RecDoc 2015-056642 CONFORMED 1092 SECOND AVE I.A.

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AC R_ a DATE(MM/DDt YYY) CERTIFICATE OF LIABILITY 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 1° REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must he 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 „v-- certificate holder In lieu Of such endorsement(s). c CONTACT W PRODUCER -O AOn Risk Insurance Servi ces West , Inc. PHON: San Jose CA Office (NC . No. Extl: (866) 283-7122 FAX No ): (800) 363-0105 V 60 South Market Street , Suite 1100 E-MAIL p San Jose CA 95113 USA ADDRESS: I INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: United Specialty Insurance company 12537 Andrei ni Rrothers , Inc . INSURER B: The American Insurance Company 21857 151 Main Street Half Moon Ray CA 94019 USA INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570057789710 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. Limits shown are as requested INSR ADDL SUER POLICYEFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DO IMMIODIYWV) LIMITS A X COMMERCIAL GENERAL LIABILITY BT01427119 09/01/2014 09/01/2015 EACH OCCURRENCE $1 , 000 , 000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $50 , 000 PREMISES (Ea occurrence) MED EXP (Any one person) Excluded PERSONAL& ADV INJURY $1, 0001000 0 GEN'LAGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $2 , 000, 000 m POLICY X PE� LOC PRODUCTS - COMPIOPAGG $2 , 000, 000 n cD OTHER: N- B AUTOMOBILE LIABILITY S 89 MZA 80307671 09/01/201409/01/2015 COMBINED SINGLE LIMIT $1, 000,000 (Ea accident) . . BODILY INJURY( Per person) O X ANY AUTO z X ALL OWNED X SCHEDULED BODILY INJURY(Per accident) 0 AUTOS _ AUTOS U X HIRED AUTOS NON-OWNED PROPERTY DAMAGE _ AUTOS (Per accident) w Comp/Coll Deductible $1 , 000 y UMBRELLA LIAR OCCUR EACH OCCURRENCE O EXCESS LIAB CLAIMS-MADE AGGREGATE BED ,RETENTION WORKERS COMPENSATION AND PER STATUTE OTH- EMPLOYERS' LIABILITY YIN ER ANY PROPRIETOR I PARTNER/EXECUTIVE EL. EACH ACCIDENT OFFICERIMEMBER EXCLUDED? N /A (Mandatary in NH) E.L. DISEASE-EA EMPLOYEE If yes, descdbe under EL. DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS below i DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (AGGRO 101, Additional Remarks Schedule, may be attached if more space is required) P-.2 RE : 1092 second Ave . , Redwood City . city of Redwood City Engineering & Construction , and each of their respective officers , employees are included as Additional iF Insured with respect to the General Liability and Automobile Liability policies ; and granted a waiver of subrogation for ira General Liability and Automobile Liability policies , as required by written contract , but limited to the operations of the Insured under said contract . weeg CERTIFICATE HOLDER CANCELLATION .ag-e SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE y�y -�, POLICY PROVISIONS. �+�t' II City Of Redwood City Engineering AUTHORIZED REPRESENTATIVE >'® & Construction al Po Box 391 Sin a h�n,Aretanee via Z? _5om Redwood City CA 94064 USA �t � , ©• 988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01 ) The ACORD name and logo are registered marks of ACORD