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HomeMy WebLinkAboutSan Jose Conservation Corps - Insurance Certificate (2018)SANJOSE -37 HRCTn3 ACOi?L7- CERTIFICATE OF LIABILITY INSURANCE �'''• DATER4Br1DD1YYY1f) 05/09/2017 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFwATE 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: 9 the certificate holder.ls an ADDITIONAL INSURED, the policy(tes) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions afthe 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). PROOUCER License of 0584249 r Heffernan Insurance Brokers 14006 O'Brien Drive Menlo hark, CA 94025 PHONE FAX E 1 650 842 -5200 No : 650 842.5201 1 INJURFRMI AFFORDING E NAIC iNgsym A. •Noripmfits insurance Alliance of Calffibmis 01184 INSURED try •O k River insurance Company 34830 INSURER C DAM GE TTO ENTED -. San Jose Conservation Corps and Charter School INSURER 0, 20,000 1660 Berger Drive San Jose, CA 95112 M8URt7t E 1,00000 �_�_0.�_�. INSURER F: GATE 2,000,000 COVERAIAPS CFRTIFIPATR M1IMRGR• orv[Qlnfd MIIMRFR• 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POI ICLES DESCRIBED HERItIN IS SUBJECT TO ALL THE TERMS, ' EXCLUSIONS.AND.CONDITIONS OF SUCH - POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R TYPE OF INSURANCE DL BURR POLICY NUMBER to POLICY EFF POLICY EXP YYYYI LGIIIrB A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE J OCCUR SEXUAL CONDUCT UAB X 201701904NP0 04101/201 T 04/0112018 EACH OCCURRENCE 1,090,000 DAM GE TTO ENTED -. $00 -000 X 20,000 P INJURY 1,00000 �_�_0.�_�. L AGGRE9ATE LIMIT AP EL PER POLICY X LOC GATE 2,000,000 /OP AGG E 2,000,000 SOC SERVICE PRO 1,000,000 A ALrrOMOaa:E I:lAB1I1TY X" ANVAUTO jMI 0N SCHEDULED AUr08LY AUTOS AUTOS ONLY ASTOB ONLY X 201701904NPO 0410112017 04/0112018 COMBINED SINGLE LIMIT (EaU 1,000,000 BODILY INJURY BODILY BBRODILYINJUpRgY (Par acddW) iPaldeTMn_tL�_ A X UMBRELLA UAB EXCESS LIAR X OCCUR CLAIMS -MADE 71701904UMBNPO 04/0112017 04101/2018 EAQH OCCURRENCE 4,000,000 AGORME 41000,000 DED I X RETENTION $ 10,000 BORXERS COMPENSATION D ENYLOYERS LU EL% Fr� ExR - EEPJEXECUTWE R esdasorlL�eun 0 w1A AWC817304 04101/2017 04101/2018 �( PER OTH — �. EACH ACCIDENT - ___ 110000000 L E f • EA EMPLOYEE 1,000,000 E- T 1,000,000 A Social' ery ce ro . 01701904NPO 04 112017 0 1 018 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES µ1CORO 101, Additional Remarks Schedule, may be aaachad H mars a Is requlredl Re: As Per Contract or Agreement on File with insured. City of Gilroy, Its officers, elected or appointedoofficials, employees, agents and volunteers are Included as an additional Insured (primary and non-contributory) on General Liability policy and additional Insured on Automobile Liability policy par the attached endorsamenm, if required. Completed operations endorsement for the General Liability policy Is attached, if required. Cancellation notice for the General Liability Is attached, If required. This certificate repiaces and supersedes all previously Issued certificates. City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 ACORN 25 (20161631 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED Mf ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE IV L- 0 1988 -2015 The ACORD name and logo are registered marks of ACORD reserved. POLICY NUMBER: 2017 -01904-NPO COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location (s) Of Covered Operations Any person or organization that you are required to All Insured premises and operations. add as an additional insured on this policy, under a written contract or agreement currently In effect, or becoming effective during the term of this policy. The additional Insured status will not be afforded with respect to liability arising out of or related to your activltles as a real estate manager for that person or organization. Information required to complete this Schedule, If not shown above, will be shown In the Declarations. 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, but only with respect to liability for " bodily injury", "property damage" or "personal and advertising Injury" caused, in whole or in part, by. 1. Your ads 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. However: 1. The insurance afforded to such additional Insured only applies to the extent permitted by law; and 2. If coverage provided to the additional Insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This Insurance does not apply to "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;ofthe additional insured(s) at the location of the covered operations has been completed; or CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 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 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 Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement; the most we will pay on behalf of the additional Insured Is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown In the Declarations; whichever Is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 2010 0413 0 Insurance Services Office, Inc., 2012 Page 2 of 2 POLICY NUMBER: 2017 - 01904 -NPO COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization that you are required to add as an additional .Insured on this policy, All Insured premises and operations. under a written contract or agreement currently in effect, or becoming effective during the term of this policy. The additional Insured status will not be afforded with respect to liability arising out of or related to your activities as a real estate manager for that person or organization. Information required to complete this Schedule, If not shown above, will be shown In the Deciarations. 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, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described In the Schedule of this endorsement performed for that additional Insured and Included in the "products - completed operations hazard ". 2. If coverage provided to the additional insured is required by a contract or agreement, the Insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement. to provide for such additional insured. B. With respect to the Insurance afforded to these additional Insureds, the following Is added to Section III — Limits Of Insurance: However: If coverage provided to the additional insured is 1. The insurance afforded to such additional required by a contract or agreement, the most we insured only applies to the extent permitted will pay on behalf of the additional insured is the by law; and amount of insurance: CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown In the Declarations; whichever Is less. This endorsement shall not increase the applicable Limits of insurance shown in the Declarations. CG 20 37 04 13 0 Insurance Services Office, Inc., 2012 Page 2 of 2 NONPROFITS INSURANCE AMANCE OF C.AMORNIA R Nand %r(nturnnea A Naart jorNWprojHa. NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA (NIAC) www.insurancefornonproflte.oro POLICY CHANGE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. COMPANY: Nonprofits Insurance Alliance of California (01904) POLICY NUMBER: 2017 -01904 NAMED INSURED: San Jose Conservation Corps and Charter School POLICY CHANGE EFFECTIVE: 04/01/2017 COVERAGE PART AFFECTED: BUSINESS AUTO POLICY CHANGE#: 1 Page 1 The following additional insured(sylose payee(s) islare hereby added to read: Veh # VIN # Additional Insured - NIAC -A1 NIA City of Gilroy, its officers, elected or appointed officials, employees, agents and volunteers 7351 Rosanna St. Gilroy, CA 95020 All other terms, limits and conditions remain the same. ADDITIONAL PREMIUM: $0 RETURN PREMIUM: $0 TOTAL PREMIUM: $0 05108/2017 0 (02786) NONPROFITS INSURANCE �W ALLIANCE Of CALIFORNIA A Head for insurance. A Heart for Nanprof4ts. POLICY NUMBER: 2017 - 01904 -NPO THIS ENDORSEMENT CHANGES THE POLICY, PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON - CONTRIBUTORY ENDORSEMENT FOR PUBLIC ENTITIES This endorsement modifies Insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II - WHO IS AN INSURED is amended to Include any public entity as an additional Insured for whom you are performing operations when you and such person or organization have agreed in a written contract or written agreement that such public entity be added as an additional insured(s) on your policy, but only with respect to liability for "bodily Injury", "property damage" or "personal and advertising injury" caused, :in whole or in part, by- 1 . Your negligent acts or omissions; or 2. The negligent acts or omissions of those acting, on your behalf; in the performance of your ongoing operations. No such public entity is an additional insured for liability arising out of the "products- completed operations hazard" or for liability arising out of the sole negligence of that public entity. B. With respect to the insurance afforded to these additional insured(s), the following additional exclusions apply. This Insurance does not apply to °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 perforated 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 Injury or damage arises has been put to its 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. The following is added to SECTION III — LIMITS OF INSURANCE: The limits of insurance applicable to the additional Insured(s) are those specified in the written contract between you and the additional insured(s), or the limits available under this policy, whichever are less. These limits are part of and not in addition to the limits of insurance under this policy. D. With respect to the insurance provided to the additional insured(s), Condition 4. Other Insurance of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS is replaced by the following: 4. Other Insurance a. Primary Insurance This insurance is primary if you have agreed in_a written contract or written agreement: NIAC -E61 1215 Page 1 of 2 (1) That this Insurance be primary. If other Insurance is also primary, we will share with all that other insurance as described Inc. below; or (2) The coverage afforded by this insurance is primary and non - contributory with the additional lnaured(s)' own Insurance. Paragraphs (1) and (2) do not apply to other insurance to which the additional Insured(s) has been added as an additional Insured or to other insurance described In paragraph b. below. b. Excess Insurance This insurance Is excess over: 1. Any of the other Insurance, whether primary, excess, contingent or on any other basis:. (a) That is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar coverage for "your work "; (b) That is fire, lightning, or explosion Insurance for premises rented to you or temporarily occupied by you with permission of the owner; (c) That is Insurance purchased by you to cover your liability as a tenant for "property damage" to premises temporarily occupied by you with permission of the owner; or (d) If the loss arlses out of the maintenance or use of aircraft, "autos" or watercraft to the extent not subject to Exclusion g. of SECTION I — COVERAGE A— BODILY INJURY AND PROPERTY DAMAGE. (e) That is any other insurance available to an additional insured(s) under this Endorsement covering liability for damages arising out of the premises or operations, or products - completed operations, for which the additional insured(s) has been added as an additional insured by that other insurance. (1) When this Insurance is excess, we will have no duty under Coverages A or B'to defend the additional Insured(s) against any °suit" If any other Insurer has a duty-to defend the additional Insured(s) against that "suit". If no other insurer defends, we will undertake to do so, but we will be entitled to the additional insured(s)' rights against all those other insurers. (2) When this Insurance is excess over other insurance, we will pay only our share of the amount of the loss, if any, that exceeds the sum of: (a) The total amount that all such other insurance would pay for the loss In the absence of this insurance; and (b) The total of all deductible and self - insured amounts under all that other insurance. (3) We will share the remaining loss, If any, with any other insurance that is not described in this Excess Insurance provision and was not bought specifically to apply in excess of the Limits of Insurance shown in the Declarations of this Coverage Part. c. Methods of Sharing If all of the other Insurance available to the additional Insured(s) permits contribution by equal shares,.we will follow this method also. Under this approach each Insurer contributes equal amounts until It has paid its applicable limit of insurance or none of the loss remains, whichever comes first. If any other the other insurance available to the additional insured(s) does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share Is based on the ratio of its applicable limit of insurance to the total applicable limits of Insurance of all insurers. €VIAC -E61 1215 Page 2 of 2 IL 02 70 0912 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL This endorsement modifies Insurance provided under the following: CAPITAL ASSETS PROGRAM (OUTPUT POLICY) COVERAGE PART COMMERCIAL AUTOMOBILE COVERAGE PART COMMERCIAL GENERAL LIABILITY COVERAGE PART COMMERCIAL INLAND MARINE COVERAGE PART COMMERCIAL PROPERTY COVERAGE PART CRIME AND FIDELITY COVERAGE PART EMPLOYMENT- RELATED PRACTICES LIABILITY COVERAGE PART EQUIPMENT BREAKDOWN COVERAGE PART FARM COVERAGE PART LIQUOR LIABILITY COVERAGE PART MEDICAL PROFESSIONAL LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART PRODUCTSICOMPLETED OPERATIONS LIABILITY COVERAGE PART A. Paragraphs 2. and 3. of the Cancellation Common Policy Condition are replaced by the following: 2. All Policies In Effect For 60 Days Or Less If this policy has been in effect for 60 days or less, and Is not a renewal of a policy we have previously issued, we may cancel this policy by mailing or delivering to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, advance written notice of cancellation, stating the reason for cancellation, at least: a. 10 days before the effective date of cancellation If we cancel for: (1) Nonpayment of premium; or (2) Discovery of fraud by: (a) Any Insured or his or her representative In obtaining this insurance; or (b) You or your representative In pursuing a claim under this policy. b. 30 days before the effective date of cancellation if we cancel for any other reason. 3. All Policies In Effect For More Than 60 Days a. If this policy has been in effect for more than 60 days, or is a renewal of a policy we issued, we may cancel this policy only upon the occurrence, after the effective date of the policy, of one or more of the following: (1) Nonpayment of premium, Including payment due on a prior policy we issued and due during the current policy term covering the same risks. (2) Discovery of fraud or material misrepresentation by: (a) Any insured or his or her representative in obtaining this insurance; or (b) You or your representative In pursuing a claim gder this policy. (3) A judgment by a court or an administrative tribunal that you have violated a California or Federal law, having as one of its necessary elements an act which materially Increases any of the risks insured against. IL 02 70'0912 © Insurance Services Office, Inc., 2012 Page 1 of 4 (4) Discovery of willful or grossly negligent acts or omissions, or of any violations of state laws or regulations establishing safety standards, by you or your representative; which materially Increase any of the risks insured against. (5) Failure by you or your representative to Implement reasonable loss control requirements, agreed to by, you as a condition of policy issuance, or which were conditions precedent to our use of a particular rate or rating plan, if that failure materially Increases any of the risks Insured against. (0) A determination by the Commissioner of Insurance that the: (a) Loss of, or changes in, our reinsurance covering all or part of the risk would threaten our financial Integrity or solvency; or (b) Continuation of the policy coverage would: .(i) Place us in violation of California law or the laws of the state where we are domiciled; or (11) Threaten our solvency. (7) A change by you or your representative In the activities or property of the commercial or industrial enterprise, which results In a materially added, Increased or changed risk, unless the added, increased or changed risk Is Included In the policy. b. We will mail or deliver advance written notice of cancellation, stating the reason for cancellation, to the first Named Insured, at the mailing address shown in the policy, and to the producer of record, at least: (1) 10 days before the effective date of cancellation if we cancel for nonpayment of premium or discovery of fraud; or (2) 30 days before the effective date of cancellation If we cancel for any other reason listed In Paragraph 3.a. B. The following provision Is added to the Cancellation Common Policy Condition: 7. Residential Property This provision applies to coverage on real. property which Is used predominantly. for residential purposes and consisting of not more than four dwelling units, and to coverage on tenants' household personal property in a residential unit, if such coverage is written under one of the following: Commercial Property Coverage Part Farm Coverage Part — Farm Property — Farm Dwellings, Appurtenant Structures And Household Personal Property Coverage Form a. If such coverage has been In effect for 60 days or less, and is not a renewal of coverage we previously issued, we may cancel this coverage for any reason, except as provided in b. and c. below.. b. We may not cancel this policy solely because the first Named Insured has: (1) Accepted an offer of earthquake coverage; or (2) Cancelled or did not renew a policy Issued by the California Earthquake Authority (CEA) that included an earthquake policy premium surcharge. However, we shall cancel this policy if the first Named Insured has accepted a new or renewal policy issued by the CEA that includes an earthquake policy premium surcharge but falls to pay the earthquake policy premium surcharge authorized by the CEA. c. We may not cancel such coverage solely because corrosive soil conditions exist on the premises. This restriction (c.) applies only if coverage is subject to one of the following, which exclude loss or damage caused by or resulting from corrosive soil conditions: (1) Commercial Property Coverage Part — Causes Of Loss — Special Form; or (2) Farm Coverage Part — Causes Of Loss Form — Farm Property, Paragraph D. Covered Causes Of Loss -- Special. Page 2 of 4 0 Insurance Services Office, Inc., 2012 IL 02 70 0912 4,, , . C. The following is added and supersedes any (2) The Commissioner of Insurance finds provisions to the contrary: that the exposure to potential losses will Nonrenewal threaten our solvency or place us In a .1. Subject to the provisions of Paragraphs C2. hazardous condition. A hazardous condition Includes, but Is not limited to, a and C.3. below, If we elect not to renew this condition in which we make claims policy, we will mall or deliver written notice, payments for losses resulting from an stating the reason for nonrenewal, to the first earthquake that occurred within the Named Insured shown in the Declarations, and preceding two years and that required a to the producer of record, at least 60 days, but reduction In policyholder surplus of at not more than 120 days, before the expiration least 26% for payment of those claims;. oranniver$ary date. or We will mail or deliver our notice to the first (3) We have: Named Insured, and to the producer of record, at the mailing address shown in the policy. a Lost or experienced a substantial () 2. Residential Property reduction int he availability or scope of reinsurance coverage; or This provision applies to coverage on real (b) Experienced a substantial increase property. used predominantly for residential in the premium charged for purposes and consisting of not more than four reinsurance coverage of our dwelling units, and to coverage on tenants' . residential property insurance household property contained In a residential policies; and unit, If such coverage Is written under one of the following: the Commissioner has approved a plan Commercial Property Coverage Part for the nonrenewals that is fair and Farm Coverage Part —Farm Property —Farm equitable, and that is responsive to the changes in our reinsurance position. Dwellings, Appurtenant Structures And Household Personal Property Coverage Form c. We will not refuse to renew such coverage solely because the first Named Insured has a. We may elect not to renew such coverage cancelled or did not renew a policy, issued for any reason, except as provided in b., c. by the California Earthquake Authority, that and d. below. Included an earthquake policy premium b. We will not refuse to renew such coverage surcharge. solely because the.first Named Insured has d. We will not refuse to renew such coverage accepted an offer of earthquake coverage. solely because corrosive soil conditions However, the following applies only to exist on the premises. This restriction (d.) insurers who are.. associate participating applies only if coverage is subject to one of Insurers as established by Cal. Ins. Code the following, which exclude foss or Section 10089.16. We may elect not to damage caused by or resulting from renew such coverage after the first Named corrosive soil conditions: Insured has accepted an offer of (1) Commercial Property Coverage Part — earthquake coverage, If one or more of the Causes Of Loss — Special Form; or following reasons applies: (2) Farm Coverage Part — Causes Of Loss 1 The nonrenewal is based on sound O The Form — Farm Property, Paragraph D. underwriting principles that relate to the Covered Causes Of Loss — Special. coverages provided by this policy and that are consistent with the approved 3. We are not required to send notice of rating plan and related documents filed nonrenewal In the following situations.- with the Department of Insurance as a. If the transfer or renewal of a policy,. without required by existing law; any changes in terms, conditions or rates; is between us and a member of our Insurance group. IL 02 70 0912 © Insurance Services Office, Inc., 2012 Page 3 of 4 k " f b. If the policy has been extended for 90 days or less, provided that notice has been given in accordance with Paragraph C.1. c. If you have obtained replacement coverage, or If the first Named Insured has agreed, in writing, within 60 days of the termination of the policy, to obtain that coverage. d. If the policy is for a period of no more than 60 days and you are notified at the time of Issuance that it will not be renewed. e. If the first Named Insured requests a change In the terms or conditions or risks covered by the policy within 60 days of the end of the policy period. f. If we have made a written offer to the first Named Insured, in accordance with the Umeframes shown in Paragraph C.1., to renew the policy under changed terms or conditions or at an Increased premium rate, when the Increase exceeds 25 %. Page 4 of 4 C Insurance Services Office, Inc., 2012 IL 02 70 0912 NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA SERVICED BY ALLIANCE MEMBER SERVICES P.O BOX 8507 SANTA CRUZ CA 95061 NOTICE OF CANCELLATION OF INSURANCE Named Insured & Mailing Address SAN JOSE CONSERVATION CORPS AND CHAR" 1560 BERGER DRIVE SAN JOSE CA 95112 Producer 02786 HEFFERNAN INSURANCE BROKERS - MENLO PARK 1350 CARLBACK AVENUE, SUITE 200 WALNUT CREEK CA 94596 Policy No.: 2017 -01904 Type of Policy: GENERAL LIABILITY OCCURRENCE Date of Cancellation: 07/27/2017; 1201 A.M. Pacific Time at the mailing address of the Named Insured. We are cancelling this policy Your insurance will cease on the Date of Cancellation shown above. The reason for cancellation is nonpayment of premium r Your interest in this policy as an "insured" or other party of interest is being cancelled effective 07/27/2017; 12:01 A.M Pacific Time at the mailing address of the named insured. Additional Insured CITY OF GILROY, ITS OFFICERS, ELECTED OR APPOINTED OFFICIALS, EMPLOYEES AGENTS AND VOLUNTEERS 7351 ROSANNA ST GILROY CA 95020 Date Mailed 11th day of July, 2017 AUTHORIZED SIGNATURE CACC15NONPMNT FORM# CC9697CA51995 07112017MYNY ODEN 3 0 12 04a Copy for Additional Insured Page 1 of 1 NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA SERVICED BY ALLIANCE MEMBER SERVICES P O BOX 8507 SANTA CRUZ CA 95061 RESCISSION NOTICE Named Insured & Mailing Address Producer 02786 SAN JOSE CONSERVATION CORPS AND CHAR" HEFFERNAN INSURANCE BROKERS - MENLO PARK 1560 BERGER DRIVE 1350 CARLBACK AVENUE, SUITE 200 SAN JOSE CA 95112 WALNUT CREEK CA 94596 Policy No 2017 -01904 Type of Policy: GENERAL LIABILITY OCCURRENCE The CANCELLATION notice Issued to be effective 07/27/2017 Is hereby rescinded. Additional Insured CITY OF GILROY, ITS OFFICERS, ELECTED OR APPOINTED OFFICIALS, EMPLOYEES AGENTS AND VOLUNTEERS 7351 ROSANNA ST. GILROY CA 95020 Date Mailed 27th day of July, 2017 AUTHORIZED SIGNATURE CACS15RSCN C FORM# CS01CA22006 07262017MNNY ODEN 3 0 12 04a Copy for Additional Insured Page 1 of 1 NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA SERVICED BY ALLIANCE MEMBER SERVICES P.O. BOX 8507 SANTA CRUZ CA 95061 RESCISSION NOTICE Named Insured & Mailing Address Producer 02786 SAN JOSE CONSERVATION CORPS AND CHAR" HEFFERNAN INSURANCE BROKERS - MENLO PARK 1560 BERGER DRIVE 1350 CARLBACK AVENUE,'SUITE 200 SAN JOSE CA 95112 WALNUT CREEK CA 94596 Policy No. 2017 -01904 Type of Policy: GENERAL LIABILITY OCCURRENCE The CANCELLATION notice issued to�be effective 11/01/2017 is hereby,rescinded. Additional Insured CITY.OF GILROY ITS OFFICERS ELECTED OR APPOINTED OFFICIALS_ E_M_PL_ 7351 ROSANNA ST GILROY CA 95020 FORM# CS01 CA22006 ooEN 3 0 12 04a� _ - Copy for Additional'Insured C_ACS15RSCN_C 102420171VINW Page 1 of 1 NONPROFITS INSURANCE -ALLIANCE O_ F CALIFORNIA_ SERVICED BY ALLIANCE MEMBER SERVICES P.O: BOX 8507 (SANTA CRUZ CA 95061 RESCISSION-NOTICE Named Insured & Mailing Address Producer 0.2786' SAN JOSE CONSERVATION CORPS AND CHAR" 'HEFFERNAN INSURANCE BROKERS - MENLO PARK 1560 BERGER DRIVE 1350 CARLBACK AVENUE, S_ _ SUITE 200_ SAN JOSE _ CA 06112 WALNUT CREEK CA 94596 Policy No.- : 2017 -01904 Type of Policy. GENERAL LIABILITY OCCURRENCE The'CANCELLATION notice,issued to be effective 11/01/2017 isfiereby rescinded. Additional Insured CITY OF GILROY 'ITS OFFICERS ELECTED OR APPOINTED OFFICIALS EMP-L 7351 ROSANNA ST. GILROY CA 95020 FORM# 6801CA22606 ODEN 3 0 12 04a Copy for Additional Insured Date Mailed - 25t_h day of October, 2017 i AUTHORIZED SIGNATURE C_ ACS15RSCN: C 10242017MNNY Page 1 of U S 4 t NONPROFITS INSURANCE ALLIANCE OF CALIFORNIA SERVICED BY ALLIANCE MEMBER S_ E__RVIC_ E_S__ P.O. BOX 8507 SANTA CRUZ CA 95061 RESCISSION NOTICE Named Insured'& Mailing Address Producer 02786 SAN JOSE_ CONSERVATION CORPS AND CHAR" HEFFERNAN INSURANCE BROKERS - MENLO _ PARK 1560 BER_GER DRIVE 1350 CAR_LBACK AVENUE, S_ UIT_E_ 2.0.0 SAN JOS_E CA 95112 WALNUT CREEK CA 94596 Policy No.- 2017 -01904 Type of Policy: GENERAL LIABILITY OCCURRENCE The CANCELLATION notice issued to be effective 11/01/2017 Is hereby rescinded. r Additional Insured CITY OF GILROY, ITS OFFICERS, ELECTED OR APPOINTED OFFICIALS, EMPLOYEES AGENTS AND VOLUNTEERS 7351 'ROSANNA ST. GILROY CA 95020 FORM# CS01CA22006 ODEN3 0 12 04a Copy for Additional' Insured y 1 Date Marled 25th day of October, 2017 lam• _ AUTHORIZED SIGNATURE CACS15RSCN -C 10242017MNNY Page 1, of 1 �r I Additional Insured CITY OF GILROY, ITS OFFICERS, ELECTED OR APPOINTED OFFICIALS, EMPLOYEES AGENTS AND VOLUNTEERS 7351 'ROSANNA ST. GILROY CA 95020 FORM# CS01CA22006 ODEN3 0 12 04a Copy for Additional' Insured y 1 Date Marled 25th day of October, 2017 lam• _ AUTHORIZED SIGNATURE CACS15RSCN -C 10242017MNNY Page 1, of 1 �r I NO_ NPROFITS INSURANCE ALLIANCE OF CALIFORNIA SERVICED BY ALLIANCE MEMBER SERVICES - - P.O_ . BOX 8507 SANTA CRUZ CA 95061 RESCISSION NOTICE Named Insured, & Mailing Address Producer 02786 SAN JOSE CONSERVATION CORPS AND CHAR' HEFFERNAN INSURANCE BROKERS - MENLO PARK 1560 BERGER DRIVE 1350 CARLBACK AVENUE, SUITE 200 SAN JOSE CA 95112 WALNUT CREEK CA 94596 Policy No.: 2017 -01904 Type of Policy. GENERAL LIABILITY OCCURRENCE The CANCELLATION' notice issued to be effective 11/01/2017 is hereby rescinded. i r Additional Insured' CITY OF GILROY, _I_TS OFFICERS, ELECTED OR APPOINTED_ OFFICIALS, EMPLOYEES AGENTS AND VO_ LUNTEERS -7351 ROSANNA ST. 6EROYCA,95020 - ,FORM #, CS01 CA22006 ODEN 3 012 04a Copy for Additional Insured Date Mailed 25th day of October, 2017 - AUTHORIZED SIGNATURE CACSI5RSCN C 10242017MNFJY Page 1 of 1