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HomeMy WebLinkAboutBengal Engineering - Insurance Certificate (2019)ACOO CERTIFICATE OF LIABILITY INSURANCE DATE 01/18/2019Y) 01 /18/2019 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 CONTACT NAME: Tina Jackson Tina Jackson Insurance Services, Inc A/C,"N . EXt): 8059662500 is/C, No): 3834 Pemm PI I MAIL ADDRESS: tina@tinajacksonins.com A Santa Barbara, CA 93110 I INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Hanover Insurance Group INSURED INSURER B : U.S. Specialty Insurance Company Bengal Engineering, Inc I INSURERC: INSURER D : 360 S. Hope Ave. Suite C-110 INSURER E : Santa Barbara CA 93105 INSURER F : 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) I LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 0133A316654 1001257 06/15/2018 06/15/2019 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE ❑X PREMISESS( OCCUR I DAMAGERENTED 300,000 (Ea occurrence) $ MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7 PRO- ❑ LOC JECT OTHER: A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED X AUTOS ONLY X AUTOS ONLY UMBRELLALIAB OCCUR EXCESS LIAB HCLAIMS-MADE DED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below B Professional Liability Retroactive 9/17/97 GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP/OP AGG $ 4,000,000 AW3A50250500 12/12/18 12/12/19 COMBINED SINGLE LIMIT $ 1 000,000 (Ea accident) + BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) EACH OCCURRENCE AGGREGATE WD D557061 00 05/15/18 05/15/19 X I PER STATUTE I I OTH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 USS 18 29008 09/17/1809/17/19 $1,000,000 Per Maim $2,000,000 Agg� egate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Gilroy, its officials, officers and employees are listed as Additional Insured in respects to general liability. Coverage is primary and non-contributory. Waiver of subrogation applies. 10th Street Detail Design CERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna Street ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD rho anover Insurance Group - THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY. This endorsement modifies insurance provided under the following: BU8NE80[WNER8COVERAGE FORM Name Of Person Or Organization CITY {]FG|LR{]Y. ITS ELECTED OFFICIALS, SCHEDULE Location And Description Of Completed Operations AND EMPLOYEES OFFICIALS AND EMPLOYEES (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) For the purpose of coverage provided by this endorsement, the following changes are made to SECTION 11 - LIABILITY: A. The following is added to SECTION U - LIABILITY, C. Who Is An Insured: Any person or organization shown in the Schedule above is also on additional insured' but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in par. by 'your work" at the location designated and described in the Schedule oboma, performed for that additional insured and included in the "prod uota-oornp|mted operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted bylaw; 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 one required by the contract oragreennant to provide for such additional insured. B. The following is added to SECTION 11 - LIABILITY,Rtn And D8edh:e| Expenses Limits Of Insurance: If coverage provided to the additional insured is required by o contract or agreement, the most we will pay on behalf ofthe additional insured is the amount ofinsurance: 1. Required bythe contract oragreement; or 2. Available under the applicable Limits of Insurance shown inthe Dec|anationm' ' whichever |mless. This endorsement ahe|| not inonymme the applicable Limits of Insurance shown in the DmdoneUona. ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED. 391-16020816 Includes copyrighted material ofInsurance Services Office, mc.with its permission, Page lof1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ [TCAREFULLY. ���U ��~°~°...E°=°=='WNERSLIABILITYSPECIAL �~�~==E�°"==°""==~°=~Nx This endorsement modifies insurance provided under the following: BUS|NEGS[WNERBC{VERAGE FORM SUMMARY OF COVERAGES Y. Additional Insured by Contract, Agreement orPermit 2, Additional Insured ' Broad Form Vendors 3. Alienated Premises 4. Broad Form Property Damage - Borrowed Equipment, Customers Goods and Use of Elevators 5. Incidental Malpractice (Employed Nurses, EyNT`sand Paramedics) 6. Personal and Advertising Injury -BnoodForm 7. Product Recall Expense Product Recall Expense Each Occurrence Limit Product Recall Expense Aggregate Limit Product Recall Deductible 8. Unintentional Failure to Disclose Hazards 9. Unintentional Failure to Notify Limits Page Included 1 Included 2 Included 3 Included 3 Included 3 Included 4 Included 4 $25,000 5 Occurrence $5O`OOO Aggregate ^ $500 5 Included 6 Included 8 This endunyonlont amends coverages provided under the Bueineaeownene Coverage Form through now coverages and broader coverage grants. This coverage hu subject to the provisions applicable to the Businessowners Coverage Form, except as provided below. The following changes are made to SECTION 11 - LIABILITY: 1. Additional Insured by Contract, Agreement or Permit The following is added to SECTION 11 - LIABILITY, C.Who 1mAm Insured: Addidona{ Insured by Contract, Agreement or Permit a. Any person or organization with whom you agreed in a written oontract, written agreement or permit toadd such person or organization as an additional insured on your policy is an additional insured only with respect to liability for "bodily injury". ITproperty damage", o[ "personal and advertising injunry" caused, in whole or in part by youraots or omissions, or the acts Vromissions ofthose acting onYour behalf, but only with respect to: (1) "Your work" for the additional insured(s) designated in the contract, agreement or (2) Premises you own. rent, lease or occupy -,or (3) Your maintenance, operation or use of equipment leased toyou. b. The insurance afforded to such additional insured described above: (1) Only applies to the extent permitted by |ow'ond (2) Will not be broader than the insurance which you are required by the contract, agreement or permit to provide for such additional insured. (3) Applies on o primary basis if that is required by the written contract, written agreement orpermit. (4) Will not be broader than coverage provided tVany other insured. (5) Does not apply if the "bodily injury", "property damage" or "personal and advertising in'ury"io otherwise excluded from coverage under this Coverage Part, including any endorsements thereto. 391-1006 0818 Includes copyrighted materials of Insurance Services Offices, inc..with its permission. Pagel of6 ['he Hanover Insurance Group.. OB3 A316654 1001257 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: BUSINESSOWNERS COVERAGE FORM SCHEDULE* Name Of Person Or Organization: Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations. Paragraph K. Transfer Of Rights Of Recovery Against Others To Us in Section III - Common Pol- icy 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 op- erations or "your work" done under a contract with that person or organization and included in the ""products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. BP 04 97 07 02 Copyright, ISO Properties, Inc., 2001 Page I of I Harhenover 1257 1. SECTION | - PROPERTY, if two or more of However, if you agree in a written this coverage part'a omxmnaQes apply to uontnaot, written ogreament, or the monne |ome or damage, we will not pay written permit that the insurance more than the actual amount ofthe loss or provided to any person or damage. organization included as an 2. SECTION || ~ LJAB|L[TY, it is our stated Additional Insured under this intent that the various Coverage ports' Coverage part is primary and fonna, endorsements or pp|ioioo issued to non-contributory, we will not seek the nennod insured by us, or any company contribution from any other affiliated with us` do not provide any insurance available to that Additional duplication or overlap ofonvera e for the Insured which covers the Additional = same claim, "suit", "occurrence", offense, Insured as aNamed Insured except: accident, "wrongful act" or loss. We will (1) For the sole negligence of the not pay more than the actual amount of Additional Insured; or the loss wrdamage. (2) When the Additional Insured is If this Coverage Pert and any other an Additional Insured under Coverage Part, form' endorsement or another liability policy. policy issued tothe named insured by us, bExcessinsunnnce ' or any company affiliated with us, apply to the same o|o|rn "suit", occurrence, �.. This insurance is excess over: offense, eooident, "wrongful act" or loss, �1\ Any of the other |nsunonce, the maximumn Limit of Insurance under all ^ ' whether primary, excess, such Coverage perto, forme, contingent or on any other basis: endorsements or policies combined shall not exceed the highest applicable Limit of �m� That is Fire, Extended Insurance under any one Coverage Part, Builder's Risk, fmnn. endonyennentorpolicy. Installation |nmba|/mtion Risk or similar coverage for "your work"; This condition does not apply to any Excess or Umbna||m Policy issued by um /�� �h�� is Property Insurance for specifically to apply as excess insurance over this policy. premises rented to you or temporarily occupied by you permission ofthe nvvner; G. Liberalizationwith ��\ That is insurance purchased ^ If we adopt any revision that would broaden ' by you to cover your liability the coverage under this policy without as a tenant for "property additional premium within 45 days prior to or damage" to premises rented during the policy period, the broadened to you or temporarily coverage will immediately apply to this policy. occupied by you with H. Other Insurance permission of the owner; or 1. SECTION l - PROPERTY (d) If the loss arises out of the n If there is other insurance covering the maintenance" or use of "autos or watercraft momo |oeo or damege, wewill|| pay only for t the � ` ~ extent''~^ subject to the amount of covered loss or damage in SECTION 11 - LIABILITY, excess of the amount dua fromthet other Exclusion � - Aircraft, Auto or |nsuoance, whether you can collect on it or and �/mK�m�r�f�' a wenot. But, � will not pay more than the ' applicable Limit of Insurance of SECTION | (2) Any other primary insurance - PROPERTY. available to youliability 2' ��C���P|| - L1k�[�|�� .covering for damages arising out of the premises or operations, or the If other valid and oo||eoUb|m insurance is products and completed available to the insured for a |oma we operations, for which you have cover under SECTION }) - LIABILITY, our been added as an additional obligations are limited as follows: insured by attachment of an a. Primary Insurance an ' endorsement. This insurance is primary except when When this insurance is excess, we 11 ~ paragraph b. ba|ovv applies. If this LIABILITY to defend the insured red insurance is primary, our obligations are not affected unless any of the �g�inmt any "mu|�, if any other °` other insurance is also primary. Then. insurer has a duty to defend t"ha insured against /�-' "suit". If ^''~^ ' other we will share with all that other insurer defends, | we will undertake to insurance by the method described in do so, but we `^ i|| be entitled to the paragraph �- below. 391-1003 08 16 Includes copyrighted material of Insurance Services Office, Inc., with its permission. Page 79 of 81 DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE ( 01/18/2019 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 CONTACT NAME: Tina Jackson Tina Jackson Insurance Services, Inc PHONN . Ext�: 8059662500 FAX No): 3834 Pemm PI E-MAIL ADDRESS: �I tins tina acksonins.com Santa Barbara, CA 93110 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Hanover Insurance Group INSURED INSURERB: U.S. Specialty Insurance Company Bengal Engineering, Inc INSURERC: INSURER D : 360 S. Hope Ave. Suite C-110 INSURER E Santa Barbara CA 93105 INSURER F : 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 ADDL SUBR LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y 0133A316654 1001257 06/15/2018 06/15/2019 EACH OCCURRENCE $ 2,000,000 CLAIMS ❑X OCCUR DAMAGERENTED 300,000 -MADE PREMISESS( (Ea occurrence) $ MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 POLICY PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 4,000,000 OTHER: $ A AUTOMOBILE LIABILITY AW3A50250500 12/12/18 12/12/19 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANY AUTO ( BODILY INJURY (Per person) $ OWNED i SCHEDULED BODILY INJURY AUTOS ONLY AUTOS (Per accident) $ HIRED NON -OWNED X PROPERTY DAMAGE $ X AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB HCLAIMS-MADE OCCUR EACH OCCURRENCE $ EXCESS LIAR AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION WZ3 D557061 00 05/15/18 05/15/19 X OERH AND EMPLOYERS' LIABILITY Y� ANYPROPRIETOR/PARTNER/EXECUTIVE STER ATUTE E.L. EACH ACCIDENT 1,000,000 OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Professional Liability USS 18 29008 09/17/1809/17/19 $1,000,000 Per Maim Retroactive 9/17/97 $2,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Gilroy, its officials, officers and employees are listed as Additional Insured in respects to general liability. Coverage is primary and non-contributory. Waiver of subrogation applies. Cohansey Bridge Construction Support CERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna Street ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD The anover Insurarice Group.. THUS ENDORSEMENT CHANGES THE POLICY. PLEASE READ [TCAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - This endorsement modifies insurance provided under the following: BU8NESS(WNERS COVERAGE FORM Name Of Person OrOrganization CITY C]FG|LROY,ITS ELECTED OFFICIALS, SCHEDULE Location And Description OfCompleted Operations AND EMPLOYEES OFFICIALS AND EMPLOYEES (if no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) For the purpose of coverage provided by this endorsement, the following changes are made to SECTION U-LIABILITY: A. The following is added to SECTION l| - LIABILITY, C. Who Is An Insured: Any person or organization shown in the Schedule above is also an additional insured, but only with respect to liability for "bodily injury" or "property damage" cousad, in whole or in par. by "your work" at the location designated and described in the Schedule above, performed for that additional insured and included in the "prod ucte-oomp|etad operations hazard'. Howovmr- 1. The insurance afforded to such additional insured only applies tothe extent permitted bylaw; 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. The following is added to SECTION H ~ LIABILITY, Liability And Medical Expenses Limits Of Insurance: Ifcoverage provided tothe additional insured is required by m contract or ognaemmnt, the most we will pay on behalf ofthe additional insured is the amount ofinsurance: 1. Required bythe contract oragreement; or 2. Available under the applicable Limits of Insurance shown inthe Den|arotimna' . whichever ioless. This endorsement ohmU not increase the applicable Limits of Insurance shown in the Declarations. ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED. 391460200 16 Includes copyrighted material xfInsurance Services Offiva Inc,, with its permission. Page 1 of THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SUMMARY OF COVERAGES 1. Additional Insured by Contract, Agreement or Permit 2. Additional Insured - Broad Form Vendors 3. Alienated Premises 4. Broad Form Property Damage - Borrowed Equipment, Customers Goods and Use of Elevators 5. Incidental Malpractice (Employed Nurses, EMT's and Paramedics) 6. Personal and Advertising Injury - Broad Form 7. Product Recall Expense Product Recall Expense Each Occurrence Limit Product Recall Expense Aggregate Limit Product Recall Deductible 8. Unintentional Failure to Disclose Hazards 9. Unintentional Failure to Notify Limits Page Included 1 Included 2 Included 3 Included 3 Included 3 Included 4 Included 4 $25,000 5 Occurrence $50,000 5 Aggregate $500 5 Included 6 Included 6 This endorsement amends coverages provided under the Businessowners Coverage Form through new coverages and broader coverage grants. This coverage is Subject to the provisions applicable to the Businessowners Coverage Form, except as provided below. The following changes are made to SECTION 11 - 'LIABILITY: 1. Additional Insured by Contract, Agreement or Permit The following is added to SECTION 11 - LIABILITY, C. Who Is An Insured: Additional Insured by Contract, Agreement or Permit a. Any person or organization with whom you agreed in a written contract, written agreement or permit to add such person or organization as an additional insured on your policy is an additional insured only with respect to liability for "bodily injury", "property damage", or "personal and advertising injury" caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf, but only with respect to: (1) "Your work" for the additional insured(s) designated in the contract, agreement or permit; (2) Premises you own, rent, lease or Occupy; or (3) Your maintenance, operation or use of equipment leased to you. b. The insurance afforded to such additional insured described above: (1) Only applies to the extent permitted by law; and (2) Will not be broader than the insurance which you are required by the contract, agreement or permit to provide for such additional insured. (3) Applies on a primary basis if that is required by the written contract, written agreement or permit. (4) Will not be broader than coverage provided to any other insured. (5) Does not apply if the "bodily injuryft, "property damage" or "personal and advertising injury"is otherwise excluded from coverage under this Coverage Part, including any endorsements thereto. 391-1006 0816 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 1 of 6 the Hmrer Insurance Group.. OB3 A316654 1001257 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY ALAI NST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE* Name Of Person Or Organization: * Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations. Paragraph K. Transfer Of Rights Of Recovery Against Others To Us in Section I I I - Common Pol- icy 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 op- erations or "your work" done under a contract with that person or organization and included in the ""products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. BP 04 97 07 42 Copyright, ISO Properties, Inc., 2001 Page I of I 1-he. Ha nover Insurance Group- t SECTION | -PROPERTf. if two or more of However, if you agree in a written Ulim coverage 's coverages apply to uontnaot, written eQreement, or the same |oeo or damage, we will not pay written permit that the insurance more than the actual amount ofthe loss or provided to any person or damage. organization included as an 2. SECTION |i - LIABILITY, it is our stated Additional Insured under this intent that the various Coverage Parts, Coverage part is primary and fonno` endorsements or policies issued to non-oontributory, we will not seek the named insured by uo, or any company contribution from any other do not provide any insurance available to that Additional duplicationu�, dup|iomtion or overlap ofcoverage for the Insured which covers the Additional mmrne o|a|rn, "suit", "occurrence", offense, Insured aoeNamed Insured except: accident, "wrongful act" or loss. We will (1) For the sole negligence of the not pay more than the actual amount of Additional Insured; or the |oam or damage. (2) When the Additional Insured is If this Coverage Part and any other an Additional Insured under Coverage Port, form, endorsement or another liability policy. policy issued to the named insured by us, bExcess|nswnnnce or any company affiliated with um, apply to ^ .. ' the same �|�|m "aui�' occurr�n� This insurance is excess over: � offense, accident, "wrongful act" or kmo. /�) Any of the other innunanoe, ` the maximum Limit of Insurance under all ' whether pr|nnmry, excess, such Coverage Parts, forms, contingent oronany other basis: endorsements or policies combined shall <m� That is Fire, Extendednot exceed the highest applicable Limit �f under any one Coverage Part, Coverage, Builder's Risk, endorsement or policy. Installation | Risk or similarfonn. , coverage for "your work"; This condition does not apply � to any Excess or Umbrella Policy issued by us /�� That is Property Insurance for ` specifically to apply as excess insurance over this policy. i rented to you or temporarily occupied by you with permission of the owner; G. Liberalization (c' � That is insurance purchased If we adopt any revision that would broaden by you t� cover your liability the coverage under this |i without o tenant for "p a— additional premium within 45 days prior to or ' damage" to premises rented during the policy period, the broadened to you or temporarily coverage will immediately apply to this policy. occupied by you with H. Other Insurance permission of the owner; or 1. SECTION | -PROPERTY <d\ If the loss arises out of the If'n there in other insurance covering the maintenance or use of aircraft, "autos" or watercraft same loss or damage, wewill pay only for t th ~~ ~ extent not subject to the amount of covered |oea or damage in SECTION 11 ~ LIABILITY, excess of the amount duo from that other Exclusion �^ ^�Yr�r�� Auto �r inounance , whether you can ou||ent on it or ��mt�r�maft' and ' not. But, we will not pay more than the ' 000hoob|e Limit of Insurance of SECTION U (2) Any other primary insurance - PROPERTY. available to youliability 2` ����|�hl| ~L|��|�|�� .covering for damages mrm|nQ out of the premises or openatiuns, or the K other valid and collectible insurance is products and completed available to the insured for a loss we operations, for which you have cover under SECTION || ~ LUABYL1TY, our been added as an additional obligations are limited as follows: insured by attachment of an a. Primary Insurance endorsement. mn' This insurance is primary except when When this insuranceis excess, we will have no duty under SECTION 11 ~ paragraph b. below applies. If this LIABILITY to defend the insured inSurance is primary, our obligations are not affected unless any of the against any "auit'ifany other other insurance is also primary. Then. insurer haeo dutv bm defend the insured against | )`' "auit" If no other ' we will share with all that other^'~^ insurer defends, we will undertake to insurance by 'the method described in ^~ do go but vva ` will b� entitled to the paragraph c.be]ovv. ' ,�'►co CERTIFICATE OF LIABILITY INSURANCE DATE 01/18/2019Y) 01 /18/2019 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 I CONTACT NAME: Tina Jackson Tina Jackson Insurance Services, Inc (A/CC."N . Ext): 8059662500 (AA/C. No): 3834 Pemm PI I MAIL ADDRESS: tina@tinajacksonins.com A Santa Barbara, CA 93110 I INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Hanover Insurance Group INSURED INSURER B : U.S. Specialty Insurance Company Bengal Engineering, Inc I INSURER C : INSURER D : 360 S. Hope Ave. Suite C-110 INSURER E : Santa Barbara CA 93105 INSURER F : 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 TYPE OF INSURANCE ADDL SUBR LTR INSD WVD POLICY NUMBER POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y Y OB3A316654 1001257 06/15/2018 06/15/2019 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE ❑X OCCUR DAMAGERENTED 300,000 PREMISESS (RENTED Ea occurrence) $ MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 4,000,000 POLICY PRO- ❑ LOC JECT PRODUCTS COMP/OP AGG $ 4,000,000 OTHER: $ A AUTOMOBILE LIABILITY AW3A50250500 12/12/18 12/12/19 COMBINED SINGLE LIMIT $ 1 000,000 (Ea accident) , X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY $ AUTOS ONLY AUTOS (Per accident) HIRED NON -OWNED PROPERTY DAMAGE $ X AUTOS ONLY X AUTOS ONLY (Per accident) UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB HCLAIMS-MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION WD D557061 00 05/15/18 05/15/19 X I I I AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECU I IVE Y❑ SPER TATUTE EORH E.L. EACH ACCIDENT 1,000,000 OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 B Professional Liability USS 18 29008 09/17/1809/17/19 $1,000,000 Per claim Retroactive 9/17/97 $2,000,000 Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Gilroy, its officials, officers and employees are listed as Additional Insured in respects to general liability. Coverage is primary and non-contributory. Waiver of subrogation applies. Bridge Preventative Maintenance Program CERTIFICATE HOLDER CANCELLATION City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna Street ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE i - ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Z�s Ha"enover JWP_Zl Insurance Group - THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ |TCAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - This endorsement modifies insurance provided under the following: BU8NESSC%NNERS COVERAGE FORM SCHEDULE Name Of Person Or Organization Location And Description Of Completed Operations CITY {]FG|LROY,ITS ELECTED OFFICIALS, AND EMPLOYEES OFFICIALS AND EMPLOYEES (If no entry appears above, information required to cmm�plete this endorsement will be shown in the Declarations as applicable to this endorsement.) For the purpose of coverage provided by this endorsement, the following changes are made to SECTION 11 - LIABILITY: A. The following is added to SECTION D - LIABILITY, C.Who [s An Insured: Any person or organization shown in the Schedule above is also on additional insured, 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 above, performed for that additional insured and included in the "prod uobg-oornp|eted operations hazard" However: 11^ 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 the insurance afforded to such oddit|ohol insured will not be broader than that vvh|oh you are required by the contract oraQroennent to provide for such additional insured. B. The following is added to SECTION 11 ~ LIABILITY, D. Liability And Medical Expenses Limits OfInsurance: If coverage provided tothe additional insured is required by a contract oragreement, the most vvmwill pay qnbehalf ofthe additional insured |e the amount ofinsurance: 1. Required by the contract or aQnaanngn1; or 2. Available under the applicable Limits of Insurance shown inthe Den|anat|ono' . whichever is |oaa. This endorsement shall not |nonaaae the applicable Limits of Insurance shown in the ueo/amyoona. ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED. 391-16020816 Includes copyrighted material ofInsurance Services Office, |nc..with its permission. Page 1of1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ [TCAREFULLY. ^US.ESSO~~NERS LIABILITY SPECIAL BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSKOWNERSC[yVER/GE FORM SUMMARY OF COVERAGES 1. Additional Insured byContract, Agreement orPermit 2. Additiona||nsured-BroadFonnVendona 3. Alienated Premises 4. Broad Form Property Damage - Borrowed Equipment, Customers Goods and Use mfElevators 5. Incidental Malpractice (Employed Nurses, EMT'sand Paramedics) 6. Personal and Advertising Injury - Broad Form 7. Product Recall Expense Product Recall Expense Each Occurrence Limit Product Recall Expense Aggregate Limit Product Recall Deductible 8. Unintentional Failure to Disclose Hazards 9. Unintentional Failure to Notify Limits Page Included 1 Included 2 Included 3 Included 3 |nduded 3 Included 4 Included 4 $25OOO , 5 Occurrence $50,000 Aggregate ° $500 5 Included 6 Included 6 This endmnyarnerd amends coverages provided under the 8uninmoaownemo Coverage Form throhngvv coverages and brooder coverage grants. This coverage ba subject to the provisions applicable to the Businessowners Coverage Form, except as provided below. The following changes are made to SECTION U| - LIABILITY: 1. Additional fmwmrad by Contract, Agreement or Permit The fm||pvving is added to SECTION iK - LIABILITY, C.Wbo Is An Insured: Additional Insured by Contnact. Agreement or Permit a. Any person or organization with vvhorn you agreed in a written oontrect, written agreement or permit toadd such person or organization as an additional insured on your policy inonadditional insured only with respect to liability for "bodily injury", " rtdamage", or "personal and advertising injury" oauoed, in whole or in partby your acts or omissiona, or the acts or oon|ae|ons of those acting on your behalf, but only with respect to: (1) "Your work" for the additional insured(s) designated inthe contract, agreement or (2) Premises you ovvn, reni, lease or oocupy;or (3) Your maintenance, operation or use of equipment leased k»you. b, The insurance afforded to such additional insured described above: M> Only applies to the extent permitted by law;and (2) Will not be broader than the insurance which you are required by the oontnaot, agreement or permit to provide for such additional insured. (3) Applies on a primary basis if that is required by the written contract, written agreement orpermit. (4) Will not be broader than coverage provided boany other insured. (5) Does not apply if the "bodily injury", "property damage" or "personal and advertising in'ury"|s otherwise excluded from coverage under this Coverage Part, including any endorsements thereto. 391-1006 08 16 mduums copyrighted materials of Insurance Services Offices, Inc., with its permission. Pagel mf6 �s TheAN Hanover Insurance Group.. OB3 A316654 1001257 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECO\/ERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE* Name Of Person Or Organization: * Information required to complete this Schedule, if notshown on this endorsement, will be shown in the Declarations. Paragraph K. Transfer Of Rights Of Recovery Against Others To Us in Section III - Common Pol- icy 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 op- erations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. BP 04 97 07 02 Copyright, ISO Properties, Inc., 2001 Page I of I The anover t SECTION | ~ PROf»ERFY, if two or more of Hovvever, if you agree in o written this coverage part's coverages apply, to cmntract, written oQreement, or the same loss or damage, we will not pay written permit that the insurance more than the actual amount ofthe loss or provided to any person or damage. organization included as an 2. SECTION || ~ LIABILITY, it is our stated Additional Insured under this intent that the various Coverage Parts, Coverage Part is primary and fonne' endorsements or policies issued to non-oonYr|butory, we will not seek the named insured byus, orany company contribution from any other affiliated with us, do not provide any insurance available 10that Additional duplication or overlap ofcoverage for the Insured which covers the Additional same o|ainn. "suit", "oocurrencell offense, Insured aseNamed Insured except: accident, "wrongful act" or loss. We will (1) For the sole negligence of the not pay more than the actual amount of Additional Insured; or the loss ordamage. (2) When the Additional Insured is If this Coverage part and any other an Additional Insured under Coverage Port, form, endorsement or another liability policy. policy issued tothe named insured by us, b. Excesslmsunsnce orany company affiliated with us, apply to the same claim, "suit", occurrence, This insurance ioexcess over: offense, accident, "wrongful got" or |oae' �1\ Any of the other insurance, the maximum Limit of Insurance under all ` ' whether primary, excess, such Coverage Parts, forme, contingent ormnany other baaia'` ' endorsements or ooUciom combined aho|| not exceed the highest'applicableohLimit of �a� That is Fire, Extended Insurance under any one Coverage po�. Coverage, Builder's Risk,, Installation Risk or similarfmnn.endoraemantorpm|icy. coverage for "your This condition does not apply to any Excess or Umbrella Policy issued by um ' �tA That is Property Insurance for specifically to apply as excess insurance overth|�po||oy. �n�m|mea rented �o you or temporarily occupied by you with permission ofthe owner; G. Liberalization If we adopt any revision that would broaden ' ��� That is insurance purchased by you to cover your liability — the coverage under this |i without as a tenant for "property additional premium -within 45deyo prior to or damage" to premises '-'--- during the policy period, the broadened to you or - temporarily' coverage will immediately apply tothis policy. by you H. Other Insurance permission ofthe owner; or 1. SECTION - PROPERTY (d) If the loss orieam out of the If there is other insurance covering the maintenance or use of aircraft, "autos" or watercraft oomo loss or damage, we will pay only for � th °~ e extent ''" subject to t the amount of covered loss or damage in SECTION |[ - L|���81LI7�p excess of the amount due from other " Exclusion � ~ Aircraft, Auto or insurance, whether you can collect on it or . and Watercraft; a not. But, vvm will not pay more than the aonUoob|e Limit of Insurance of SECTION | (2) Any other primary insurance -PROPERTY. available to you covering liability 2' SECTION || -L|AB|L}TY for damages arising out of the premises or operations, or the if other valid and collectible insurance is products and completed available to the insured for o loss we operations, for which you have cover under SECTION [| - L|AB|L(TY, our been added as on additional obligations are limited as follows: insured by attachment of an m. Primary Insurance endorsement. This insurance is primary except when When this insurance is excess, we vvi|| have no duty under ��ECT|K�y0 K\ - h � b�}�vv applies. |f this r�'"u'"p ' ' LIABILITY to defend the insured insurance is phmary, our obligations are not affected unless any of the aga|nmt any "mu|y^ if any other Then, other insurance is also primory. ' insurer has a duty to defend the `' insured against that "suit". If no other we will share with all that other insurance by the method described in - insurer defends, we will undertake to paragraph c'be|ovv. do so' but we will be entitled to the SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 2,000,000 4,000,000 300,000 2,000,000 A 10,000 x x x 12/12/17 CA AW3A50250500 1,000,000 tina@tinajacksonins.com 12/12/18 Bengal Engineering, Inc 8059662500 Y OB3A316654 1001257 93117 250 Big Sur Drive Y 09/17/2018 3834 Pemm Pl A WZ3 D557061 00 05/15/19 Santa Barbara 05/15/18 x 1,000,000 1,000,000 B 1,000,000 USS 18 29008Professional Liability Retroactive 9/17/97 09/17/1909/17/18 $1,000,000 Per Claim $2,000,000 Aggregate Tina Jackson Hanover Insurance Group U.S. Specialty Insurance Company A x Tina Jackson Insurance Services, Inc City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 City of Gilroy, its officials, officers and employees are listed as Additional Insured in respects to general liability. Coverage is primary and non-contributory. Waiver of subrogation applies. 10th Street and Cohansey Bridge Santa Barbara, CA 93110 x 06/15/201906/15/2018 4,000,000 1,he. Hanover Insurance Group.. 0133 A316654 1001257 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: BUSINESSOWNERS COVERAGE FORM Name Of Person Or Organization CITY OF GILROY, ITS ELECTED OFFICIALS, SCHEDULE Location And Description Of Completed Operations AND EMPLOYEES OFFICIALS AND EMPLOYEES (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) For the purpose of coverage provided by this endorsement, the following changes are made to SECTION II - LIABILITY: A. The following is added to SECTION II - LIABILITY, C. Who Is An Insured: Any person or organization shown in the Schedule above is also an additional insured. 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 above, performed for that additional insured and included in the "products -completed operations hazard". 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. The following is added to SECTION II - LIABILITY, D. Liability And Medical Expenses 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. ALL OTHER TERMS, CONDITIONS AND EXCLUSIONS REMAIN UNCHANGED. 391-1602 08 16 Includes copyrighted material of Insurance Services Office, Inc, with its permission Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SUMMARY OF COVERAGES 1. Additional Insured by Contract, Agreement or Permit 2. Additional Insured - Broad Form Vendors 3. Alienated Premises 4. Broad Form Property Damage - Borrowed Equipment, Customers Goods and Use of Elevators 5. Incidental Malpractice (Employed Nurses, EMT's and Paramedics) 6. Personal and Advertising Injury - Broad Form 7. Product Recall Expense Product Recall Expense Each Occurrence Limit Product Recall Expense Aggregate Limit Product Recall Deductible 8. Unintentional Failure to Disclose Hazards 9. Unintentional Failure to Notify Limits Page Included 1 Included 2 Included 3 Included 3 Included 3 Included 4 Included 4 $25,000 5 Occurrence $50,000 5 Aggregate $500 5 Included 6 Included 6 This endorsement amends coverages provided under the Businessowners Coverage Form through new coverages and broader coverage grants. This coverage is subject to the provisions applicable to the Businessowners Coverage Form, except as provided below. The following changes are made to SECTION II - LIABILITY: 1. Additional Insured by Contract, Agreement or Permit The following is added to SECTION II - LIABILITY, C. Who Is An Insured: Additional Insured by Contract, Agreement or Permit a. Any person or organization with whom you agreed in a written contract, written agreement or permit to add such person or organization as an additional insured on your policy is an additional insured only with respect to liability for "bodily injury", "property damage", or "personal and advertising injury" caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf, but only with respect to: (1) "Your work" for the additional insured(s) designated in the contract, agreement or permit; (2) Premises you own, rent, lease or occupy -,or (3) Your maintenance, operation or use of equipment leased to you. b. The insurance afforded to such additional insured described above: (1) Only applies to the extent permitted by law; and (2) Will not be broader than the insurance which you are required by the contract, agreement or permit to provide for such additional insured. (3) Applies on a primary basis if that is required by the written contract, written agreement or permit. (4) Will not be broader than coverage provided to any other insured. (5) Does not apply if the "bodily injury", "property damage" or "personal and advertising injury"is otherwise excluded from coverage under this Coverage Part, including any endorsements thereto. 391-1006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 1 of 6 1'he. Hanover Insurance Group- 0133 A316654 1001257 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: BUSINESSOWNERS COVERAGE FORM SCHEDULE* Name Of Person Or Organization: * Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Declarations. Paragraph K. Transfer Of Rights Of Recovery Against Others To Us in Section III - Common Pol- icy 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 op- erations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. BP 04 97 07 02 Copyright, ISO Properties, Inc., 2001 Page 1 of 1 Hanover Insurance Group- OB3 A316654 1001257 1. SECTION I - PROPERTY, if two or more of However, if you agree in a written this coverage part's coverages apply to contract, written agreement, or the same loss or damage, we will not pay written permit that the insurance more than the actual amount of the loss or provided to any person or damage. organization included as an 2. SECTION II - LIABILITY, it is our stated Additional Insured under this intent that the various Coverage Parts, Coverage Part is primary and forms, endorsements or policies issued to non-contributory, we will not seek the named insured by us, or any company contribution from any other affiliated with us, do not provide any insurance available to that Additional duplication or overlap of coverage for the Insured which covers the Additional same claim, "suit", "occurrence", offense, Insured as a Named Insured except: accident, "wrongful act" or loss. We will (1) For the sole negligence of the not pay more than the actual amount of Additional Insured; or the loss or damage. (2) When the Additional Insured is If this Coverage Part and any other an Additional Insured under Coverage Part, form, endorsement or another liability policy. policy issued to the named insured by us, b. Excess Insurance or any company affiliated with us, apply to the same claim, "suit", occurrence, This insurance is excess over: offense, accident, "wrongful act" or loss, (1) Any of the other insurance, the maximum Limit of Insurance under all whether primary, excess, such Coverage Parts, forms, contingent or on any other basis: endorsements or policies combined shall (a) That is Fire, Extended not exceed the highest applicable Limit of Coverage, Builder's Risk, Insurance under any one Coverage Part, Installation Risk or similar form, endorsement or policy. coverage for "your work"; This condition does not apply to any (b) That is Property Insurance for Excess or Umbrella Policy issued by us specifically to apply as excess insurance premises rented to you or over this policy. temporarily occupied by you with permission of the owner; G. Liberalization (c) That is insurance purchased If we adopt any revision that would broaden by you to cover your liability the coverage under this policy without as a tenant for "property additional premium within 45 days prior to or damage" to premises rented during the policy period, the broadened to you or temporarily coverage will immediately apply to this policy. occupied by you with H. Other Insurance permission of the owner; or 1. SECTION I - PROPERTY (d) If the loss arises out of the If there is other insurance covering the maintenance or use of aircraft, "autos" or watercraft same loss or damage, we will pay only for the extent not subject to the amount of covered loss or damage in S SECTION II LIABILITY, excess of the amount due from that other Exclusion g. Aircraft, Auto or insurance, whether you can collect on it or Watercraft; and not. But, we will not pay more than the applicable Limit of Insurance of SECTION 1 (2) Any other primary insurance - PROPERTY. available to you covering liability 2. SECTION 11 - LIABILITY for damages arising out of the premises or operations, or the If other valid and collectible insurance is products and completed available to the insured for a loss we operations, for which you have cover under SECTION 11 - LIABILITY, our been added as an additional obligations are limited as follows: insured by attachment of an a. Primary Insurance endorsement. This insurance is primary except when When this insurance is excess, we will have no duty under SECTION 11 - paragraph b. below applies. If this LIABILITY to defend the insured insurance is primary, our obligations against any "suit" if any other are not affected unless any of the insurer has a duty to defend the other insurance is also primary. Then, insured against that "suit". If no other we will share with all that other insurer defends, we will undertake to insurance by the method described in do so, but we will be entitled to the paragraph c. below. 391-1003 08 16 Includes copyrighted material of Insurance Services Office, Inc, with its permission page 79 of 81