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Attachment E
<br />,4L,-bKPI�Oe 89 of 121 CERTIFICATE OF LIABILITY INSURANCE
<br />DAT (MM )
<br />/2019
<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(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER James E. McGovern, Inc.
<br />1625 EI Camino Real
<br />Belmont, CA 94002
<br />CONTACT
<br />NAME: James E. McGovern, Inc.
<br />PHONE
<br />NNo Ext): 650-593-8216 A/C No): 650-594-9130
<br />E-MAIL
<br />ADDRESS:
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />12/31/2018
<br />INSURERA: Colony Insurance Company
<br />39993
<br />www.jemins.com
<br />INSURED
<br />B. Area Paving Co., Inc.
<br />P.O. Box 340
<br />INSURER B : Travelers Casualty Insurance Cc of America A+ XV
<br />19046
<br />INSURERC: Topa Insurance Company A- VII
<br />18031
<br />INSURERD: State Compensation Insurance Fund NR
<br />35076
<br />San Carlos CA 94070
<br />INSURER E,
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICYZ JE� [::] LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />INSURER F:
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />COVERAGES CERTIFICATE NUMBER: 4F7a1RnR REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<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 PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />INSD
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MM/DDIYYYY
<br />POLICY EXP
<br />MM/DDIYYYY
<br />LIMITS
<br />A
<br />✓
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE 1/ OCCUR
<br />✓
<br />103GL002146001
<br />12/31/2018
<br />12/31/2019
<br />EACH OCCURRENCE
<br />$1,000,000
<br />DAMAGE TO RENTED
<br />PREMISES Ea occurrence
<br />$ 100,000
<br />GEN'L
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL & ADV INJURY
<br />$1,000,000
<br />AGGREGATE LIMIT APPLIES PER:
<br />POLICYZ JE� [::] LOC
<br />OTHER:
<br />GENERAL AGGREGATE
<br />$2,000,000
<br />PRODUCTS - COMP/OP AGG
<br />$ 2,000,000
<br />$
<br />B
<br />AUTOMOBILE
<br />✓
<br />LIABILITY✓
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY ✓ AUTOS
<br />HIRED D✓ AUTOS ONLY ✓ AUTOS ONEY
<br />BA911176348-18
<br />12/31/2018
<br />12/31/2019
<br />Eaa(CMBINEDtSINGLELIMIT
<br />$1,000,000
<br />BODILY INJURY (Per person)
<br />$
<br />BODILY INJURY (Per accident)
<br />$
<br />(Par aERdTnDAMAGE
<br />$
<br />C
<br />V
<br />UMBRELLA LIAB
<br />EXCESS LIAB
<br />�/
<br />OCCUR
<br />CLAIMS -MADE
<br />XL6608412-02
<br />12/31/2018
<br />12/31/2019
<br />EACH OCCURRENCE
<br />$2,000,000
<br />AGGREGATE
<br />$ 2,000,000
<br />DED RETENTION $
<br />$
<br />D
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANYPROPRIETOR/PARTNER/EXECUTIVEF-1E.L.
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />NIA
<br />✓
<br />909-9552-18
<br />5/15/2018
<br />5/15/2019
<br />; STATUTE OTH-
<br />ER
<br />EACH ACCIDENT
<br />$1,000,000
<br />E.L. DISEASE - EA EMPLOYEE
<br />$1,000,000
<br />E.L. DISEASE - POLICY LIMIT
<br />$1,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE::General Service Agreement
<br />The City of Redwood City, its officers, employees, volunteers and agents are named as Additional Insured & Primary Non-contributory
<br />"30 day written Notice of Cancellation, except for non -pay of premium which is 10 days.
<br />CERTIFICATE HOLDER CANCELLATION
<br />City of Redwood Cit
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />Public Works Depa ment
<br />Attn: Right of Way, Streets Supervisor
<br />1400 Broadway Street
<br />Redwood City CA 94063
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />AUTHORIZED REPRESENTATIVE
<br />Sylvia McGovern
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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