AgdaPkt 2015-04-27 Interview and Joint SA and PFA

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7.2.A. - Page 27 c 0 CERTIFICATE OF LIABILITY INSURANCE OATE(h1MIDDIYYYY) � ,� 1a1z4i2o12 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(lea)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain photos may require an endorsement. A statement on this cartfftcate dose not confer rights to the certificate holder In lieu of such endorsement a. .,... FRODuceR NAME: Mont Insurance Services,Inc. �p�i!c�le,Ext):561.21�1.6, L9 1 iAAic,Ho):561.79g.3307 7'108 Fairway Drive E t. Suite 226 ADORESS:CIarlccartg(1Slil;ntjnsurance.COm Palm Beach Gardens,FL 33418 INSURERS) CcyCRAGR -NAM# IN9URERAr21JrICIT American Ins.Co. 16535 INSURED INSURER B c - Clark Builders Group,LP INSURaRa$ 4401 Wilson Boulevard INSURER 0: Suite 600 • Arlington VA 22203 ENSURER E: _ INSURER F: COVERAGES CERTIFICATE NUMBER:145341312 REVISION NUMBER: THIS 18 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,L_IMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. • 1L TYPE OF INSURANCE, a AWL p POLICY NURSER 'NPOLICY M1 1YYDD POLICY LIMITS . GENERAL LIABILITY EACH OCCURRENCE $• r-I.COMMERCIALOENERALLIABILITY •-E.8E9' -••-n. $ 1 CLAW S•MAUE 1 1 OCCUR , . - • ono,areonj.$ PERSONAL&AOVINAIRY $ • GENERAL AGGREGATE $ _,_y GEFTL AGGREGATE LIMIT APPLIES PER: PRODUCT •COMP/OP AGO $ —1 POLICY n Fret. I-1 Loo IrI $ A AUTOMOBILE LlA131LITY V V BAP4Be55330T 61112012 \511I2011 EeaSr nfINOtEUMIT X000,000 J X ANY AUTO BODILY INJURY(Prot poreon) $ —ALLOWNED SCHEDULED BODILY INJURY(Per oddest) $ A FRO MM E $HIRED AUTOS e B lsAI) 4 S UManaLLALEAD OCCUR I EACH OCCURRENCE S , excessLIAe CLAIMS-MADE lsOGREGATE S DED I 1 RETENTIONS a ,q WORKERS COMPENEATiON y VIIC4119E53008 511/2012 3/1/2013 X UT1M i's I I°I R. AND EMPLOYERS'LIABILITY ANY PRCPRIETORIPARTNERIEXECUTIVE�Y!N E.L.EACH ACCIDENT $2,000,000 OFFICER AEMBEREXCL.UDEO? l_:....i N/A R.L.p19EASE-EAEMPLOYEE 5$008,944 (Mendslory In NO) ItVyes descEbo under E.L.DISEASE-POLICY LIM I 52 000.000 DESCRIPTION OFOPERATIONS below c DEavRIPII ONOFOPERATIONS!LOCATIows'VEHICLES WAHavhACORO101,Add hlonxlRoma,Rw Schedule,N MOM fpeaeIs requ€fed) RE:Veterans Boulevard,540 Veterans Boulevard,Redwood City,CA. • City of Redwood,its Council,boards,commissions,officers,employees,and agents are named as Additional Primary Insured as required by written contract.Additional insured status Is Primary and Non-Contributory.No policy will permit cancellation without thirty(30)written notice of cancellation. Group Code:too 5005 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES I%CANCELLER BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Redwood City ACCORDANCE WITH THE POLICY PROVISIONS, Engineering and Construction • . P.O.Box 391 AUTHORIZED REPRESENTATIVE Redwood CA 94064 p. I ar s,Kt.¢ • 01988-2010 ACORD CORPORATION. All rights reserved. ACORO 26(2010106) The ACORD name and logo are registered marks of ACORD .