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<br />~ ....
<br /> A TT ACHMENT "B-2"
<br /> AUTOMOBILE LIABILITY ENDORSEMENT
<br /> POLICY INFORMATION
<br />PRODUCER . AtJ-;t>I1~~ POLICY INFORMATION:
<br /> CAt.. ,i-~/4 :>7"'.... /~ Insurance Company:
<br /> ~!,> Policy No.: 2 M ~ ~ 1'1 t:J (to) t../tJJ/1
<br /> Policy Period: (from) '2...1 'fi4S
<br />Telephone No. LOSS ADJUSTMENT EXPENSE o Included in Limits
<br /> o In Addition to Limits
<br />DEDUCTABLE: $ SDD>. .-- crself-Insured 0 Retention (check which)
<br />NAMED INSURED (Licensed Contractor) APPLICABILITY. This insurance pertains to the operation and/or
<br /> MAttI 0 ~6V I (,..II/~ t::I tenancy of the named insured under all written agreements and permits
<br /> in force with the Entity unless checked here CJ in which case only the
<br /> following specific agreements and permits with the Entity are covered:
<br /> CITY AGREEMENTS/PERMITS - (Describe work and location below)
<br /> w~M. <L r>MJiiI--r/cvtf #~
<br />TYPE OF INSURANCE OTHER PROVISIONSD
<br />CJ COMMERCIAL AUTO POLICY I
<br />CJ BUSINESS AUTO POLICY
<br />c!OTHER
<br />LIMITS OF LIABILITY (per occurrence) CLAIMS: Underwriter's representative for claims pursuant to this
<br /> insurance.
<br />$2,000,000 for Combined Single Limit Name:
<br /> Address:
<br /> Telephone: ( )
<br />$ per accident. for bodily iniury and property damageD I
<br />In consideration of the premium charge and notwithstanding any inconsistent statement in the policy to which this endorsement is
<br />attached or any endorsement now or hereafter attached thereto, it is agreed as follows:
<br />1. INSURED: The The City of Redwood City, its Council members, commissions, committees, boards, officers, employees, and
<br />agents as additional insureds are included as insureds with regard to damages and defense of claims arising from: the ownership,
<br />operation, maintenance, use, loading or unloading of any auto owned, leased, hired or borrowed by the Named Insured, or for which
<br />the Named Insured is responsible.
<br />2. CONTRIBUTION NOT REQUIRED. As respects work performed by the Named Insured for or on behalf of the Entity, the
<br />insurance afforded by this policy shall: (a) be primary insurance as respects The City of Redwood City, its Council members,
<br />commissions, committees, boards, officers, employees, and agents as additional insureds; or (b) stand in an unbroken chain of
<br />coverage excess of the Named Insured's primary coverage. Any insurance or self-insurance maintained by the The City of Redwood
<br />City, its Council members, commissions, committees, boards, officers, employees, and agents as additional insureds shall be excess
<br />of the Named Insured's insurance and not contribute with it.
<br />3. CANCELLATION NOTICE. With respect to the interests of the Entity, this insurance shall not be canceled, except after thirty (30)
<br />days prior written notice by receipted delivery has been given to the Entity.
<br />4. SCOPE OF COVERAGE. This policy affords coverage at least as broad as:
<br /> (1) If primary, Insurance Services Office Form Number CA0001 (Ed. 1/87), Code 1 ("any auto"); or
<br /> (2) If excess, affords coverage which is at least as broad as the primary insurance forms referenced in the preceding Section (1).
<br />Except as stated above, nothing herein shall beheld to waive, alter or extend any of the limits conditions, agreements or exclusions of
<br />the policy to which this endorsement is attached.
<br />ENDORSEMENT HOLDER I
<br /> AUTHORIZED
<br />City of Redwood City REPRESENTATIVE CJ Broker/Agent CJ Underwriter CJ -
<br />Attn.: Engineering & Construction I, (print/type name), warrant
<br />P.O. Box 391 that I have authority to bind the above-mentioned insurance company,
<br />Redwood City, CA 94064 and by my signature hereon do so bind this company to this
<br /> endorsement.
<br /> Signature
<br /> (origina/ signature required)
<br /> Telephone: ( ) Date Signed
<br />
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