Loading...
HomeMy WebLinkAboutEMC Planning Group - Insurance Certificates (2020)DATE (MWDDNYYY) ACOIRD® CERTIFICATE OF LIABILITY INSURANCE I 12/04/2019 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 Monique Thanos, CIC NAME: Carmel Insurance Agency PHONE (831) 624-1234 FAX (831) 624-4605 (A/C, No. Ext): LAIC, Not: San Carlos 2 NW of 8th E-MAIL moni uet carmelinsurance.com ADDRESS: q P.O. Box 6117 INSURER(S) AFFORDING COVERAGE NAIC # Carmel CA 93921-6117 INSURERA: Admiral Insurance Company INSURED INSURER B : Nationwide Mutual 23787 EMC Planning Group, Inc. INSURER C: Republic Indemnity 9999 301 Lighthouse Avenue INSURER D : Suite C INSURER E : Monterey CA 93940 INSURER F : COVERAGES CERTIFICATE NUMBER: GL1Prof, Auto, WC, Exc 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 CONTRACTOR 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 AIJUL SUdK POLICY EFF POLICY EXP LIMITS LTR INSD wvn POLICY NUMBER (MMIDDIYYYYI IMMIDDIYYYY) X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE � OCCUR REMISES Es occurrence) $ 50,000 X •$10,000 Deductible/Occurrence MED EXP (Any one person) $ 5,000 A FEIECC2432502 12/01/2019 12101/2020 PERSONAL& ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000 PRO ❑ X 4,000,000 POLICY JECT LOC PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT (Ea accident) • $ 1,000,000- X ANYAUTO BODILY INJURY (Per person) $ B OWNED SCHEDULED ACP3088546333 12/01/2019 12/01/2020 AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Medical payments $ 5,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A X EXCESS LIAB CLAIMS -MADE FEIEXS2432602 12/01/2019 12/01/2020 AGGREGATE $ 2,000,000 DED I I RETENTION $ $ - WORKERS COMPENSATION XI ST I I ERH AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE Tl1TE 1,00Q,000 C OFFICER/MEMBER EXCLUDED? NIA 18205510 12/01/2019 12/01/2020 E.L. EACH ACCIDENT $ (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 Each Wrongful Act/Clalm $2,000,000 Professional Liability A Claims Made Retroactive Date 8/22/02 FEIECC2432502 12/01/2019 12/01/2020 General Aggregate Limit $2,000,000 Deductible/Wrongful Act $10,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: Uvas Creek Outfall Alternate Mitigation Project, Subject to a Signed, Written Agreement: Certificate Holder is named as Additional Insured under the General Liability per attached endorsement CG2010 1001 and under the Auto Liability per attached endorsement CA2048 1013. 10 Days Notice of Cancellation for Non -Payment of Premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Gilroy, its officers, officials & employees ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD EMC Planning Group, Inc. Endorsement Number: 33 Additional Insured — Owners, Lessees or Contractors — Scheduled Person or Organization This endorsement, effective 12/1/2019 attaches to and forms a part of Policy Number FEI-ECC-24325-02. This endorsement changes the Policy. Please read it carefully. In consideration of an additional premium of SAuulied, this endorsement modifies insurance provided under the following: COMWERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name and Address of Person or Organization: The City of Gilroyits officers, officials and employees 7351 Rosanna Street 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.) A. Section II — Who is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to `bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed or (2) That portion of `your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project~ CG 20 10 10 01 0 ISO Properties, Inc., 2000 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE M& endorsement modiftes Insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM wfth respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modltled by this endorsement. This endorsernentidentnies person(s) or organization(s) who are "Insureds° for Covered Autos Liability Coverage under the Who Is An insured provision of the Coverage Farm. This endorsement does not alter coverage provided In the Coverage Form. SCHEDULE Name Of Person(s) Or Organhation(s): THE CITY CF GILROY, ffS OFFICERS, OFFICIALS AND EMPLOYEES . 1J.. tnfanmation rBau[red to ompiete this Schedule if not shown above. wiuiiawn In the Deoteradons; Each person or organization shown In the Schedule Is an 'Insured" for Covered Autos Liability Coverage, but only to the -extent that person or organization quallfles as an "insured" under the Who Is An Insured provtslon contained In Paragraph A.1. of Section Il — . Covered Autoe Liability Coverage In the Business Auto and Motor Carrier Coverage Fors and Paragraph D.Z of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA20481©13 ACP BA. 30-&8Slat 19307 ® Insurance Services Otiice. IAMB 2011 Aoerrr COPY CAUM01300 0100 Page 1. of 1 . 47 40112050 ACO ® DATE (MMIDDIYYYY) A� CERTIFICATE OF LIABILITY INSURANCE I 12/04/2019 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(les) 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 Monique Thanos, CIC NAME: Cannel Insurance Agency PHONE (831) 624-1234 I FAX (831) 624-4605 (grc. San Carlos 2 NW of 8th -MA ADDRESS: q o. Ext)moni uet carmelinsurance.com (Alc. No): P.O. BOX 6117 INSURER(S) AFFORDING COVERAGE NA(C # Carmel CA 93921-6117 INSURER A : Admiral Insurance Company INSURED INSURER B : Nationwide Mutual 23787 EMC Planning Group, Inc. INSURER C: Republic Indemnity 9999 301 Lighthouse Avenue INSURER D : Suite C INSURER E : Monterey CA 93940 INSURER F : COVERAGES CERTIFICATE NUMBER: GL/Prof, Auto, WC, Exc 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 AVUL SUISH POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVO POLICY NUMBER (MMIDDIYYYY) (MMIDD/YYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE � OCCUR PREMISES (Ea�occurrence) $ 50.000 X $10,000 Deductible/Occurrence MED EXP (Any one person) $ 5,000 A FEIECC2432502 12/01/2019 12/01/2020 P v RY $ 2.000,000 i GEN'LAGGREGATE LIMIT APPLIES PER: ERSONALBAD INJU GENERAL AGGREGATE $ 4,000,000 PRO X 4,000,000 POLICY1:1 JECT LOC PRODUCTS-COMPlOPAGG $ OTHER: $ AUTOMOBILE LIABILITY _ COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ B OWNED - SCHEDULED ACP3088546333 12/01/2019 12/01/2020 AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED PROPERTY DAMAGE $ _ AUTOS ONLY AUTOS ONLY (Per accident) Medical payments $ 5,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A X EXCESS LIAR CLAIMS -MADE FEIEXS2432602 12/01/2019 12/01/2020 AGGREGATE $ 2,000,000 DED I I RETENTION $ $ WORKERS COMPENSATION X STATUTE I I AND EMPLOYERS' LIABILITY YIN ERH ANY PROPRIETORMARTNER/EXECUTIVE C OFFICER/MEMBEREXCLUDED? F-1 NIA 18205510 12/01/2019 -12/01/2020 E.L. EACH ACCIDENT $ 1,000,000 (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 Each Wrongful Acf/Claim $2,000.000 Professional Liability A Claims Made Retroactive Date 8122/02 FEIECC2432502 12/01/2019. 12/01/2020 General Aggregate Limit $2,000,000 Deductible/Wrongful Act $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached If more space Is required) RE: Hecker Pass Specific Plan General Plan Amendment and Tentative Map, Subject to a Signed, Written Agreement: Certificate Holder is named as Additional Insured under the General Liability per attached endorsement CG20101001 and under the Auto Liability per attached endorsement CA2048 1013. 10 Days Notice of Cancellation for Non -Payment of Premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, [NOTICE WILL BE DELIVERED IN The City of Gilroy, its officers, officials & employees ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks Of ACORD EMC Planning Group, Inc. Endorsement Number: 33 Additional Insured — Owners, Lessees or Contractors — Scheduled Person or Organization This endorsement, effective 12/1/2019 attaches to and forms a part of Policy Number FEI-ECC-24325-02. This endorsement changes the Policy. Please read it carefully. In consideration of an additional premium of$Aonlied, this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name and Address of Person or Organization: The City of Gilroyits officers, officials and employees 7351 Rosanna Street 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.) A. Section II -- Who is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily injury" or `property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed or (2) That portion of `your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 0 ISO Properties, Inc., 2000 �e coMaectcIa.nuro ca20ae1o1s TFd8 ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies Insu'rance.provided under the foitowing: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by his endorsement, he provisions of the Coverage Fam apply untess modified by this endorsement. This endorsement Identifies persons or organizatlon(s) who are "Insurede for Covered Autos Liability Coverage under the Who is An Insured p=Ion of the Coverage Form.. This endorsement does not alter coverage . provided In he Coverage Form. SCHEDULE name Of Persons} Or Organlzatlon(s): THE CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES . I tn%mation reaulred to rmmnlete this "edifie l If not shown above. will be shown In the Decdarettons. Each person or organization shown in the Schedule is an `Insured" for Covered Autos Liability Coverage, but only to the -extent that person or organization qualMes as an "insured" under the Who Is An Insured pmviwon Ccontained i Covered AutosLiabiitty Coverage In he Buslness Auto and Motor Carrier Coverage Forms and Paragraph D& of Section I - Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 ® Insurance Servh:es 4ftice. IBM, 2011 ACP 8A 30■"34$833 BICT 10361 AGENT COPY CAZ048101300 ciao Aco ® DATE (MMIDDIYYYY) CERTIFICATE 4F LIABILITY INSURANCE I 12/04/2019 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(les) 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 NAME CT Monique Thanos, CIC Carmel Insurance Agency PHONE (831) 624-1234 I FAX (831) 624-4605 IN o. ExO: (AIC, No): San Carlos 2 NW of 8th ADD ESS: moniquet@carmelinsurance.com P.O. BOX 6117 INSURERS) AFFORDING COVERAGE NAIC 0 Carmel CA 93921-6117 INSURERA: Admiral Insurance Company INSURED INSURER B • Nationwide Mutual 23787 EMC Planning Group, Inc. INSURER C : Republic Indemnity 9999 301 Lighthouse Avenue INSURER D : Suite C INSURER E : Monterey CA 93940 INSURER F : COVERAGES CERTIFICATE NUMBER: GL/Prof, Auto, WC, Exc 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 CONTRACTOR 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 AUUL'SU8H' POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INFO WVID POLICY NUMBER (MMIDDIYYYYI IMMIDDIYYYYI LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2.000,000 CLAIMS -MADE © OCCUR UAMII U I rr 50,000 PREMISES (Ea oc ocaurenoel $ X $10.000 Deductible/Occurrence MED EXP (Any one person) $ 5,000 A FEIECC2432502 12/01/2019 12/01/2020 PERSONALSADVINJURY $ 2,000.000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,000 X JECT 4,000,000 POLICY Luc PRODUCTS-COMProPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ B OWNED SCHEDULED ACP3088546333 12/01/2019 12/01/2020 AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accidenD Medical payments $ 5,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000.000 A X EXCESS LIAR 11 CLAIMS -MADE FEIEXS2432602 12/01/2019 12/01/2020 AGGREGATE $ 2,000.000 DED I I RETENTION $ $ WORKERS COMPENSATION I I ERH AND EMPLOYERS' LIABILITY YIN STATUTE ANY PROPRIETORIPARTNERIEXECUTIVE C OFFICERIMEMBER EXCLUDED? NIA 18205510 12/01/2019 12/01/2020 E.L. EACH ACCIDENT $ 1,000,000 (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 Each Wrongful Act/Claim $2,000,000 Professional Liability A Claims Made Retroactive Date 8122/02 FEIECC2432502 12/01/2019 12/0112020 General Aggregate Limit $2,000,000 Deductible/Wrongful Act $10.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required) RE: "City. of Gilroy On -Call Environmental Review Agreement," Subject to a Signed, Written Agreement: Certificate Holder is named Additional Insured under the General Liability per attached endorsement CG20101001 and under the Auto Liability per attached endorsement CA2048 1013. 10 Days Notice of Cancellation for Non -Payment of Premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Gilroy, its officers, officials and employees ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD EMC Planning Group, Inc. Endorsement Number: 33 Additional Insured — Owners, Lessees or Contractors — Scheduled Person or Organization This endorsement, effective 12/1/2019 attaches to and forms a part of Policy Number FEI-ECC-24325-02. This endorsement changes the Policy. Please read it carefully. In consideration of an additional premium of SAuolied, this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCFIEDULE Name and Address of Person or Organization: The City of Gilroyits officers, officials and employees 7351 Rosanna Street 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,) A. Section II — Who is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily injury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed or (2) That portion of `your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 0 ISO Properties, Inc., 2000 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modMes insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modlfled by this endorsement. This endorsement identilles personsj or organization(s) who are ainsurede for Covered Autos Liability Coverage ender the Who Is An Insured provision of the Coverage Form. This endomernent does .not sitar coverage provided In the Coverage Form. SCHEDULE Nance Of Person(s) Or Organizatlon(s): THE CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES ' Infonrratfon reaefred to c+nmplete this Schedule, N not shown above. w�ehow�nInIn the Dwaraticns. Each person or organization shown In the Schedule Is an Insured! for Covered Autos Liability Coverage, but only to the•exbent that person or organization qualifies as an Insured" under the Who Is. An insured provision oontaimW in Paragraph A.I. of Section If — . Covered Autos Liability Coverage In the Business Auto erld Motor Carrier Coverage Forms and Paragraph Da of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 ® Insurance Serv1cW Office. ft, 2011 ACP BA =.s ss0s sICT 19=1 AGW COPY Ca►"101300 0140 ACORV CERTIFICATE OF LIABILITY INSURANCE DATE (MM1DOlYYYY) I 12/04/2019 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(les) must have ADDITIONAL IN 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 Monique Thanos, CIC Carmel Insurance Agency PHONE (831) 624-1234 I FAX (831) 624=4605 I1k1C. No. Extl: (AIC, Nol: San Carlos 2 NW of 8th E-MAIL moniADDRESS: q uet@carmelinsurance.com P.O. BOX 6117 INSURER(S) AFFORDING COVERAGE NAIC # Carmel CA 93921-6117 INSURERA: Admiral Insurance Company INSURED INSURER B : Nationwide Mutual 23787 EMC Planning Group, Inc. INSURER C; Republic Indemnity 9999 301 Lighthouse Avenue INSURER D : Suite C INSURER E : Monterey CA 93940 INSURER F : COVERAGES CERTIFICATE NUMBER: GL/Prof, Auto, WC, Exc 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 AU11L SU8H POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INS I) WVtm POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE a OCCUR REM SES (Eat occurrence) $ 50,000 X $10,000 Deductible/Occurrence MED EXP (Any one person) $ 5,000 A FEIECC2432502 12/01/2019 12/01/2020 PERSONAL& ADV INJURY $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 iC POLICY PRO-7 LOC PRODUCTS - COMPIOP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) X ANYAUTO BODILY INJURY (Per person) $ B OWNED ! SCHEDULED ACP3088546333 12/01/2019 12/01/2020 BODILY INJURY (Per accident) $ _ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) Medical payments $ 5,000 UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 2,000,000 A X EXCESS LIAR CLAIMS -MADE FEIEXS2432602 12/01/2019 12/01/2020 AGGREGATE $ 2,000,000 DED I I RETENTION $ $ WORKERS COMPENSATION %CI STATUTE I I ERH AND EMPLOYERS' LIABILITY YIN C ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N 1 A 18205510 12/01/2019 12/01/2020 E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Professional Liability Each Wrongful Act/Claim $2,000,000 A Claims Made Retroactive Date 8/22/02 FEIECC2432502 12/01/2019 12/01/2020 General Aggregate Limit $2,000,000 DeductibleMlrongful Act $10,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: "City of Gilroy On -Call Planning Services Agreement," Subject to a Signed, Written Agreement: Certificate Holder is named as Additional Insured under the General Liability per attached endorsement CG2010 1001 and under the Auto Liability per attached endorsement CA2048 1013. 10 Days Notice of Cancellation for Nan -Payment of Premium. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN The City of Gilroy, its officers, officials and employees ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 Q 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016183) The ACORD name and logo are registered marks of ACORD EMC Planning Group, Inc. Endorsement Number: 33 Additional Insured — Owners, Lessees or Contractors — Scheduled Person or Organization This endorsement, effective 12/1/2019 attaches to and forms a part of Policy Number FEI-ECC-24325-02. This endorsement changes the Policy. Please read it carefully. In consideration of an additional premium of SAWied, this endorsement modifies insurance provided under the following: CONEVIERCLAL GENERAL LIABILITY COVERAGE PART SCBEDULE Name and Address of Person or Organization: The City of Gilroyits officers, officials and employees 7351 Rosanna Street 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.) A. Section II — Who is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. R With respect to the insurance afforded to these additional insureds, the following exclusion is added: 2. Exclusions This insurance does not apply to "bodily injury" or "property damage" occurring after. (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered.operations has been completed or (2) That portion of `your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 0 180 Properties, inc., 2000 ram, COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement Identifies person(s) or organization(s) who are "Insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided In the Coverage Form. SCHEDULE Name Of Person(s) Or Organization(s): THE CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES Information reaulred to complete this Schedule, If not shown above. will be shown in the Declarations. . , . .. ., Each person or organization shown In the Schedule is an "Insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.I. of Section II — Covered Autos Liability Coverage In the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 ACP BA 30.8.8346333 SICT 19301 AGENT COPY CA2048101300 0100 . 47 0012050