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HomeMy WebLinkAboutCOI - Frontier California, Inc. - Expires 2022-06-01_ Page 1 of 1 AC RD D® CERTIFICATE OF LIABILITY INSURANCE DATE([ ��- 06/02/202102/2021 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 endorsements). PRODUCER CONTACT NAME: Willis Towers Watson Certificate Center Willis Towers Watson Southeast, Inc. --�--� -� -FAX — - - c/o 26 Century Blvd PHONE 1-877-945-7378 FAX 1-888-467-2378 A/C No): E-MAIL certificates@willia.com P.O. Box 305191 ADDRESS: Nashville, TN 372305191 USA INSURER S AFFORDING COVERAGE NAIC #__ INSURERA: Steadfast Insurance Company 26387 f INSURED INSURER B : Zurich American Insurance Company 16535 Frontier California Inc. -- - — - - -- - 401 Merritt 7 INSURERC: American Zurich Insurance Company 40142 Norwalk, CT 06851 INSURER 0 ---- - - - - INSURER E INSURER F : COVERAGES CERTIFICATE NtIMRFR- W21167567 RFVISInN NIIMRFR- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE AOaL 5UBR POLICY EFF POLICY EXP '• LIMITS POLICY NUMBER MMrDD/YY1. MM/DDIYYYY GENERAL LIABILITY CLAIMS -MADE � OCCUR I__ EACH OCCURRENCE RENTED PREMISES_iEa occurrence $ 1,000,000 17MFRCIAL $ _ 500, 000 ' A MED EXP (Any one person) $ 10,000 1 $ 1,000,000 Y GLO 0285992-04 06/01/2021 06/01/2022'. PERSONAL 8 ADV INJURY GENT X $ 2,000,000 $ 2,000,000 AGGREGATE LIMIT APPLIES PER: POLICY Cj JECTPRO• L—! LOC GENERAL AGGREGATE PRODUCTS - COMPiOP AGG $ OTHER: AUTOMOBILE LIABILITY X j ANY AUTO COMBINED SINGLE LIMIT tEa accident) $ 1, 000, 000 T` , $ BODILY INJURY (Per person} B OWNED SCHEDULED Y BAP 0285990-04 06/01/2021 AUTOS ONLY AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY 06/01/2022 BODILY INJURY (Per accident) I $ $ - PROPERTY DAMAGE ^ Per accident _ $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ ' ; AGGREGATE ---- - - - $ EXCESS UAB CLAIMS -MADE DED f7 RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY C ANYPROPRIETOR)PARTNEWEXECUTIVE Y / N OFFICERrMEMBEREXCLUDED? Na 'N/A WC 0285988-04 (AOS) 06/01/2021 (Mandatory In NH) 06/01/2022 X I PER STATUTE ERH _ -------- $ 1,000,000 - $ 1,000,000 E.L. EACH ACCIDENT — -- - - - E.L. DISEASE • EA EMPLOYEE It es, describe under D>SCRIPTION OF OPERATIONS below I $ 1,000,000 v E.L. DISEASE - POLICY LIMIT B !Workers Compensation (WI) WC 0285989-04 (RETRO) 06/01/2021 06/01/2022 EL Each Accident $1,000,000 Per Statute EL Disease -Ea Empl. $1,000,000 and Employers Liab. f IEL Disease-Pol. Limits2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Frontier California Inc. Is insurance certificate for permitting purposes with the City of Gilroy, CA. The City of Gilroy, and its officers, employees and agents shall be named as Additional Insureds as respects the General Liability and Auto Liability policies where required by written contract. rFRTIFIrATF Nnl nFR rANrFI I ATInN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 I lJij U 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD sa 'D: 21153294 BATCH: 2114086 2 of 9 721 POLICY NUMBER: GLO 0285992-04 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations The City of Gilroy, and its officers, The City of Gilroy, CA employees and agents 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 the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 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 location 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 12 19 © Insurance Services Office, Inc., 2018 Pagel of 2 Wolters Kluwer Financial Services, Inc I Uniform Forms C. 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 insurance; whichever is less. This endorsement shall applicable limits of insurance applicable limits of not increase the Page 2 of 2 ©Insurance Services Office, Inc., 2018 CG20101219 3 of 9 721 Page 1 of 1 A ® DATE (MM/DDIYYYY) ACCN?" CERTIFICATE OF LIABILITY INSURANCE kk.� 06/02/2021 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 CONTACT Willis Towers Watson Certificate Center NAME: Willis Towers Watson Southeast, Inc. PHONE FAX c/o 26 Century Blvd E 1-877-945-7378 (A/C,No: 1-888-467-23?8 P.O. Box 305191 ADDRE SS: certificates@willis.com —r Nashville, TN 372305191 USA INSURER(S) AFFORDING COVERAGE « _Wj_ NAIC # INSURERA: Steadfast Insurance Company ji 26387 INSURED INSURERS. Zurich American Insurance Company 16535 Frontier California Inc. 401 Merritt 7 INSURER C • American Zurich Insurance Company 40142 Norwalk, CT 06851 INSURER D : INSURER E : _ INSURER F : I r%^A100Ar%_ee f`CQTICInATC MI10ARCR• W21167564 RFVISIAN NIIMRFR- 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 POLICY EFF TYPE OF - — POLICY NUMBER MMOD/YYY POLICY EXP MMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE i $ 1,000,000 CLAIMS -MADE OCCUR t - I DAMAGE TO RENTED PREMISES Ea oceurrence)___i $ 500,000 MED EXP (Any one person) $ 10,000 A i Y GLO 0285992-04 06/01/2021 06/01/2022 PERSONAL & ADV INJURY $ 1,000,000 GEN'L `GENERAL AGGREGATE $ 2.000, 000 AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOG $ 2,000,000 X I PRODUCTS - COMPrOP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1Ea accident) $ 1, 000, 000 _-_ BODILY INJURY (Per person) $ X ANY AUTO BODILY INJURY (Per accident) $ B OWNED SCHEDULED Y BAP 0285990-04 06/01/2021 06/01/2022 AUTOS ONLY AUTOS PROPERTY DAMAGE $_ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY $ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERPER AND EMPLOYERS' LIABILITY Y / N 1 1,000,000 E.L. EACH ACCIDENT ANYPROPRIETORIPARTNERIEXECUTIVE � No OFFICERIMEMBEREXCLUDED. N/A WC 0285988-04 (AOS) 'iC 06/01/2021 06/01/2022 — ----- --------i__ $ -- - - - - - (Mandatory to NH) E.L. DISEASE • EA EMPLOYEES $ 1, 000, 000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 1 It es, describe under DESCRIPTION OF OPERATIONS below B iWorkers Compensation (WI) WC 0285989-04 (RETRO) 06/01/2021 06/01/2022iEL Each Accident $1,000,000 JPer Statute IEL Disease -Ea Empl. $1,000,000 and Employers Liab. I EL Disease-Pol. Limi $2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Re: Frontier Project ##5263786. Frontier California Inc.'s insurance certificate for permitting purposes with the City of Gilroy, CA. The City of Gilroy, and its officers, employees and agents shall be named as Additional Insureds as respects the General Liability and Auto Liability policies where required by written contract. CERTIFICATE MOLDER %;ANtaLLA I IUN -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gilroy AUTHORIZED REPRESENTATIVE 7351 Rosanna Street+I Gilroy, CA 95020 01988-2016 ACORD CORPORATION. All rights reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SR rD: 21153294 sATcx: 2114086 4 of 9 721 POLICY NUMBER: GLO 0285992-04 COMMERCIAL GENERAL LIABILITY CG20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations The City of Gilroy, and its officers, The City of Gilroy, CA employees and agents 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 the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 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 location 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 12 19 O Insurance Services Office, Inc., 2018 Pagel of 2 Wolters Kluwer Financial Services, Inc. I Uniform Forms C. 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 insurance; whichever is less. This endorsement shall applicable limits of insurance applicable limits of not increase the Page 2 of 2 ©Insurance Services Office, Inc., 2018 CG20101219 5of9 721 Page 1 of 1 ACORfi7® CERTIFICATE OF LIABILITY INSURANCE DATE 06/02/2021Y) 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 Willis Towers Watson Certificate Center NAME: Willis Towers Watson Southeast, Inc. PHONE FAX c/o 26 Century Blvd t_ 1-877-945-7378 A/C No: 1-888-467-2378 P.O. Box 305191 ADDRESS: certificates@willia.com T _ Nashville, TN 372305191 USA INSURERS AFFORDING COVERAGE_ I NAIC# INSURER A • Steadfast Insurance Company 26387 INSURED INSURERS: Zurich American Insurance Company 16535 Frontier California Inc. 401 blerritt 7 INSURER C • American Zurich Insurance Company 40142 Norwalk, CT 06851 INSURER D : INSURER E : INSURER F : rnvFRec;F-q CFRTIFICOTF NIIMRFR- W2116756S 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. tNSR LTR ��- rADDL-SUER!--- - POLICY EFF TYPE OF INSURANCE i INSD WVD, POLICY NUMBER MMIDDIYY POLICY EXP MMIDD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 1,000,000 $RENTED CLAIMS -MADE a OCCUR DAMAGE TO PREMISES (Ea occurrence) $ 500,000 MED EXP (Anyone person) $ 10,000 A Y GLO 0285992-04 06/01/2021 06/01/2022 PERSONAL & ADV INJURY $ 1,000,000 GENT GENERAL AGGREGATE $ 2,000,000 AGGREGATE LIMIT APPLIES PER: O. POLICY [ jE i LOC PRODUCTS - COMP/OP AGO $ 2,000,000 $ OTHER: I AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT -LEa accidentZ_ $ 1,000,000 BODILY INJURY (Per person) $ X ANY AUTO B OWNED SCHEDULED Y Y BAP 0285990-04 06/01/2021 AUTOS ONLY AUTOS HIRED NON -OWNED X ! AUTOS ONLY X AUTOS ONLY 06/01/2022 BODILY INJURY (Per accident) $ — —� PROPERTY DAMAGE Per accident)_—;$ i Is UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE i $ 1 $ EXCESS LIAB HCLAIMS-MADE DED RETENTION$ - C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETORPARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? No N 1 A i (Mandatory In NH) WC 0285988-04 (AOS) 06/01/2021 06/O1/2022 X STATUTE EH R E.L. EACH ACCIDENT _ E.L. DISEASE . EA EMPLOYEE $ 1,000,000 _ $ 1,000,000 II yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE POLICY LIMIT $ 1,000,000 8 lWorkers Compensation (WI) WC 0285989-04 (RETRO) 06/01/2021 06/01/2022•EL Each Accident $1,000,000 1Per Statute �EL Disease -Ea Empl. $1,000,000 land Employers Liab. ;EL Disease-Pol. Limi $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Frontier Project #5273663. Frontier California Inc.'s insurance certificate for permitting purposes with the City of Gilroy, CA. The City of Gilroy, and its officers, employees and agents shall be named as Additional Insureds as respects the General Liability and Auto Liability policies where required by written contract. 1`G92TIr=lf`AT9= Wril nGR r_ANt_FI I ATInN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gilroy AUTHORIZED REPRESENTATIVE 7351 Rosanna Street Gilroy, GA 95020 i J� ��•�•7 _ " U 1988-201b AGUHU GUHFUHA I IUN. All rigntS reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD sR za: 21153294 sATM 2114086 6of9 721 POLICY NUMBER: GLO 0285992-04 COMMERCIAL GENERAL LIABILITY CG20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations The City of Gilroy, and its officers, The City of Gilroy, CA employees and agents 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 the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 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 location 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 12 19 © Insurance Services Office, Inc., 2018 Pagel of 2 Wolters Kluwer Financial Services, Inc. I Uniform Forms C. 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 insurance; whichever is less. This endorsement shall applicable limits of insurance applicable limits of not increase the Page 2 of 2 c0 Insurance Services Office, Inc., 2018 CG 20 10 12 19 7 of 9 721 Page 1 of 1 DATE (MMIDDNYYY) AC"R" CERTIFICATE OF LIABILITY INSURANCE IIkl�� 06/02/2021 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 poiicy(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 Willis Towers Watson Certificate Center NAME: Willis Towers Watson Southeast, Inc. -�— ' -- c/o 26 Century Blvd (At No.PHONE 1-877-945-7378 FAX No: 1-888-467-2378 E-MAIL P.O. Box 305191 ADDRESS: certificates@willis.com Nashville, TN 372305191 USA INSURER S AFFORDING COVERAGE T NAIC # INSURED Frontier California Inc. 401 Merritt 7 Norwalk, CT 06851 INSURER A • Steadfast Insurance Company 26387 INSURER B • Zurich American Insurance Company 16535 INSURER C - American Zurich Insurance Company 40142 INSURER D : INSURER E : IKMI loco c . CnVFRAGFR CFRTIFICATF NIIMRFR- W21167566 RFVIRInN NI IMRFR- 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 ADDL $U81t' POLICY EFF POLICY EXP LIMITS POLICY NUMBER MM�DDrYYYY MMODIYYYY X ! COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE L7X OCCUR DAMAGE TO $ 500,000 PREMISES RENTED occurrence)_T MED EXP (Any one person) $ 10,000 A Y GLO 0285992-04 06/01/2021 06/01/2022 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL_AGGREGATE $ 2,000,000 I POLICY L JE LOC PRODUCTS COMP/OP AGG $ _ 2,000,000 Is I OTHER: AUTOMOBILE LIABILITY ! COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X ANY AUTO I BODILY INJURY (Per person) $ B OWNED SCHEDULED Y BAP 0285990-04 06/01/2021 ' 06/01/2022 1, BODILY INJURY (Per accident)' $ AUTOS ONLY AUTOS X HIRED X NON -OWNED PROPERTY DAMAGE $ u AUTOS ONLY AUTOS ONLY j$ UMBRELLA LIAB OCCUR EACH OCCURRENCE ; $ EXCESS LIAB i CLAIMS -MADE AGGREGATE Is DED RETENTION$ $ WORKERS COMPENSATION X STATUTE LEB AND EMPLOYERS' LIABILITY Y / N -- . C I ANYPROPRIETORIPARTNER/EXECUTIVE No E.L. EACH ACCIDENT $ 1,000,000 OFFICEWMEMBEREXCLUDED? ,NIA WC 0285988-04 (AOS) 06/01/2021 06/01/2022!- - — - - -- - 000 , (Mandatory In NH) � E.L. DISEASE - EA EMPLOYEE $ 1, 000, 11 yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ 1,000,000 B Workers Componsation (WI) WC 0285989-04 (RETRO) 06/01/2021 06/01/2022!EL Each Accident $1,000,000 Per Statute �EL Disease -Ea Empl. f$1,000,000 land Employers Liab. 4EL Disease-Pol. Limit $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Re: Frontier Project #WO896889. Frontier California Inc.'s insurance certificate for permitting purposes with the City of Gilroy, CA. The City of Gilroy, and its officers, employees and agents shall be named as Additional Insureds as respects the General Liability and Auto Liability policies where required by written contract. CFRTIFICATF HOLDFR CANCFI_I OTInN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gilroy AUTHORIZED REPRESENTATIVE 7351 Rosanna Street Gilroy, CA 95020 OO 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD sR 1D: 21153294 anxcs: 2114086 8 of 9 721 POLICY NUMBER: GLO 0285992-04 COMMERCIAL GENERAL LIABILITY CG20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or anization s Locations Of Covered Operations The City of Gilroy, and its officers, The City of Gilroy, CA employees and agents 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 the person(s) or organizabon(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 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 location 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 12 19 ©Insurance Services Office, Inc., 2018 Page 1 of 2 Wolters Kluwer Financial Services, Inc. I Uniform Forms C. 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 applicable limits of insurance. not increase the Page 2 of 2 O Insurance Services Office, Inc., 2018 CG20101219 9 of 9 721