUNE 240, 2016 AT 12.01 A.M. AND EXPIRING APRIL 1, 2017 AT 12.01 A.M. SAFETY NETWORK, INC. 2310 N LARKIN AVE FRESNO, CA 93727 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, SAFETY NETWORK, 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: JUNE 27,/2016 ( 4, AUTHORIZED REPRESENT IVE PRESIDENT AND CEO SCIF;FORM 10217IREV.7.2014) 2570 OLD DP 417 SAFET -1 OP ID: SM 14 W?® CERTIFICATE OF LIABILITY INSURANCE D1 012 012 01 YY) 10!20/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY .OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,.the policy(ies) must 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 Iieu of such endorsement(s). PRODUCER Imhoff SunlandtPacWestAlliance License # 0632759 CONTACT NAME: Imhoff Sunland Ins Sery , Inc. PHONE 559- 226 -5191 F Not 559-226-5197 2843 N. Maroa I P.O. Box 4579 Fresno, CA 93744 E AIL - ADDRESS; INSURER (S) AFFORDINO COVERAGE NAIC 0 Imhoff Sunland Ins Serv, Inc. INSURERA:Philadelph)a Indemnity Ins. Co 18058 INSURED Safety Network, Inc. Safety Network Traffic Control INSURER 9: EACH OCCURRENCE $ Services, Inc; Safety Network INSURERC: INSURER D., S Traffic Signs, Inc 2310 N. Larkin Ave Fresno,: CA 93727 -8644 INSURER E: INSURER F . - C"UFRAGFM L_COTICII!ATC Id11RACCO. Ru IRRnco. 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 6Y PAID.CLAIMS. INSR TR TYPE OF INSURANCE POLICY NUMBER POLICY EFF MMID POLICY EXP NUODNM - LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑OCCUR EACH OCCURRENCE $ P EMI E e S MED EXP W7 one person) S PERSONALS ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: RPOLICY ❑ JECT ❑ LOC GENERAL AGGREGATE $ PRODUCTS - COMPlOP AOG :$ $ OTHEFt A AUTOMOBILE LIABILITY X ANYAuro PHPKIS05862 06/06/2016 06/06/2017 COMBINED SINGLE LIMIT ea d $ 1,000,000 BODILY INJURY (Per person) $ ALL AUTOS AUTOS AUTOSULED BODILY INJURY (Per acc.derd) S NON -OWNED HIRED AUTOS AUTOS PROPERTY enp E $ UMBRELLA LIAR " OCCUR EACH OCCURRENCE S AGGREGATE $ EXCESS LIAR CLAIMS -MADE DEO- RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y! N ANY PROPMETORMARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED? ] NIA P TH. SSA ATE E E.L. EACH ACCIDENT Is _ E.L. DISEASE - EA EMPLOYE S (Mandatory In NH) desonbe urnler E.L. DISEASE - POLICY LIMIT S m S IPTION OF OPERATIONS below - A Hired Material PHPK1505862 06/6612616 06/06/2017 Damage DESCRIPTION OP OPERATIONS I LOCATIONS/ VEHICLES (ACORO 101, Additional Remarks Sohodule..may be attached if nwo spaeo Is roqurrod) 16- RFP- PW.!390 Regulatory Sign Inventory and Retroereflectivity Assessment Blanket Additional Insured per form PI -CA -003 as required by written contract - form attached 30 Day'Cancellation Clause except 10 days for nonpayment of premium. CITYGII SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN- Cl ty of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. 7361 Rosanna Street _ .. , .. _ ___ .. Gilroy, CA 95020 - AUTHORIZED REPRESENTATIVE All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Polley # PHPKIS05862 PI -CA -003 (004) THIS ENDORSEMENT CHANGES THE POLICY PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies Insurance provided under the following: BUSINESS AUTO COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply' unless modified by the endorsement. A. SECTION II —COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1, Who Is An Insured is amended by adding the following: The following are also "Insureds ": Any person or organization for whom you are required by an "insured contract" to procure "bodily injury" or "property damage" liability Insurance arising out of the'operation of a covered "auto" with your permission. However, this. additional insurance does not apply to: 1. The owner or anyone else from whom you hire or borrow a covered "auto;" This exception does not apply if the covered "auto" is a "trailer" connected to. a covered "auto" you own; 2. Your "employee" If the covered "auto" Is owned by that "employee" or a member of his or her household; 3. Anyone using a covered '.auto" while he or she Is working In a business of selling, servicing, repairing, parking or storing "autos" unless that business is yours; 4. Anyone other than your "employees," partners (if you are o partnership), members (if you are a limited liability company), or a lessee or borrower, or any of their "employees,' while moving property to or from a covered "auto'; or 5. A partner (if you are a partnership), or a member (if you are a limited liability company) for covered "auto" owned by him or her or a member of his or her household. B. The "Insured contract" must be In, effect during the policy period shown in the Declarations and must have been executed prior to the "bodily injury" or "property, damage"; C. This person or organization is an "insured" only to the extent you are liable due to your ongoing operations for that "insured ", whether the work Is performed by you or for you, and only to the extent you are held liable for an "accident" occurring while a covered "auto" is being driven by-you or one of your employees. D. There Is no coverage provided to this person or organization for "bodily injury" to its employees or for "property damage" to its property. E. Coverage for this person or organization shall be limited to the extent of your negligence or fault according to the applicable principles of comparative negligence or fault. F. The defense of any claim or "suit" must be tendered by this person or organization as soon as practicable to all other Insurers which potentially provide Insurance for such claim, or "suit ". G. A person's or organization's status as an "Insured" under this endorsement ends when your operations for that "Insured" are completed. Page 1 of 2 PI-CA-003 (04/14) H. The coverage extended to any additional insured. by this,endorsement is limited to, and subject to all terms, conditions, and exclusions of the Coverage Part to which this endorsement is attached. In addition, coverage shall not exceed the terms and conditions that are required by the terms of the written agreement to add any "insured," or.to procure insurance. I. The following additional exclusions apply: The Insurance afforded to any person or organization as an "insured" under this endorsement does not apply to "loss ": 1. Which occurs prior to the date your contract Is effective with such person or organization; 2. Arising out of the sole negligence of any person or organization that would not be "insured" except for this endorsement; or 3. Which occurs after you returned the leased or rented "auto" to the lessor or the policy period ends, whichever occurs first. Page 2 of 2