Loading...
HomeMy WebLinkAboutBunton Clifford & Associates - Insurance Certificate (2019)BUNTCLI -01 FRANCISCON ACOROw CERTIFICATE OF LIABILITY INSURANCE 41%...../ DATE (MMIDDIYYYY) 8/30/2018 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 # 0E67768 IOA Insurance Services 3875 Hopyard Road Suite 200 Pleasanton, CA 94588 CONTACT NAME: Jennifer Cervantes PHONE (A /C, No, Eat): (925) 660 -3533 50033 (A /C, No): nooREss: jennifer.cervantes @ioausa.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Travelers Indemnity Company of Connecticut 25682 INSURED Bunton, Clifford & Associates, Inc. dba BCA Architects 505 South Market Street San Jose, CA 95113 INSURER B : Travelers Property Casualty Company of America 25674 INSURER C : RLI Insurance Company 13056 INSURER D : Travelers Casualty & Surety Company of America 31194 INSURER E : INSURER F : X COVERAGES CERTIFICATE 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 INSD SUBR WVD POLICY NUMBER POLICY EFF (MM /DD/YYYYI POLICY EXP (MM /DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 6808H870283 03/11/2018 03/11/2019 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGETORENTED PREMISES (Ea occurrence) $ 1,000,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE POLICY OTHER: X LIMIT APPLIES PER: LOG GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON -OWNED AUTOS ONLY BA3F416764 03/11/2018 03/11/2019 COMBINED SINGLE LIMIT (Ea accident) 1,000,000 $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE CUP8647Y644 03/11/2018 03/11/2019 EACH OCCURRENCE $ 4,000,000 AGGREGATE $ 4,000,000 DED RETENT ON $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER /EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N I A PSW0001551 09/01/2018 09/01/2019 X PER STATUTE OTH- ER 1,000,000 E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 1,000,000 E.L. DISEASE - POLICY LIMIT $ D D Professional Liab. Professional Liab. 106831434 106831434 11/14/2017 11/14/2017 11/14/2018 11/14/2018 Per Claim 1,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requi ed) • 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 City of Gilroy, its officers, officials and volunteers 7351 Rosana Street (Gilroy. CA 95020 ACORD 25 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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. B. C. D. E. F. G. BLANKET ADDITIONAL INSURED EMPLOYEE HIRED AUTO EMPLOYEES AS INSURED SUPPLEMENTARY PAYMENTS — INCREASED LIMITS TRAILERS — INCREASED LOAD CAPACITY HIRED AUTO PHYSICAL DAMAGE 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: An "employee" of yours is an "insured" while operating a covered "auto" hired or rented under a contract or agreement in an "em- ployee's" name, with your permission, while CA T4 20 02 15 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 ". C. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION II — COVERED AUTOS LIABILITY COVERAGE: © 2015 The Travelers Indemnity Company. All rights reserved. InrI,irias rnnvrinhfari matarlal of Insiiranrw San/ir,s (lffira Ino with its nwrmisslnn Page 1 of 3 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 A.4., ,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. Page 2 of 3 (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 t� 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 A.4., 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. © 2015 The Travelers Indemnity Company. All rights reserved. CA T4 20 02 15 InrllldAS rnnvrinhtprt matarial of Insiiranrp SPrvirwc rlfftrq Inr. with Its narmicclnn 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 A.4., 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 CA T4 20 02 15 COMMERCIAL AUTO (2) Any: (a) Overdue lease or loan payments at the time of the "loss "; a (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.S., 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. © 2015 The Travelers Indemnity Company. All rights reserved. Innhv1PC rnnvrinhtAri matarial of Ins.ir, nra SPrvlr.PV tlffira Inn with its narmIssInn Page 3 of 3 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: CG D3 82 09 15 e. f. 9. This insurance does not apply to the rendering of, or failure to render any "professional services ". 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. 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. © 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. Page 2 of 2 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. © 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- 8E870283 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- 8H870283 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 CG 24 04 10 93 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. Copyright, Insurance Services Office, Inc., 1992 Page 1 of 1 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 4 -84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT — CALIFORNIA 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. Schedule Person or Organization All persons or organizations that are party to a contract that requires you to obtain this agreement, provided you executed the contract before the loss. Job Description Jobs performed for any person or organization that you have agreed with in a written contract to provide this 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 Insured Bunton, Clifford & Associates, Inc. Policy No. PSW0001551 Insurance Company RLI Insurance Company Countersigned By Endorsement No. ©1998 by the Workers' Compensation Insurance Rating Bureau of California. All rights reserved. BUNTCLI -01 FRANCISCON ACORO° CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 8/30/2018 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 CONTACT ,Jennifer Cervantes NAME: PHONE FAX (A/C, No, Ezt): (925) 660 -3533 50033 (A/C, No): IOA Insurance Services 3875 Hopyard Road Suite 200 ADDRIESS: jennifer.cervantes @ioausa.com Pleasanton, CA 94588 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Travelers Indemnity 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 1 000 ��� $ INSURER F: MED EXP (Any one person) $ 10,000 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE FIV-1 OCCUR 6808H870283 03/11/2018 03/11/2019 DAMAGE TO RENTED PREMISES Ea occurrence 1 000 ��� $ MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY � JECT El LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 $ X BODILY INJURY Per person) $ ANY AUTO BA3F416764 03/11/2018 03/11/2019 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,000 EXCESS LIAB CLAIMS -MADE CUP8647Y644 03/11/2018 03/11/2019 AGGREGATE $ 4,000,000 DED RETENTION $ $ C WORKERS COMPENSATION ANDEMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE PSW0001551 09/01/2018 09/01/2019 X PER OTH- STATUTE ER E.L. EACH ACCIDENT 1,000,000 $ OFFICER /MEMBER EXCLUDED? ❑ (Mandatory in NH) NIA E.L. DISEASE - EA EMPLOYEE $ 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 11/14/2018 Per Claim 1,000,000 D Professional Liab. 106831434 11/14/2017 11/14/2018 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe 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 Gilrov, CA 95020 ACORD 25 (2016/03) @ 1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD f "' COMMERCIAL GENERAL LIABILITY PdLI(!Y NUM OER: 640- 8ii870883 THIS ENMRSEIIIIIIIIINT C"VVGES THE POLIO'. PLAA3E REBID IT CAREFMLY. SCHEDULED AWtONALIHOLKED (A6H1TECT'S. ENQtMWM AND 11lRV'EYBRS) This erWor9ernent rnvd*n insurance ppppkerl under the %Naming: COidIWERCIAL GENERAL LIABILITY COVERAGE PART SCHiDULt N"E OI` RERGOMas OR ORGAMiZATKNW: CITY O! GILMOY, IT9 OFFICERS, M1110LOYINIO, "MINTS IdiD V0LUKTa§i1ie 7351 A0011110iiat STIMT SILF" CA D5020 PROJECT /LOCATION OF COVERED OPERATIONS: PER WRITTEN CONTRACT PROVWIOMG 1. The fGAD"n@ is adiiad to 3GCTiQd II — HMO ii a. This insurance elates not a@* iD the AN IA56MD: rendering of or failure to renter any The person or organization rhown in IN "prok9sional servltes ". Schedule above is an addRypriW inwrod on thin } In The event that the Limlts of Insurance of the Coverer Part, bLK: Coverage ParK 9hewn in @he Declarations a< Only with respect to lisfitltyr }dir }y inj►try", exossal tine I nits of liabWity required Nor the "written contract requiring insurance", tins " property damage" � "psrserrad injury"; and insurance provided to the addlllonal influred b. MF, end only to the extent that, that injury or shall be limited to the limit' cif liablllty requited Mamage is caused by acts or omissionl: of by *at "wlikoen cop"d requiring insuinswe ". you or your subcorRractor in tMe peftrmance This andergement does not increase the of "your evork" tb which the "written contract limits of insurance descriked in Section Iii — necluiring insurance" applies, or in connection Lin*6 Of Insurance. with p�n1l9e9 egad by Or rerilited to you. q. This insurance dam not app* to baolil)i The person e* erliizatlom does riot qualify as Mn injur�l or "property damage" ca,uied by "your aa"tiertei impired: work" and included in the "products - completed epwollons hmEmrd" unless thm c. With respect to the inde pec pewdent situ oi "written contract requiring insurance" "issions of such person or apanizatisn; or *wRicaly requires you to provide such ak For "Iredily injory ", "propsoy darnaga" or coverage for tPpt acidlllwal insured, and then "personal injury" for which Such person or the lhsUtance provided to that addWnal organization ha6 arssuntool Iiabiiityr in a imwu*ad applies only to such "bodily injury" ow contract or agrsa nerit. " property damage" Thai occurs before the and of lie paned oT time for Which the "wittan The insurance promWed to such addWonal ineureal contract requiring insurance" re*res you to is limits arb %kws: provide such coverage dt the end c# the poky period, whickwor A 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 COOOWRCIAL GEMERAL LIABILITY P. The follovMrlg is added tp Paragraph 4.a. of 99CT"M N — COi ERCIAL 4EIVRAL LIAMITY CCMIIR011s: The insurance provided to the addltiorvi insured shown in the Schedule alwva ir, ivica&F over any vald and collectibt other inwance, Ooftr primary, excess, contingent or on any oher basis, that is available to he additional insiiired for a bl:s we cover. However, p yw specliically agree in IiQ "written contract requiring insurance" that this insurance provided to the additiorwi insured under this Coverage Park must apply on a primary basis or a primary and non- coritribdIQry basirk, this insurance is primary to other insurance available to the additional insured vdhich covers That person or orgpinizatlon as a named insured for such loss, and v?e NMI not share witMl the dther insurance, provided thatt: (1) T* "bodily injury" or "property dlamao" for which cavemge R sbt.flt occurs; and (2) The "personal injury" for which coverage is sought arses out of an o0ense committed; altar you have i;igrnea that "wrlion contract requiring insurance ". 19U9 tnil; ir*wance provided to the additional inuired siM is excess over veld and collecMe oher insurance, whether primary, excess, contlroent or on any other I arlis, that is availabite to the ado"onal insured When that person or orgpnization t5 an additional insured under any other insurance. 3. The foMowirtg is idled to Paragraph S., Transfirr of Righle Of Recovery Ayain9t Others To Uz, oT IECTICN FV — CO■MMCIPi- MMMRPJ- LIABILITY CO%MTMMS: VVe waive any right of recovery we may have agahiet the additional insuPPM shun A the Schedule abum becouse of poyiments we mo e for "bodily injury" "propedy darne@e" or "pere0nol isjurry" aririn9 arri of yolrr m orle on or Tor the project, or at the localon, shown in the'checM labor, peftrmed by you or on your behalf, done upiolm a "**alien contract Iequiring Onuramce" wAh them permw or orgsniea*w. We waive this right orilyr Where you have agreed to do so as part of the " writien contract regioiring insurance" vdil-i gutM person or orgplydzation signed by you befm, and in effect when, the "bod*j injury" or "praperiy aierr, " occurs, er the "pai-sonol injury" of niao it comm1had. 4. The idlewind definition is ard@W to the DUMATIONG Sec9ian: "TVrittisn contract requiring in&t,aance" means hat part of any Nritten contract \Nth the person or ergwimplOons shown in the Schedule a Mwe, Lrrrler which yrou are required to include shot W%on or organs w9w as an add■onal inrured on 1ht5 Coverage Part, provided That the ' bodMy injtly" and "pROpnrty demale" atcurS arld the "personal injury" is cmiovel by min oiierree committed: a. A%ar you halve signed that written contract; b. White that part of the vwitlen contract is in effect; end r. Waire the and of the piney popiwd. Page 2 of 2 © 2015 The Tr■wim irm6mr* C mpoW. ail ishis rr n d. CG D3 82 09 15 Irubmhrrthe arappipW d rmhoil of h�rw awnl..e Oiirw, Imo., wW it pmoiwin COMMERCIAL GENERAL LIABILITY POLICY NUMBER: 680- 8H870283x THIS ■NUMSEMNT CFL%Nr&g THE PULICY..■46U MAD 11 CAMPI ILLY. OTHER INSURANCE - DE6,01NATED ADDITONAL IiIli IDS - PROOARY A NO NO Ok"ISWTORY MM RESPECT TO CERTAIN 01 "R NSURAMCE This en4orsoment ntiorlifies insurance prooiderl undw the feiiswing: COWPERCIAL GEIMEIlAL LIABILITY COVERAGE PART SCMEDULN Gosi@&aWA AAcltional iirrrred CITY OR GILBIOY, ITS OS'lIOWS, s LOYMS, iiBiidTS hKiD VOi,iiiiMiRM (!F no erRry appeerro above, information required to coreplaiQ thin andorsemsnt Al be shown in the Dscliralcns as applkeb* to @his endbmoMel-R.) RROV1910M6 The fdllowinq is added to Paragraph 4. a., Primary Frisurance, of SEQJ10W IV — C(9RMRCVAL GEfIr ERAL LIAINLITY CORMTI(M5: The insurance afforded under this Coverage Part to W additional insured designated in the Schedule ebmw is ppimard to other ipsuralme that is available to such additional insured which cowers such addiiiisnal insured arm i nirrted inawred, and we wll not shire evlth that dther insurance, provi*d that f you agree in a wri@tea c@Mrwtt or 2grMnerR that the lhsurance effe isal to such aldeiitionel insured upler this Camp- CG D4 26 07 08 ale PaK rapt apply on a p0may bask, a a primay a rd memconirWoutooy bersis, this insurance is primary to arlch oher inawance only M.' (1) The "bodly injury" or "property damage " for which coverage is sought is caused by an "occurrence" that lakes plwe; and (2) The "persorkal injury" ar "adrrirtising injury" for which coverage irl sought arises out of an offensre @hat Ps cornmiNed; subsechent to the signing and execution dt @hat con - trett or agpowrmlint 1py you. © 2008 The Travelers Companies, Inc, Page 1 of 1 COMMERCIAL GENERAL LIABILITY - POLICY NUMBER: 680 - 8x870283 TPIIS EPWQRt AT CHANGES TFE MUC`F. (LEASE IgE&G IT CAREFULLY. WAIVER OF TRAl16FER OF RIUM3 OF RECOVERY AGARlST OV&S TO U6 Thio andersement modifies insurance 1wwi*kd under tNt fallowir%: COMMERCIAL GiEWRAL LIABILITY COVERAGE PART S+C"EDUlE %roe of Frsw or Cirgrreiadion: CIWZ OF ISILROY, ITS OFFICWS, EMPLOYEES, AGENTS AND VOLUNTEERS GILROY CA 95020 (If w rritry appoers abrrre, informstimn required to crmplaie this ondar9eosnt will Ise 9hrwn in the Docloraiions as applicable to this endoraimant.) The TRANSFER OF RIGHTS GF RECOVERY AGAINST OTHERS TO US ConcOon (Section IV- COMMERCIAL GENERAL LIABILITY CONCITIONS) is amrnieei IW the addition of the foliowinl: We waive any right of rocorery we maV ham agoirat the person or orjWnizalon shown in ft Scha&ga above becaLme of plyPhentS we make for lhjury or "rage arising rut of your ongoing aper"ans or your Wark" dona under a cor-dract u!h hat, poraw or orgarOzation and included in the "products - compleled operations hazerdy." This waiver WNes rn6y to the person a eny nizetion shown in the Schedule &home. 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.