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ACCMOF CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDD/YYYY)
5/18/2021
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
(MP) Heffernan Insurance Brokers
1460E O'Brien Drive
CONTACT
NAME:
PHONE . 650-842-5200 ac No : 650-842-5201
E-MAIL
ADDRESS:
Menlo Park CA 94025
INSURERS AFFORDING COVERAGE NAIC p
INSURER A: Liberty Mutual Fire Insurance Company 23035
Licensed: 0564249
INSURED SHIEHAR-01
Shields, Harper & Co.
4591 Pacheco Blvd.
INSURER B : Westchester Surplus Lines Insurance Company 10172
INSURER C : Republic Indemni Company of California 43753
INSURER D :
Martinez CA 94553
INSURER E :
INSURER F :
GUvtKAGES CERTIFICATE NUMBER 1Q1QfiR3R31 0=%1IQtntI K111RAoco.
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
I TYPE OF INSURANCE
ADDL SUBR
Iimsb wynI
POLICY NUMBER
POLICY EFF POLICY EXP
MMIDD/YYYY MMfDD
LIMITS
B
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE a OCCUR
G27572480007
3/18/2021 3/18/2022
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence
$ 100,000
MED EXP (Any one person)
S 10.000
PERSONAL & ADV INJURY
S 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO-
JECT LOC
GENERAL AGGREGATE
S 2,000,000
PRODUCTS - COMP/OP AGG
I $ 2,000,000
OTHER:
Is
A
I AUTOMOBILE LIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
X HIRED X NON -OWNED
AUTOS ONLY AUTOS ONLY
AS2Z61064691041
3/18/2021 3/18/2022
I COMBINED SINGLE LIMIT
Ea accident
I S 1.000.000
BODILY INJURY (Per person)
Is
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
Per accident
S
S
B
X UMBRELLA LIAR
X
I OCCUR
G27572492 007
3/18/2021 3/18/2022
EACH OCCURRENCE
I S 5,000,000
AGGREGATE
S 5,000,000
EXCESS LIAB
CLAIMS -MADE
DED RETENTION $
Is
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRIETOR/PARTNER/EXECUTIVE ❑
OFFICER/MEMBEREXCLUDED?
NIA
25171605
4/15/2021 4/15/2022
X STA LITEI ERH
E.L. EACH ACCIDENT
$1,000.000
E.L. DISEASE - EA EMPLOYEE
-- - - -- ---
S 1,000,000
- - - - - -
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT I
S 1.000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: As Per Contract or Agreement on File with Insured.
U=K 1 II -ILA I t t1ULUhR CANCEL 1 OTIr)N
City of Gilroy
7351 Rosanna Street
Gilroy, CA 95020
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
(9 1983-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD