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OP ID: TV <br />ACORO I DATE(MMIDD/YYYY) <br />`..� CERTIFICATE OF LIABILITY INSURANCE 0612912017 <br />III <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to I <br />the terms and conditions of the policy, certain policies may require an endorsement A statement on this certificate does not confer rights to the 1 <br />certificate holder In lieu of such endorsement(s). <br />PRODUCER (CONTACT <br />Insurance Solutions & Services NAME: <br />619 Amboy Avenue I PAHiOONN . E,,,.732-738-6080 I Fl NUI: 732-738.6081 <br />Edison, NJ 08837 I (:•MAIL <br />Frank G. Jacobs "DRESS: <br />IcuoDUCER <br />sioM5Rou:GES-011 1 <br />INSURER(SI AFFORDING COVERAGE NAICS I <br />INSURED Groundwater & Environmental I wsuRERA:Great Divide Insurance Company 25224 <br />Services, Inc. I INSURERS: Nautilus Insurance Company 17370 I <br />5046 Commercial Circle Suite F <br />Concord, CA 94520 I INSURER C: I <br />I INSURER D: I <br />INSURER E: I <br />T`'cp rry;�•T/p'1drl/, pgr�t`l IY INSURERF:REVISION NUMBER: <br />COVERAGES <br />THIS IS O CERTIFY THAT THE POLIO OF(INSURANIELI TED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE OR THE POLICY PERIOD I <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY ''ERTAIN, —HE INSURANCE AFFORDED BY THE POUCIE1 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH 'OLICIES..IMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS. <br />I'ASTYPEOFINSURANCE AOUL SUER POLICY EFF POLICY E1cP <br />IN80 "In POLICY NUMBER IMM/ODIYYYYI IMM/DDIYYYYI LIMITS <br />GENERAL LIABILITY q , E 1,000 DD <br />A X COMMERCIAL GENERAL LIABILITY X 3LP202300010 07/01121117 07101/20181 'TM"SES tEa �� 5 300 D0 <br />PREMISES /Eeamlaenml E <br />CLAIMSMADE FRI OCCUR MED EXP(AWmepmson) 5 10,00 <br />(PERSONAL&ADV INJURY 5 1,0110,0001 <br />1 GENERAL AGGREGATE S 2,000,0001 <br />G <br />ENL AGGREGATE IGGATIE LIMIT APPLIES PER (PRODUCTS-COMP/OPAGG S 2,000,001 <br />7POLICY AFcai T I LOC 5 <br />AUTOMOBILE LIABILITY X COMBINED SINGLE LIMIT $ 111D1100� <br />A X ANY AUTO BAP202299610 07/01!2017 07101/2018(Eaacvdant) 1 BODILY INJURY (Per P=an) 5 <br />ALLOWNEDAUTOS BODILY INJURY (Per accident) $ <br />— SCHEDULED AUTOS PROPERTY DAMAGE <br />HIREDAUTOS (PER ACCIDENT) $ <br />_ NON-OWNEOAUTOS I S <br />5 <br />UMBRELLAUAS OCCUR I EACH OCCURRENCE S 10,000,0011( <br />B X IXCESSLIAR CWMSMAOE X I AGGREGATE Is 10,000,001 <br />FFX202300110 07/01/2017 07/01/2018 Is <br />DEDUCTIBLE r <br />A RETENTION 5 0 I I TORY LIN RSI I ER $ <br />W ERS COMPENSATION - - II X WC STAWC STATU—' OTOTH- -- — AND EMPLOYERS' LIABILITY <br />A ANY PROPmETORIPARTNER/EXECUnVE YIN WCA202299210 07/01/2017 07/01/2018 E.L EACHABCIDENT Is 1x000,00 <br />OMCERIMEMBER EXCLUDED? FN MIA � I <br />(MyyaB8ecWo�ry In E.L. DISEASE -EA EMPLOY S 1x0110,00 <br />OE.SFRIP11ON pF OPERATIONS Wow E.L. DIBEABE-POLICY LIMIT $ 1,000,OU <br />CCP2005634 0710112017 0710V2018 <br />6 IPProof� tonal X CCP20056 4 07101/2017 07/01/2018 IAgglregate 10,000,00 <br />DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES tArtnch ACORD 101, Additional Remedy SShedWe, Nm ora space is repaired) I <br />The Cit% of Redwood Cil and REG8 Se uo)a Station,LLC are included as <br />Additional Insured with the exception o Workers Compensation as respects <br />the operations of the Insured.Additionarinsured status is subject to <br />written contract requirements.Coverage is provided on a primary & <br />non-contributory basis. <br />,PERTIFICATE HOLDER CANCELLATION <br />GES1900 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />City of Redwood City ACCORDANCE WITH THE POLICY PROVISIONS. <br />Public Works Division <br />Ms. Sindy Mulyone-Danre AUTHORWF REPRESENTATIVE <br />1400 Broadway Street <br />(Redwood Citv. CA 94063 <br />01988-2009 ACORD CORPORATION. All rights reserved. <br />ACORD 25 (2009109) The ACORD name and logo are registered marks of ACORD <br />