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CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />PRODUCER CONTACTNAME:
<br />PHONE(A/C, No, Ext):
<br />FAX
<br />(A/C, No):
<br />E-MAILADDRESS:
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />INSURED
<br />INSURER A :
<br />INSURER B :
<br />INSURER C :
<br />INSURER D :
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:XXXXXXX
<br />INSRLTR TYPE OF INSURANCE ADDLINSD SUBRWVD POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-JECT LOC
<br />OTHER:
<br />EACH OCCURRENCE
<br />DAMAGE TO RENTED
<br />PREMISES (Ea occurrence)
<br />MED EXP (Any one person)
<br />PERSONAL & ADV INJURY
<br />GENERAL AGGREGATE
<br />PRODUCTS - COMP/OP AGG
<br />COMBINED SINGLE LIMIT(Ea accident)
<br />BODILY INJURY (Per person)
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE(Per accident)
<br />EACH OCCURRENCE
<br />AGGREGATE
<br />E.L. EACH ACCIDENT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />$
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />OWNED
<br />AUTOS ONLYHIRED
<br />AUTOS ONLY
<br />SCHEDULED
<br />AUTOSNON-OWNED
<br />AUTOS ONLY
<br />UMBRELLA LIAB OCCUR
<br />EXCESS LIAB CLAIMS-MADE
<br />DED RETENTION $
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />Y / N
<br />N / A
<br />PERSTATUTE OTH-ER
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />CERTIFICATE HOLDER CANCELLATION
<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 />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved
<br />The ACORD name and logo are registered marks of ACORD
<br />Lockton Insurance Brokers,LLC
<br />CA License #0B99399
<br />777 S. Figueroa Street, 52nd fl.
<br />Los Angeles CA 90017
<br />213-689-0065
<br />SCS Engineers
<br />3900 Kilroy Airport Way, Ste 100
<br />Long Beach, CA 90806-6816
<br />SCSEN01
<br />3/31/2025
<br />1508808
<br />X
<br />2,000,000
<br />XXXXXXX
<br />XXXXXXX
<br />XXXXXXX
<br />XXXXXXX
<br />XXXXXXX
<br />XXXXXXX
<br />X
<br />X
<br />X X,C,U Included
<br />X Contractual Liab.
<br />2,000,000
<br />1,000,000
<br />25,000
<br />2,000,000
<br />10,000,000
<br />10,000,000
<br />Professional Liability - Claims Made Per Claim: $2,000,000 Aggregate: $2,000,000
<br />N
<br />X
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />Steadfast Insurance Company 26387
<br />Zurich American Insurance Company 16535
<br />A BAP 0112780-09 04/01/2024 04/01/2025
<br />A GLO 0112778-09 03/31/2024 03/31/2025
<br />B PEC 0112862-09 03/31/2024 03/31/2025
<br />A WC0112779-09 04/01/2024 04/01/2025
<br />NOT APPLICABLE
<br />See Attachments
<br />City of Pleasanton
<br />Attention: Becky Hopkins
<br />PO Box 520
<br />Pleasanton, CA 94566
<br />18587992
<br />18587992
<br />03/14/2024
<br />X X
<br />Y N
<br />N N
<br />Y
<br />N N
<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 BELOW.
<br />THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE
<br />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. If
<br />SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this
<br />certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY
<br />PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO
<br />WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO
<br />ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />RE: Job #: 10486222. Job Info: Providing Senate Bill 1383 assistance. The City of Pleasanton, its officers, employees and agents are Additional Insured(s) as per the attached endorsement or policy
<br />language. Insurance provided to Additional Insured(s) is primary and non-contributory as per the attached endorsements or policy language. Waiver of subrogation applies as per the attached
<br />endorsements or policy language, where allowed by law. Separation of Insured clause/Cross Suits Liability is included on the General Liability and Auto Liability policies.
<br />Docusign Envelope ID: 593FD8B3-9810-4728-8093-A5DA5894F3D5
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