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HomeMy WebLinkAboutCOI - MGE Underground, Inc. - Expires 2021-10-01P32(AH)2X(02 A� V CERTIFICATE 4F LIABILITY INSURANCE 10/05/2020 ' 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 poiicy(ies) must 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 LIC #OM77949 1-888-845-2248 McSherry & Hudson, LLC Insurance Services CONTACT NAME: PHONE , 408-550-2130 1 fAJC No: 408-550-2119 160 west Santa Clara Street Suite 715 E-MAIL ADDRESS: San Jose, CA 95113 INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: OLD REPUBLIC GEN INS CORP 24139 Charles M. Griswold _ INSURED INSURERB: STARR IND & LIAB CO 38318 MOE Underground, Inc. INSURERC: Tokio Marine Specialty Insurance Compare 23850 INSURER D: TRAVELERS PROP CAS CO OF AMER 25674 P.O. Box 4189 INSURERE: Paso Robles, CA 93447 INSURER F : COVERAGES CERTIFICATE NUMBER: 60461685 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 INSURANCEADDLSUBR POLICY NUMBER POLICY EFF MMIDp POLICY EXP MMIDD LIMITS A GENERAL LIABILITY X AlCGO6891807 10/01/2 10/01/21 EACH OCCURRENCE $ 1, 000, 000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_x1 OCCUR DAMAGE TO RENTED PREMISES Ea occurrence)$ 100, 000 MED EXP (Any one person) $ 5, 000 PERSONAL S ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY X PRO- LOC Emp Ben. $ 1, 000, 000 A AUTOMOBILE LIABILITY AICA06891807 10/01/2 10/01/21 SINGLE LIMIT CEOs accident) 1, 000, 000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per acadent) $ B UMBRELLA LIAB X OCCUR 1000584627191 10/01/1 11/01/20 EACH OCCURRENCE $ 9,000,000 AGGREGATE $ 9,000,000 X EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERJEXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N I A AICW06891807 10/01/2 10/01/21 X WCSTATU OTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 C Pollution Liability PP Per C a Agg M M D Installation Floater QT-660-4E989568-TIL-20 10/01/2 10/01/21 Limit 2,000,000 D Scheduled Equipment QT-660-4E989568-TIL-20 10/01/2 10/01/21 Limit 2,781,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) RE: All California Operations Additional Insured: the City of Gilroy, its Officers, Officials, Representatives, Agents, E¢>ployees and Volunteers. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Public works Department, Engineering Division ACCORDANCE WITH THE POLICY PROVISIONS, 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 gZAO� USA 01988-2010 ACORD CORPORATION. All rights reserved. M 00 tr-, Z L:1 ACORD 25 (2010105) sarahBj 60461685 The ACORD name and logo are registered marks of ACORD POLICY NUMBER: A-1CG-068918-07 COMMERCIAL GENERAL LIABILITY CG20121219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION -- PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: WHERE REQUIRED BY PERMIT OR AUTHORIZATION. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. 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. CG 20 12 12 19 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. © Insurance Services Office, Inc., 2018 Page 1 of 1 A ti :K) £ f8561 AN-1 O W o a� in0 0 W a 0 W Cf z a oc co u Cl) z f LL O 93 m W > a O L 1 m �P fi CDrI cq w V a u N o N O o U, i ~ Z O `d E QQ C� W z ¢ 10 0 "' O u W o u u 41 0 Lu 0 a� 0 a m w a o ��o LU pp° y p H 10 CO)V / N C ,Cqd� TI ei rNl Z LL — •• a 10 to p a a b V z sniWXxlIOZI$ P52(+x)2xixr2 A� �® CERTIFICATE OF LIABILITY INSURANCE DATE 0 10,08/28,202020 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 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 LIC #OM77949 1-888-845-2248 McSherry & Hudson, LLC Insurance Services CONTACT NAME: PHONE 408-550-2130 FAX No: 408-550-2119 E-MAIL ADDRE88: 160 West Santa Clara Street Suite 715 San Jose, CA 95113 INSURER 8 AFFORDING COVERAGE NAIC 0 INSURER A: OLD REPUBLIC GEN INS CORP 24139 Charles M. Griswold INSURED INSURERB: STARR IND & LIAB CO 38318 MGE Underground, Inc. IN8URERC: Tokio Marine Specialty Insurance Compan3123850 INSURER D: TR+VELEIRS PROP CAS CO OF AMER 25674 P.O. Box 4189 INSURERE, Paso Robles, CA 93447 INSURER F : COVERAGES CERTIFICATE NUMBER: 60486752 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 RR POLICY NUMBER POLICY EFF MM A POLICY EXP MMIDD LIMITS A GENERAL LIABILITY X X AlCGO6891807 10/01/2 10/01/21 EACH OCCURRENCE $ 1, 000, 000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR D E T NTEO PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5, 000 PERSONAL & ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOP AGG $ 2, 000, 000 POLICY X JECTPRO-F-] LOC Emp Ben. $ 1, 000, 000 A AUTOMOBILE LIABILITY X X AlCA06891807 10/01/2 10/01/21 COMBINED SINGLE LIMIT Ea accident 1, 000, 000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ B UMBRELLA LIAB X OCCUR 1000584627191 10/01/1 11/01/20 EACH OCCURRENCE $ 9,000,000 AGGREGATE $ 9.000, 000 X EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y f N OFFICER/MEMBER EXCLUDED? [ (Mandatory In NH) N f A X AlCW06891807 10/01/2 10/01/21 X I WCSTATU- I JOTH- TORY LIMITS ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 11000,000 C Pollution L ty PP Per C a Agg M M D Installation Floater QT-660-4E989568-TIL-20 10/01/2 10/01/21 Limit 2,000,000 D Scheduled Equipment QT-660-4E989568-TIL-20 10/01/2 10/01/21 Limit 2,781,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, Addilional Remarks Schedule, If more space Is required) RE:RB: MGE Underground, Inc. Job # 19C0003 / PM # 35127119 / 56C Cable Replacement at 730 Dartmouth Pl, Gilroy CA Additional Insured: City of Gilroy, its officers, officials, employees and volunteers. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 6�� USA ©1988-2010 ACORD CORPORATION. All rights reserved. M IM Y, fV z LL ACORD 25 (2010105) sarahsj 60496752 The ACORD name and logo are registered marks of ACORD �i2(1 02XIKQ POLICY NUMBER: A-1CG-068918-07 COMMERCIAL GENERAL LIABILITY CG 20 12 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - SPATE OR GOVERNMENTAL M AGENCY OR SUBDIVISION OR POLITICAL N SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: CITY OF GILROY, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. 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. 2. This insurance does not apply to: a. "Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG 20 12 12 19 O Insurance Services Office, Inc., 2018 Page 1 of 1 P52«w284x)2 N N POLICY NUMBER: A-1CG-068918-07 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED coNsTRucYioN PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): EACH OF YOUR CONSTRUCTION PROJECTS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, ex- cept damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard", and for medi- cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Construction Project Gen- eral Aggregate Limit. F22. W. M n N Z W CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 13 B. For all sums which the insured becomes legally C. obligated to pay as damages caused by "occur- rences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be at- tributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical D. expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2 of 2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 0 OLD REPUBLIC GENERAL INSURANCE CORPORATION 0 CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Or Organization(s): WHERE REQUIRED BY WRITTEN CONTACT. Location(s) of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. If so, we will share with that other insurance by the method described in paragraph 4.c. of Section IV — Commercial General Liability Conditions. All other terms and conditions remain unchanged. Named Insured MGE UNDERGROUND, INC. Policy Number A-1.CG-068918-07 Endorsement No. 000 Policy Period 10 / 01 / 2 0 2 0 to 10 / 01 / 2 0 21 Endorsement Effective Date: 10 / 01 / 2 0 2 0 Producer's Name: MCSHERRY & HUDSON Producer Number: 44Po0 AUTHORIZED REPRESENTATIVE CG EN GN 0029 09 06 DATE M M N 1�2('(K 2X00-1 POLICY NUMBER: A-lCG-068918-07 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 w THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ° WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) ell z w This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS Name Of Person(s) Or Organization(s): SCHEDULE WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG24041219 O Insurance Services Office, Inc., 2018 Page 1 of 1 psa,x2lux2 h G N N POLICY NUMBER: A-1CA-068918-07 COMMERCIAL AUTO CA 20 48 10 13 0C THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR M M COVERED AUTOS LIABILITY COVERAGE > z W 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. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: MGE UNDERGROUND, INC. Endorsement Effective Date: 10/01/2020 SCHEDULE Name Of Person(s) Or Organization(s): WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT. Information required 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 O Insurance Services Office, Inc., 2011 Page 1 of 1 ht2GOtt28Uo2 n POLICY NUMBER: A-1CA-068918-07 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY M M AGAINST OTHERS TO US (WAIVER OF SUBROGATION) z 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 the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: MGE UNDERGROUND, INC. Endorsement Effective Date: 10/01/2020 SCHEDULE Name(s) Of Person(s) Or Organization(s): WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the `loss" under a contract with that person or organization. CA04441013 C Insurance Services Office, Inc., 2011 Page 1 of 1 PS:r.�w2H(xl2 4 0 OLD REPUBLIC GENERAL INSURANCE CORPORATION WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE 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. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHEN REQUIRED BY WRITTEN CONTRACT. The premium charge for this endorsement is $0.00 Named Insured MGE UNDERGROUND, INC. Policy Number A-1CW-068918-07 Endorsement No. 000 Policy Period 10/01/2020 to 10/01 /2021 Endorsement Effective Date: 10/01/2020 Producers Name: MCSHERRY & HUDSON Producer Number: 44P00 AUTHORIZED REPRESENTATIVE DATE M M Sri z w WC 99 0316 (09/06) '526(HQ S002 SUPPLEMENT TO CERTIFICATE OF INSURANCE I DATE 1o/oe/soap NAME OF INSURED: MOB underground, Inc. Additional Description of Operations/Remarks from Page l : Additional Information: Includes: General Liability: Additional Insured per attached forms CG20121219. Primary Wording per attached form CGENGN00290906. Per Aggregate Limit per attached form CO25030509. Waiver of Subrogation per attached form CG24041219. Automobile Liability: Additional Insured per attached form CA20481013. Waiver of Subrogation per attached form CA04441013. Workers Compensation: Waiver of Subrogation per attached form WC990315 (09/06). P521.W28(X)2 ACORO CERTIFICATE OF LIABILITY 10/08/2020Y"' INSURANCE 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 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 endorsements). PRODUCER LIC #OM77949 1-888-845-2248 McSherry & Hudson, LLC Insurance Services CONTACT NAME: PHONE 408-550-2130 FAX A/C No 408-550-2119 160 West Santa Clara Street Suite 715 E-MAIL ADDRESS: San Jose, CA 95113 INSURERS AFFORDING COVERAGE NAIC 0 INSURER A: OLD REPUBLIC GEN INS CORP 24139 Charles M. Griswold INSURED MGE Underground, Inc. INSURER B : STARR IND & LIAB CO 38318 INSURERC: Tokio marine Specialty Insurance Compare 23850 INSURER D: TRAVELERS PROP CAS CO OF AMER 25674 P.O. Box 4189 INSURERE: Paso Robles, CA 93447 INSURER F COVERAGES CERTIFICATE NUMBER: 60486761 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. ILTR TYPE OF INSURANCE L POLICY NUMBER MSUBR PMMDY EFF POMIDDAnrM Y EXP LIMITS A GENERAL LIABILITY X X AlCGO6891807 10/01/2 10/01/21 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Fx_1 OCCUR NTED DAMAGE TO PREMISES EaEoccurrence) $100, 000 MED EXP (Any one person) E S, 000 PERSONAL & ADV INJURY $ 1, 000, 000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2, 000, 000 GENI AGGREGATE LIMIT APPLIES PER: PRO - POLICY X iEcT LOC Emp Ben. $1,000,000 A AUTOMOBILE LIABILITY X X AlCA06891807 10/01/2 10/01/21 CEOMBBINED SINGLE LIMIT _1a accident) 11000, 000 BODILY INJURY Per ( Pew) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ X HIRED AUTOS 7( NON -OWNED AUTOS PROPERTY DAMAGE Par accident $ $ B LIAR X OCCUR 1000584627191 10/01/1 11/01/20 EACH OCCURRENCE $ 9,000,000 X LUMBRELLA AB CLAIMS -MADE AGGREGATE $ 9,000,000 RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 h ANY PROPRIETOPJPARTNERIEXECUTIVE OFFICER/MEMBER EXCLUDED? a N 1 A X AlCW06891807 10/01/2 10/01/21 X WCSTA IT- OTH- ORYUs ER_ E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1, 000, 000 (Mandatory In NH) If yas, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 C Pollution L ty PP Per U1a m Agg M M D Installation Floater QT-660-4E989568-TIL-20 10/01/2 10/01/21 Limit 2,000,000 D Scheduled Equipment QT-660-4B989568-TIL-20 I 10/01/2 10/01/21 Limit 2,781,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (Attach ACORD 101, Additional Remerke Schedulo, If mom apace Is requirod) RE:RE: MGE Underground, Inc. Job # 19C0008 / Pm # 35127114 / 56C Cable Replacement at 5520 Karen Ct, Gilroy CA Additional Insured: City of Gilroy, its officers, officials, employees and volunteers. vG1%I1F1vr+r& nv&.ur=r% UANUr.LLA I 1UN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 � i USA 940*� ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD sarahsj 60486761 M fM n N S2(AX12K1K)2 POLICY NUMBER: A-1CG-068918-07 COMMERCIAL GENERAL LIABILITY CG20121219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: CITY OF GILROY, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. 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. 2. This insurance does not apply to: a. "Bodily injury', "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. n 00 's. O 00 M Cn N Z W CG 20 12 12 19 O Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: A-1CG-068918-07 COMMERCIAL GENERAL LIABILITY CG 25 03 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): EACH OF YOUR CONSTRUCTION PROJECTS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally obligated to pay as damages caused by "occur- rences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. A separate Designated Construction Project General Aggregate Limit applies to each des- ignated construction project, and that limit is equal to the amount of the General Aggregate Limit shown in the Declarations. 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, ex- cept damages because of "bodily injury" or "property damage" included in the "products - completed operations hazard", and for medi- cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Con- struction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Ag- gregate Limit shown in the Declarations nor shall they reduce any other Designated Con- struction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Decla- rations, such limits will be subject to the appli- cable Designated Construction Project Gen- eral Aggregate Limit. rn rn z W CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 2 13 P526012MM2 B. For all sums which the insured becomes legally C. When coverage for liability arising out of the M = obligated to pay as damages caused by `occur- "products -completed operations hazard" is pro- c rences" under Section I — Coverage A, and for all vided, any payments for damages because of medical expenses caused by accidents under "bodily injury" or "property damage" included in Section I — Coverage C, which cannot be at- the "products -completed operations hazard" will tributed only to ongoing operations at a single reduce the Products -completed Operations Ag- designated construction project shown in the gregate Limit, and not reduce the General Ag- Schedule above: gregate Limit nor the Designated Construction s 1. Any payments made under Coverage A for Project General Aggregate Limit. damages or under Coverage C for medical D. If the applicable designated construction project expenses shall reduce the amount available has been abandoned, delayed, or abandoned under the General Aggregate Limit or the and then restarted, or if the authorized contract - Products -completed Operations Aggregate ing parties deviate from plans, blueprints, de - Limit, whichever is applicable; and signs, specifications or timetables, the project will 2. Such payments shall not reduce any Desig- still be deemed to be the same construction pro- nated Construction Project General Aggre- ject. gate Limit. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. Page 2of2 © Insurance Services Office, Inc., 2008 CG 25 03 05 09 0 OLD REPUBLIC GENERAL INSURANCE CORPORATION 0 0 CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE M M in ell THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. z LU THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Or Organization(s): WHERE REQUIRED BY WRITTEN CONTACT. Location(s) of Covered Operations Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. If so, we will share with that other insurance by the method described in paragraph 4.c. of Section IV — Commercial General Liability Conditions. All other terms and conditions remain unchanged. Named Insured MGE UNDERGROUND, INC. Policy Number A-1CG-068918-07 Endorsement No. 000 Policy Period 10/01/2020 to 10/01/2021 Endorsement Effective Date: 10/01/2020 Producer's Name: MCSHERRY & HUDSON Producer Number: 44P00 AUTHORIZED REPRESENTATIVE CG EN GN 0029 09 06 DATE 71�26M)28002 POLICY NUMBER: A-1 CG-068918-07 COMMERCIAL GENERAL LIABILITY CG24041219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. n 0 0 M M N z w CG 24 04 12 19 O Insurance Services Office, Inc., 2018 Page 1 of 1 P12(AX12SM2 ■ 0 Y 7 N POLICY NUMBER: A-iCA-068918-07 COMMERCIAL AUTO j CA 20 48 10 13 w THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ° DESIGNATED INSURED FOR M COVERED AUTOS LIABILITY COVERAGE N z u 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. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: MGE UNDERGROUND, INC. Endorsement Effective Date: 10 / 01 / 2020 SCHEDULE Name Of Person(s) Or Organization(s): WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT. Information required 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 O Insurance Services Office, Inc., 2011 Page 1 of 1 PS2c.iw2NtNi2 POLICY NUMBER: A-1CA-068918-07 COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ° WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) N z 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 the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: MGE UNDERGROUND, INC. Endorsement Effective Date: 10/01/2020 SCHEDULE Name(s) Of Person(s) Or Organization(s): WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the `loss" under a contract with that person or organization. CA04441013 ©Insurance Services Office, Inc., 2011 Page 1 of 1 P52f,(x)2x(x)2 OLD REPUBLIC GENERAL INSURANCE CORPORATION RK- L" WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 0 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE 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. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHEN REQUIRED BY WRITTEN CONTRACT. The premium charge for this endorsement is $0.00 Named Insured MGE UNDERGROUND, INC. Policy Number A-1CW-068918-07 Endorsement No. 000 Policy Period 10/01/2020 to 10/01 /2021 Endorsement Effective Date: 10/01/2020 Producer's Name: MCSHERRY & HUDSON Producer Number: 44P00 AUTHORIZED REPRESENTATIVE DATE WC 99 0315 (09/06) M M z 1124;i028( 2 DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 10/08/2020 NAME OF INSURED: MGS Underground, Inc. Additional Description of Operations/Remarks from Page 1: Additional Information: Includes: General Liability: Additional Insured per attached forms CG20121219. Primary Wording per attached form CGENGN00290906. Per Aggregate Limit per attached form CG25030509. Waiver of Subrogation per attached form CG24041219. Automobile Liability: Additional Insured per attached form CA20481013. Waiver of Subrogation per attached form CA04441013. Workers Compensation: Waiver of Subrogation per attached form WC990315 (09/06). M M V1 N z w P52«w12scw2 A� V CERTIFICATE OF LIABILITY INSURANCE 10/08/2020 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 be endorsed. If SUBROGATION IS WANED, 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 ileu of such endorsements . PRODUCER LIC #OM77949 1-888-845-2248 McSherry & Hudson, LLC Insurance Services CONTACT NAME: PHONE AIC No 408-550-2130 FAX 408-550-2119 EMAIL ADDRESS: 160 West Santa Clara Street Suite 715 San Jose, CA 95113 INSURERS AFFORDING COVERAGE NAIC # INSURER A: OLD R13PTJBLIC GEN INS CORP 24139 Charles M. Griswold INSURED MGE Underground, Inc. INSURER B : STARR IND & LIM CO 38318 INSURERC: Tokio Marine Specialty Insurance Compan 23850 INSURER D: TRAVELERS PROP CAS CO OF AMER 25674 P.O. Box 4189 INSURERE: Paso Robles, CA 93447 INSURER F : GUVt•KAGtS CF1aT11=11'_OTF NI IMRFR- 6n4AF77n DC11101eW W 11uDCD. 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 REOUIREMENT, 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 ADDLSUBR I= Wyn POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS A GENERAL LIABILITY X X AlCG06891807 10/01/2 10/01/21 EACH OCCURRENCE $1, 000, 000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RJERM5 PREMISES occurrence $100, 000 MED EXP (Any one person) $5, 000 CLAIMS -MADE a OCCUR PERSONAL 4 ADV INJURY $1, 000, 000 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGG $2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X JFr-T F PRO- LOC Emp Ben. $1, 000, 000 A AUTOMOBILE LIABILITY X X AlCA06891807 10/01/2 10/01/21 COMBINED SINGLE LIMIT Ea accident 1, 000, 000 BODILY INJURY (Per person) $ X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY accident Per INJURY ( ) $ X NON -OWNED HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accident S $ B UMBRELLA LIAR NX OCCUR 1000584627191 10/01/1 11/01/20 EACH OCCURRENCE $ 9,000,000 X EXCESS LIAR CLAIMS -MADE AGGREGATE $ 9,000,000 DED RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYTORY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN ER EXCLUDED? D OFF(Mandatory NIA X AICW06891807 10/01/2 10/01/21 X WCSLIMIT ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 In (Mandatory in NH) If yes describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 11 000, 000 C Pollution Liability PP Per C a Agg M M D Installation Floater QT-660-4E989568-TIL-20 10/01/2 10/01/21 Limit 2,000,000 D Scbeduled Equipment QT-660-4E989566-TIL-20 10/01/2 10/01/21 Limit 2,781,000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (Attach ACORD 101, AddWonal Remarks Schodulo, If more space Is required) RE:RE: MGE Underground, Inc. Job # 19CO019 / PM # 35126690 / 56C Cable Replacement at 7785 Wren Ave, Gilroy CA Additional Insured: City of Gilroy, its officers, officials, empployses and volunteers. v1=r%1 WK&M 1 r- nvl-uCl% VAIYL.CLLA I JUN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 USA 62��o ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD sarahsj 60486770 en en f'V z �iN(X)29(*2 POLICY NUMBER: A-1CG-068918-07 COMMERCIAL GENERAL LIABILITY CG 20 12 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION — PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: CITY OF GILROY, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. 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. 2. This insurance does not apply to: a. 'Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. 'Bodily injury" or "property damage" included within the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. m U. 0 M M N W CG 20 12 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 P$26028002 ■ �f Y a X N N POLICY NUMBER: A-1CG-068918-07 COMMERCIAL GENERAL LIABILITY LL CG 25 03 05 09 00 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) M GENERAL AGGREGATE LIMIT N Z LQ This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ��icT�11I�� Designated Construction Project(s): EACH OF YOUR CONSTRUCTION PROJECTS. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. For all sums which the insured becomes legally 3. Any payments made under Coverage A for obligated to pay as damages caused by "occur- damages or under Coverage C for medical rences" under Section I - Coverage A, and for all expenses shall reduce the Designated Con - medical expenses caused by accidents under struction Project General Aggregate Limit for Section I - Coverage C, which can be attributed that designated construction project. Such only to ongoing operations at a single designated payments shall not reduce the General Ag- construction project shown in the Schedule gregate Limit shown in the Declarations nor above: shall they reduce any other Designated Con- 1. A separate Designated Construction Project struction Project General Aggregate Limit for General Aggregate Limit applies to each des- any other designated construction project ignated construction project, and that limit is shown in the Schedule above. equal to the amount of the General Aggregate 4. The limits shown in the Declarations for Each Limit shown in the Declarations. Occurrence, Damage To Premises Rented To 2. The Designated Construction Project General You and Medical Expense continue to apply. Aggregate Limit is the most we will pay for the However, instead of being subject to the sum of all damages under Coverage A, ex- General Aggregate Limit shown in the Decla- cept damages because of "bodily injury" or rations, such limits will be subject to the appli- "property damage" included in the "products- cable Designated Construction Project Gen - completed operations hazard", and for medi- eral Aggregate Limit. cal expenses under Coverage C regardless of the number of: a. Insureds; b. Claims made or "suits" brought; or c. Persons or organizations making claims or bringing "suits". CG 25 03 05 09 © Insurance Services Office, Inc., 2008 Pagel of 2 13 P5260128IM/2 K B. For all sums which the insured becomes legally C. obligated to pay as damages caused by "occur- rences" under Section I — Coverage A, and for all medical expenses caused by accidents under Section I — Coverage C, which cannot be at- tributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical D. expenses shall reduce the amount available under the General Aggregate Limit or the Products -completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Desig- nated Construction Project General Aggre- gate Limit. When coverage for liability arising out of the "products -completed operations hazard" is pro- vided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -completed Operations Ag- gregate Limit, and not reduce the General Ag- gregate Limit nor the Designated Construction Project General Aggregate Limit. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contract- ing parties deviate from plans, blueprints, de- signs, specifications or timetables, the project will still be deemed to be the same construction pro- ject. E. The provisions of Section III — Limits Of Insur- ance not otherwise modified by this endorsement shall continue to apply as stipulated. M M in N z Page 2 of 2 Insurance Services Office, Inc., 2008 CG 25 03 05 09 Ct OLD REPUBLIC GENERAL INSURANCE CORPORATION CHANGES ADDITIONAL INSURED PRIMARY WORDING SCHEDULE THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Location(s) of Covered Operations Or Organization(s): WHERE REQUIRED BY WRITTEN CONTACT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown in the schedule above unless the other insurance is provided by a contractor other than the person or organization shown in the schedule above for the same operation and job location. If so, we will share with that other insurance by the method described in paragraph 4.c. of Section IV — Commercial General Liability Conditions. All other terms and conditions remain unchanged. Named Insured MGE UNDERGROUND, INC. Policy Number A-1CG-068918-07 Endorsement No. 000 Policy Period 10/01/2020 to 10/01/2021 Endorsement Effective Date: 10/01/2020 Producer's Name: MCSHERRY & HUDSON Producer Number: 44P00 AUTHORIZED REPRESENTATIVE CG EN GN 0029 09 06 DATE AMMMM Won POLICY NUMBER: A-1CG-068918-07 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 00 W. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ 1T CAREFULLY. ° WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) n N Z W This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Name Of Person(s) Or Organization(s): WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV -- Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. CG 24 04 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1 �iN(X)29(*2 POLICY NUMBER: A-1CG-068918-07 COMMERCIAL GENERAL LIABILITY CG 20 12 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION — PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: CITY OF GILROY, ITS OFFICERS, OFFICIALS, EMPLOYEES, AGENTS AND VOLUNTEERS. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted by law; and b. 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. 2. This insurance does not apply to: a. 'Bodily injury", "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. 'Bodily injury" or "property damage" included within the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. m U. 0 M M N W CG 20 12 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 r52wN>28iro2 ■ C N_ .V KNE POLICY NUMBER: A-1CA-068918-07 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ° DESIGNATED INSURED FOR M COVERED AUTOS LIABILITY COVERAGE z W 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. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: MGE UNDERGROUND, INC. Endorsement Effective Date: 10/01/2020 SCHEDULE Name Of Person(s) Or Organization(s): WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT. Information required 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 POLICY NUMBER: A-1CA-068918-07 COMMERCIAL AUTO CA 04 44 10 13 00 w THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ° WAIVER OF TRANSFER OF RIGHTS OF RECOVERY M AGAINST OTHERS TO US (WAIVER OF SUBROGATION) N z w 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 the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: MGE UNDERGROUND, INC. Endorsement Effective Date: 10/01/2020 SCHEDULE li Name(s) Of Person(s) Or Organization(s): WHERE REQUIRED BY AN EXECUTED WRITTEN CONTRACT. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA04441013 © Insurance Services Office, Inc., 2011 Page 1 of 1 P921d14)28(x)2 OLD REPUBLIC GENERAL INSURANCE CORPORATION WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 00 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: WORKERS' COMPENSATION AND EMPLOYERS' LIABILITY INSURANCE 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. This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule WHEN REQUIRED BY WRITTEN CONTRACT. The premium charge for this endorsement is $0.00 Named Insured MGE UNDERGROUND, INC. Policy Number A-1CW-068918-07 Endorsement No. 000 Policy Period 10/01/2020 to 10/01 /2021 Endorsement Effective Date: 10/01/2020 Producer's Name: MCSHERRY & HUDSON Producer Number: 44P00 AUTHORIZED REPRESENTATIVE WC 99 0316 (09/06) DATE U. 0 00 '126002X002 DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 10/08/2020 NAME OF INSURED: M0E underground, Inc. Additional Description of Operations/Remarks from Page 1: Additional Information: Includes: General Liability: Additional Insured per attached forms CG20121219. Primary Wording per attached form CGENGN00290906. Per Aggregate Limit per attached form CO25030509. Waiver of Subrogation per attached form CG24041219. Automobile Liability: Additional Insured per attached form CA20481013. Waiver of Subrogation per attached form CA04441013. workers Compensation: Waiver of Subrogation per attached form WC990315 (09/06).