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HomeMy WebLinkAboutBunton Clifford - Insurance Certificate (2018)BUNTCLI -01 YUENG ACORO" CERTIFICATE OF LIABILITY INSUR ANCE DATE D/YYYY) 4 /3 /2 4/3/2018 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 License # OE67768 IOA Insurance Services 3875 Hopyard Road Suite 240 CONTACT Gigi Yuen NAME: PHONE FAX (A/C, No, EXt): (925) 660 -351450008 (A/c, No):(925) 416 -7869 E -MAIL Gigi.Yuen@ioausa.com DDRESS: g Pleasanton, CA 94588 INSURER (S) AFFORDING COVERAGE NAIC # INSURERA:TravelersIndemnit Company of Connecticut 25682 INSURED INSURER B: Travelers Property Casualty Company of America 25674 INSURER C: RLI Insurance Company 13056 Bunton, Clifford & Associates, Inc. dba BCA Architects INSURER D :Travelers Casualty & Surety Company of America 31194 505 South Market Street San Jose, CA 95113 INSURER E DAMAGETORENTED EMI ES Ea occurrence INSURER F: MED EXP (Any one person) COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR D POLICY NUMBER POLICY EFF D POLICY EXP DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE F_X] OCCUR 68081-1870283 03/11/2018 03/11/2019 DAMAGETORENTED EMI ES Ea occurrence 1,000,000 $ MED EXP (Any one person) 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JECT � LOC GENERAL AGGREGATE $ 2'000,000 PRODUCTS - COMP /OP AGG $ 2'000,000 $ OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ BODILY INJURY Per per on) $ X ANY AUTO BA3F416764 03/11/2018 03/11/2019 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PeOacc dent AMAGE $ AUTOS ONLY AUUTOS ONLDY B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 EXCESS LIAB CLAIMS -MADE CUP8647Y644 03/11/2018 0311112019 DED I I RETENTION $ C WORKERS COMPENSATION EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ Mandatory in NH) EXCLUDED? NIA PSWOOO1551 09/0112017 09/0112018 X STATUTE ERH AND E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Professional Liab. 106831434 11/14/2017 11114/2018 Per Claim 1,000,000 D Professional Liab. 106831434 11/14/2017 11/14/2018 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All operations of the Named Insured. General Liability: Please see Additional Insured endorsement attached; such coverage is Primary & Non - Contributory, with Waiver of Subrogation included, as required by written contract. Auto Liability: Please see Additional Insured endorsement attached, as required per written contract. Workers' Compensation: Please see Waiver of Subrogation endorsement attached, as required per written contract. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Gilroy, its officers, officials and volunteers 7351 Rosana Street G*Irov. CA 9 020 ACORD 25 (2016/03) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 680- 8H870283 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULED ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE NAME OF PERSONS OR ORGANIZATIONS: CITY OF GILROY, ITS OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS 7351 ROSANA STREET GILROY CA 95020 PROJECT /LOCATION OF COVERED OPERATIONS: PER WRITTEN CONTRACT PROVISIONS 1. The following is added to SECTION II — WHO IS AN INSURED: The person or organization shown in the Schedule above is an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury'; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions of such person or organization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply to the rendering of or failure to render any "professional services ". f. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance ", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance ". This endorsement does not increase the limits of insurance described in Section III — Limits Of Insurance. g. This insurance does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to that additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. CG D3 82 09 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY 2. The following is added to Paragraph 4.a. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured shown in the Schedule above is excess over, any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non - contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring insurance ". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. 3. The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS; We waive any right of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" on or for the project, or at the location, shown in the Schedule above, performed by you or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract with the person or organizations shown in the Schedule above, under which you are required to include that person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2015 The Travelers Indemnity Company. All rights reserved. CG D3 82 09 15 Includes the copyrighted material of Insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 680- 8x870283 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - DESIGNATED ADDITIONAL INSUREDS - PRIMARY AND NON - CONTRIBUTORY WITH RESPECT TO CERTAIN OTHER INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Additional Insured CITY OF GILROY, ITS OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) PROVISIONS The following is added to Paragraph 4. a., Primary Insurance, of SECTION IV — COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: The insurance afforded under this Coverage Part to an additional insured designated in the Schedule above is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that if you agree in a written contract or agreement that the insurance afforded to such additional insured under this Cover- age Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is primary to such other insurance only if: (1) The "bodily injury" or "property damage " for which coverage is sought is caused by an "occurrence" that takes place; and (2) The "personal injury" or "advertising injury" for which coverage is sought arises out of an offense that is committed; subsequent to the signing and execution of that con- tract or agreement by you. CG D4 26 07 08 © 2008 The Travelers Companies, Inc Page 1 of 1 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 680- 8HB70283 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF GILROY, ITS OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS GILROY CA 95020 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV- COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: 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 hazards." This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA WC 04 03 06 (Ed. 4 -84) 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be 2% of the California workers' compensation premium otherwise due on such remuneration. Person or Organization Schedule Job Description All persons or organizations that are party to a contract that Jobs performed for any person or organization that you requires you to obtain this agreement, provided you executed have agreed with in a written contract to provide this the contract before the loss. agreement. This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 09 -01 -2017 Policy No. PSW0001551 Endorsement No. Insured Insurance Company Bunton, Clifford & Associates, Inc. RLI Insurance Company Countersigned By ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. Policy Number: BA3F416764 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE — This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BLANKET ADDITIONAL INSURED B. EMPLOYEE HIRED AUTO C. EMPLOYEES AS INSURED D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS E. TRAILERS — INCREASED LOAD CAPACITY F. HIRED AUTO PHYSICAL DAMAGE G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT A. BLANKET ADDITIONAL INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an "insured" for Covered Autos Liability Coverage, but only for damages to which this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Section II. B. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COV- ERED AUTOS LIABILITY COVERAGE: H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT —INCREASED LIMIT I. WAIVER OF DEDUCTIBLE — GLASS J. PERSONAL PROPERTY K. AIRBAGS L. AUTO LOAN LEASE GAP M. BLANKET WAIVER OF SUBROGATION performing duties related to the conduct of your business. 2. The following replaces Paragraph b. in B.5., Other Insurance, of SECTION IV — BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto ". An "employee" of yours is an "insured" while C. EMPLOYEES AS INSURED operating a covered "auto" hired or rented The following is added to Paragraph A.1., Who Is under a contract or agreement in an "em- An Insured, of SECTION II — COVERED AUTOS ployee's" name, with your permission, while LIABILITY COVERAGE: CA T4 20 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 3 InrhiriAs rnnvr1nhtnr1 mntPrlal of Ingtirnnrq Rnrvinn- Offinn Inr with itc nPrmlCClnn COMMERCIAL AUTO Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't own, hire or borrow In your business or your personal affairs. D. SUPPLEMENTARY PAYMENTS — INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2) of SECTION II — COVERED AUTOS LIABILITY COVERAGE: (2) Up to $3,000 for cost of bail bonds (in- cluding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4) of SECTION II — COVERED AUTOS LIABILITY COVERAGE: (4) All reasonable expenses incurred by the "Insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. E. TRAILERS — INCREASED LOAD CAPACITY The following replaces Paragraph C.1. of SEC- TION I — COVERED AUTOS: 1. "Trailers" with a load capacity of 3,000 pounds or less designed primarily for travel on public roads. F. HIRED AUTO PHYSICAL DAMAGE The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Hired Auto Physical Damage Coverage If hired "autos" are covered "autos" for Covered Autos Liability Coverage but not covered "autos" for Physical Damage Coverage, and this policy also provides Physical Damage Coverage for an owned "auto ", then the Physical Damage Cover- age is extended to "autos" that you hire, rent or borrow subject to the following: (1) The most we will pay for "loss" to any one "auto" that you hire, rent or borrow is the lesser of: (a) $50,000; (b) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (c) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. (2) An adjustment for depreciation and physical condition will be made in determining actual cash value in the event of a total "loss ". (3) If a repair or replacement results In better than like kind or quality, we will not pay for the amount of betterment. (4) A deductible equal to the highest Physical Damage deductible applicable to any owned covered "auto ". (5) This Coverage Extension does not apply to: (a) Any "auto" that is hired, rented or bor- rowed with a driver; or (b) Any "auto" that is hired, rented or bor- rowed from your "employee ". G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES — INCREASED LIMIT The following replaces the first sentence in Para- graph A.4.a., Transportation Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. H. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT — INCREASED LIMIT Paragraph C.1.b. of SECTION III — PHYSICAL DAMAGE COVERAGE is deleted. I. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. J. PERSONAL PROPERTY The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Property Coverage We will pay up to $400 for "loss" to wearing ap- parel and other personal property which is: (1) Owned by an "insured "; and (2) In or on your covered "auto ". This coverage only applies in the event of a total theft of your covered "auto ". No deductibles apply to Personal Property cover- age. Page 2 of 3 © 2015 The Travelers Indemnity Company. All rights reserved. CA T4 20 02 15 InnIndAq rnnvrinhtP.ri matarlal of InCllrnnr.P. Sr+rvirw; nfflrw Inn. with IN narmlaclnn K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to 'loss" to one or more airbags in a covered "auto" you own that in- flate due to a cause other than a cause of 'loss" set forth in Paragraphs A.1.b. and A.1.c., but only: a. If that "auto" is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not intentionally inflated. We will pay up to a maximum of $1,000 for any one 'loss ". L. AUTO LOAN LEASE GAP The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Auto Loan Lease Gap Coverage for Private Passenger Type Vehicles In the event of a total "loss" to a covered "auto" of the private passenger type shown in the Schedule or Declarations for which Physical Damage Cov- erage is provided, we will pay any unpaid amount due on the lease or loan for such covered "auto" less the following: (1) The amount paid under the Physical Damage Coverage Section of the policy for that "auto "; and COMMERCIAL AUTO (2) Any: (a) Overdue lease or loan payments at the time of the "loss "; (b) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (c) Security deposits not returned by the les- sor; (d) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (e) Carry -over balances from previous loans or leases. M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.5., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: 5. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract exe- cuted prior to any "accident" or "loss ", pro- vided that the "accident" or "loss" arises out of the operations contemplated by such con- tract. The waiver applies only to the person or organization designated in such contract. CA T4 20 02 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 3 of 3 Innhiriac nnnvrinhtari malarial of In- nranra Rarvlr.PC OffirP Inn. with it.c narml.-Rinn TRAVELERSJlk One Tower Square, Hartford, Connecticut 06183 INSURING COMPANY: THE TRAVELERS INDEMNITY COMPANY OF CONNECTICUT Named Insured Policy Number: Policy Effective Date: Policy Expiration Date: Issue Date: ADDITIONAL Premium $ CHANGE ENDORSEMENT BUNTON, CLIFFORD & ASSOCIATES, INC.; DBA: BCA ARCHITECTS 680- 8H870283 -18 -47 03/11/2018 03/11/2019 03/30/2018 115.00 Effective from 03/29/18 at the time of day the policy becomes effective. THIS INSURANCE IS AMENDED AS FOLLOWS: Under the Commercial General Liability Coverage Part, Who Is An Insured is changed to include Additional Insured Schedule - Architects, Engineers, and Surveyors, as provided under the attached endorsement. The following Person or Organization has been added for Waiver of Transfer of Rights of Recovery Against Others: CITY OF GILROY, ITS OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS GILROY, CA, 95020 The following forms and /or endorsements is /are included with this change. These forms are added to the policy or replace forms already existing on the policy: CG D3 82 09 15 IL TO 07 09 87 CG 24 04 10 93 CG D4 26 07 08 NAME AND ADDRESS OF AGENT OR BROKER IOA INSURANCE SERVICES 3875 HOPYARD RD STE 240 Countersigned by Authorized Representative PLEASANTON CA 94588 DATE: 03/30/2018 IL TO 07 09 87 (Page 1 of 1 ) Office: SPECIALIST A &E POLICY NUMBER: 680 - 8x870283 -18 -47 EFFECTIVE DATE: 03/11/2018 ISSUE DATE: 03/30/2018 LISTING OF FORMS, ENDORSEMENTS AND SCHEDULE NUMBERS THIS LISTING SHOWS THE NUMBER OF FORMS, SCHEDULES AND ENDORSEMENTS BY LINE OF BUSINESS * IL TO 07 09 87 CHANGE ENDORSEMENT IL TO 19 02 05 COMMON POLICY DECLARATIONS IL TO 25 08 01 RENEWAL CERTIFICATE MP TO 01 02 05 BUSINESSOWNERS COVERAGE PART DECLARATIONS * IL T8 01 01 01 FORMS ENDORSEMENTS AND SCHEDULE NUMBERS IL T3 15 09 07 COMMON POLICY CONDITIONS BUSINESSOWNERS MP TO 25 02 05 SPECIAL PROVISIONS - LOSS PAYEE CP 12 18 10 12 LOSS PAYABLE PROVISIONS MP T1 30 02 05 TABLE OF CONTENTS - BUSINESSOWNERS COVERAGE PART - DELUXE PLAN MP PO 06 09 15 ARCHITECTS, ENGINEERS AND SURVEYORS PROPERTY ENHANCEMENT MP PO 07 09 15 ARCHITECTS, ENGINEERS AND SURVEYORS FLOOD ENDORSEMENT MP T1 02 02 05 BUSINESSOWNERS PROPERTY COVERAGE SPECIAL FORM MP T1 05 02 05 AMENDATORY PROVISIONS - OFFICES MP T3 27 07 03 CAUSES OF LOSS - EARTHQUAKE SPRINKLER LEAKAGE MP T3 07 03 97 PROTECTIVE SAFEGUARDS ENDORSEMENT FOR SPRINKLERED LOCATIONS AND RESTAURANTS MP T3 25 01 15 FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE MP T3 29 02 05 ERISA COVERAGE MP T3 50 11 06 EQUIPMENT BREAKDOWN - SERVICE INTERRUPTION LIMITATION MP T3 56 02 08 AMENDATORY PROVISIONS - GREEN BUILDING AND BUSINESS PERSONAL PROP COV ENHANCEMENTS MP T1 55 02 05 EMPLOYEE DISHONESTY AND FORGERY OR ALTERATION INCREASED LIMIT MP T4 90 05 10 LIMIT OF INS /OCCURRENCE ENDT - CALIFORNIA MP T5 08 01 06 CALIFORNIA CHANGES - REPLACEMENT COST MP T5 02 02 05 CALIFORNIA CHANGES - ESCROW AGENT COMMERCIAL GENERAL LIABILITY CG D4 69 07 14 TOT AGG LIMIT OTHER THAN PROJECTS CG TO 34 11 03 TABLE OF CONTENTS - COMMERCIAL GENERAL LIABILITY COVERAGE FORM CG 00 01 10 01 CG 00 01 10 01 COMMERCIAL GENERAL LIABILITY COVERAGE FORM * CG 24 04 10 93 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US CG D2 55 11 03 AMENDMENT OF COVERAGE - POLLUTION CG D3 09 11 03 AMENDATORY ENDR- PRODUCTS - COMPLETED OPERATIONS HAZARD * TEXT IN THIS FORM HAS CHANGED, OR THE FORM WAS NOT ON POLICY BEFORE. IL T8 01 01 01 PAGE: 1 OF 3 POLICY NUMBER: 680- 8H870283 -18 -47 EFFECTIVE DATE: 03/11/2018 ISSUE DATE: 03/30/2018 COMMERCIAL GENERAL LIABILITY (CONTINUED) CG D3 81 09 15 BLANKET ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) * CG D3 82 09 15 SCHEDULED ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) * CG D4 26 07 08 OTHER INS -DESIG ADDL INS - PRIMARY & NONCO CG D4 71 01 15 AMENDMENT OF COVERAGE B - PERSONAL AND ADVERTISING INJURY LIABILITY CG D2 03 12 97 AMEND - NON CUMULATION OF EACH OCC CG D2 06 06 04 AMD OF EXPECTED OR INTENDED INJY EXL - ADD OF PROP DMGE TO EXC FOR RESNBLE FORCE CG D3 79 01 16 ARCHITECTS, ENGINEERS AND SURVEYORS COVERAGE XTEND ENDORSEMENT CG D4 13 04 08 AMEND COVG - POLLUTION -EQUIP EXCEPTION CG D2 88 11 03 EMPLOYMENT- RELATED PRACTICES EXCLUSION CG D3 26 10 11 EXCLUSION - UNSOLICITED COMMUNICATION CG D3 56 05 14 MOBILE EQUIPMENT REDEFINED - EXCLUSION OF VEHICLES SUBJECT TO MOTOR VEHICLE LAWS CG D3 80 10 11 EXCLUSION - ENGINEERS, ARCHITECTS OR SURVEYORS PROFESSIONAL LIABILITY CG D4 21 07 08 AMEND CONTRAL LIAB EXCL - EXC TO NAMED INS CG D6 18 10 11 EXCLUSION - VIOLATION OF CONSUMER FINANCIAL PROTECTION LAWS CG D6 75 01 13 AMEND -WHO IS INS - ARCHIT /ENG /SURVEY ACTIV CG D7 46 01 15 EXCLUSION - ACCESS OR DISCLOSURE OF CONFIDENTIAL OR PERSONAL INFORMATION CG D7 97 01 16 AMENDMENT - OTHER INSURANCE CONDITION - ENGINEERS, ARCHITECTS OR SURVEYORS CG DO 76 06 93 EXCLUSION - LEAD CG D1 42 01 99 EXCLUSION - DISCRIMINATION CG D2 42 01 02 EXCLUSION - WAR CG T4 78 02 90 EXCLUSION - ASBESTOS EMPLOYEE BENEFITS LIABILITY CG TO 09 09 93 EMPLOYEE BENEFITS LIABILITY COVERAGE PART DECLARATIONS CG TO 43 01 16 TABLE OF CONTENTS - EMPLOYEE BENEFITS LIABILITY COVERAGE FORM CG T1 01 01 16 EMPLOYEE BENEFITS LIABILITY COVERAGE FORM MULTIPLE SUBLINE ENDORSEMENTS CG D4 09 04 08 AMENDMENT OF BODILY INJURY DEFINITION CG D4 19 07 08 AMENDMENT OF PROPERTY DAMAGE DEFINITION CG T3 33 11 03 LIMITATION WHEN TWO OR MORE POLICIES APPLY * TEXT IN THIS FORM HAS CHANGED, OR THE FORM WAS NOT ON POLICY BEFORE. IL T8 01 01 01 PAGE: 2 OF 3 POLICY NUMBER: 680- BH870283 -18 -47 EFFECTIVE DATE: 03/11/2018 ISSUE DATE: 03/30/2018 INTERLINE ENDORSEMENTS IL T3 68 01 15 FEDERAL TERRORISM RISK INSURANCE ACT DISCLOSURE IL T4 00 12 09 DESIGNATED ENTITY - NOTICE OF CANCELLATION OR NONRENEWAL PROVIDED BY US IL T4 12 03 15 AMNDT COMMON POLICY COND- PROHIBITED COVG IL T4 14 01 15 CAP ON LOSSES FROM CERTIFIED ACTS OF TERRORISM IL T3 82 05 13 EXCLUSION OF LOSS DUE TO VIRUS OR BACTERIA IL 00 21 09 08 NUCLEAR ENERGY LIABILITY EXCLUSION ENDORSEMENT (BROAD FORM) IL 01 04 09 07 CALIFORNIA CHANGES IL 02 70 09 12 CALIFORNIA CHANGES - CANCELLATION AND NONRENEWAL POLICY HOLDER NOTICES PN T4 54 01 08 IMPORTANT NOTICE REGARDING INDEPENDENT AGENT AND BROKER COMPENSATION PN MP 57 04 17 IMP NOT PROT SAFEGUARDS SPRK AND REST PN MP 38 01 11 IMPORTANT NOTICE - JURISDICTIONAL INSPECTIONS * TEXT IN THIS FORM HAS CHANGED, OR THE FORM WAS NOT ON POLICY BEFORE. IL T8 01 01 01 PAGE: 3 OF 3 POLICY NUMBER: 680- 8x870283 -18 -47 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 03 /30/2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF GILROY, ITS OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS GILROY CA 95020 (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV- COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: 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 hazards." This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 10 93 Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 POLICY NUMBER: 680 - 8x870283 -18 -47 COMMERCIAL GENERAL LIABILITY ISSUE DATE: 03/30/2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SCHEDULED ADDITIONAL INSURED (ARCHITECTS, ENGINEERS AND SURVEYORS) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1- iy:121 pill 4=1 NAME OF PERSONS OR ORGANIZATIONS: CITY OF GILROY, ITS OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS 7351 ROSANA STREET GILROY CA 95020 PROJECT /LOCATION OF COVERED OPERATIONS: PROVISIONS 1. The following is added to SECTION II — WHO IS AN INSURED: The person or organization shown in the Schedule above is an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury ", "property damage" or "personal injury"; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: c. With respect to the independent acts or omissions of such person or organization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply to the rendering of or failure to render any "professional services ". f. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance ", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance ". This endorsement does not increase the limits of insurance described in Section III — Limits Of Insurance. g. This insurance does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to that additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. CG D3 82 09 15 © 2015 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 Includes the copyrighted material of Insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY 2. The following is added to Paragraph 4.a. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured shown in the Schedule above is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non - contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organization as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring insurance ". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. 3. The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: We waive any right of recovery we may have against the additional insured shown in the Schedule above because of payments we make for "bodily injury", "property damage" or "personal injury" arising out of "your work" on or for the project, or at the location, shown in the Schedule above, performed by you or on your behalf, done under a "written contract requiring insurance" with that person or organization. We waive this right only where you have agreed to do so as part of the "written contract requiring insurance" with such person or organization signed by you before, and in effect when, the "bodily injury" or "property damage" occurs, or the "personal injury" offense is committed. 4. The following definition is added to the DEFINITIONS Section: "Written contract requiring insurance" means that part of any written contract with the person or organizations shown in the Schedule above, under which you are required to include that person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a. After you have signed that written contract; b. While that part of the written contract is in effect; and c. Before the end of the policy period. Page 2 of 2 © 2015 The Travelers Indemnity Company. All rights reserved. CG D3 82 09 15 Includes the copyrighted material of Insurance Services Office, Inc., with its permission COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 680- BH870283 -18 -47 ISSUE DATE: 03/30 /2018 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE - DESIGNATED ADDITIONAL INSUREDS - PRIMARY AND NON - CONTRIBUTORY WITH RESPECT TO CERTAIN OTHER INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Additional Insured CITY OF GILROY, ITS OFFICERS, EMPLOYEES, AGENTS AND VOLUNTEERS (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) PROVISIONS The following is added to Paragraph 4. a., Primary Insurance, of SECTION IV — COMMERCIAL GEN- ERAL LIABILITY CONDITIONS: The insurance afforded under this Coverage Part to an additional insured designated in the Schedule above is primary to other insurance that is available to such additional insured which covers such additional insured as a named insured, and we will not share with that other insurance, provided that if you agree in a written contract or agreement that the insurance afforded to such additional insured under this Cover- age Part must apply on a primary basis, or a primary and non - contributory basis, this insurance is primary to such other insurance only if: (1) The "bodily injury" or "property damage " for which coverage is sought is caused by an "occurrence" that takes place; and (2) The "personal injury" or "advertising injury" for which coverage is sought arises out of an offense that is committed; subsequent to the signing and execution of that con- tract or agreement by you. CG D4 26 07 08 © 2008 The Travelers Companies, Inc. Page 1 Of 1 CHANGE OVERPRINT /CHANGE SLIP POLICY NUMBER: 680- BH870283 -18 -47 ISSUE DATE: 03/30/2018 RATER: JM CHANGE EFFECTIVE DATE: 03 -29 -18 EFFECTIVE DATE: 03/11/2018 EXPIRATION DATE: 03/11/2019 INSURED'S NAME: BUNTON, CLIFFORD & ASSOCIATES, INC.; DBA: BCA ARCHITECTS New /Renewal: R Solicitor Code: SAL 4421F7101 MSI: x Rating Mode: S.B. ACCT. EFF. MO. DATE 18/03 03 -29 -18 Type Code Special Code: Program Code: B13 Paymode: L Audit Frequency: N Responsibility: x PREMIUM .1500 115.00 Watch File: Survey Code: Reinsurance: f DOWNSTREAM Pro Rata Factor: 0.951 PREMIUM SUMMARY Type Code Description OFFICE: SPECIALIST A &E 21X PRODUCER NAME: IOA INSURANCE SERVICES CGW82 Page 1 of 1 115.00 115.00