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05/02/2024 <br />Cornerstone Specialty Insurance Services, Inc. <br />14252 Culver Drive, A299 <br />Irvine CA 92604 <br />Tina Cowie <br />(714)731-7700 (714)731-7750 <br />tina@cornerstonespecialty.com <br />KAYUGA SOLUTION, INC. <br />28241 Crown Valley Parkway #F-216 <br />Laguna Niguel CA 92677 <br />RLI Insurance Company 13056 <br />Gemini Insurance Company 10833 <br />24/25 COVERAGES <br />A <br />ADDT'L INSURED / P & NC <br />BLNKT WVR OF SUBRO PSB0005208 03/03/2024 03/03/2025 <br />2,000,000 <br />1,000,000 <br />10,000 <br />INCLUDED <br />4,000,000 <br />4,000,000 <br />A PSA0002229 03/03/2024 03/03/2025 <br />1,000,000 <br />A <br />0 <br />PSE0002867 03/03/2024 03/03/2025 <br />1,000,000 <br />1,000,000 <br />A N PSW0003014 03/03/2024 03/03/2025 1,000,000 <br />1,000,000 <br />1,000,000 <br />B Professional Liability <br />Claims Made VNPL014943 03/03/2024 03/03/2025 <br />Each Claim $1,000,000 <br />Annual Aggregate $2,000,000 <br />Certificate Holder is Additional Insured for General Liability but only if required by written contract with the Named Insured prior to an occurrence <br />and as per attached endorsement. Coverage is subject to all policy terms and conditions. *30 days notice of cancellation, except for 10 days notice <br />for non-payment of premium. For Professional Liability coverage, the aggregate limit is the total insurance available for all covered claims reported <br />within the policy period. <br />City of Pleasanton <br />123 Main Street <br />Pleasanton CA 94566 <br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />INSURER(S) AFFORDING COVERAGE <br />INSURER F : <br />INSURER E : <br />INSURER D : <br />INSURER C : <br />INSURER B : <br />INSURER A : <br />NAIC # <br />NAME:CONTACT <br />(A/C, No):FAX <br />E-MAILADDRESS: <br />PRODUCER <br />(A/C, No, Ext):PHONE <br />INSURED <br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />OTHER: <br />(Per accident) <br />(Ea accident) <br />$ <br />$ <br />N / A <br />SUBR <br />WVD <br />ADDL <br />INSD <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 />$ <br />$ <br />$ <br />$PROPERTY DAMAGE <br />BODILY INJURY (Per accident) <br />BODILY INJURY (Per person) <br />COMBINED SINGLE LIMIT <br />AUTOS ONLY <br />AUTOSAUTOS ONLY <br />NON-OWNED <br />SCHEDULEDOWNED <br />ANY AUTO <br />AUTOMOBILE LIABILITY <br />Y / N <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />DESCRIPTION OF OPERATIONS below <br />If yes, describe under <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />$ <br />$ <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />E.L. DISEASE - EA EMPLOYEE <br />E.L. EACH ACCIDENT <br />EROTH-STATUTEPER <br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />EXCESS LIAB <br />UMBRELLA LIAB $EACH OCCURRENCE <br />$AGGREGATE <br />$ <br />OCCUR <br />CLAIMS-MADE <br />DED RETENTION $ <br />$PRODUCTS - COMP/OP AGG <br />$GENERAL AGGREGATE <br />$PERSONAL & ADV INJURY <br />$MED EXP (Any one person) <br />$EACH OCCURRENCE <br />DAMAGE TO RENTED $PREMISES (Ea occurrence) <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADE OCCUR <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO-JECT LOC <br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br />CANCELLATION <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016/03) <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />CERTIFICATE HOLDER <br />The ACORD name and logo are registered marks of ACORD <br />HIRED <br />AUTOS ONLY <br />DocuSign Envelope ID: 5C9E3D6D-78BE-43C5-A919-929E9BC66BC0