CITY SERVE OF THE TRI-VALLEY (PLHA Funds FY24-25) Contract Amendment

ANY PROPRIETOR/PARTN ER/EXECUTIVE O FFICER/MEMBER EXCLUDED? ADD L SUBRINSR LT R INSD WVD DATE (M M /D D /YY Y Y ) C ON TACTPRODUCERNAME: FAXPHONE(A /C,No):(A /C ,N o,Ext): E-MAIL ADD R ESS: IN SURER A : IN SURED IN SURER B : IN SURER C : IN SURER D : IN SURER E : IN SURER F : POLIC Y EFF POLIC Y EXPTYPEOFINSURANCE LIM ITSPOLICYNUMBER(M M /DD /Y Y Y Y )(M M /DD /Y Y Y Y ) AU T OM O BILE LIAB ILITY U M B R ELLA LIAB EXCESS LIAB W OR KERS CO M PENSATION AN D EMPLO Y ERS'LIAB ILITY D ESCRIPTIO N OF O PERAT ION S /LOC AT ION S /VEHIC LES (A C ORD 1 0 1,Additi onal Remarks Sche dule,m ay be atta ched if m ore s pace is require d) AUT HO RIZED R EPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTEDCLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL &ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO-POLICY LOC PRODUCTS -COMP/OP AGG $JECT $OTHER: COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOSHIREDNON-OWNED PROPERTY DAMAGE $(Per accident)AUTOS ONLY AUTOS ONLY $ EACH OCCURRENCE $OCCUR CLAIMS-MADE AGGREGATE $ $DED RETENTION $ PER OTH-STATUTE ER E.L.EACH ACCIDENT $ E.L.DISEASE -EA EMPLOYEE $ If yes,describe under E.L.DISEASE -POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S)AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y /N N /A (Mandatory in NH) SH O ULD ANY O F THE ABO VE DESC RIBED PO LICIES BE CANC EL LED B EF ORE TH E EXPI R ATION DATE THER EO F ,N OTICE W ILL BE D EL IVER ED IN AC CO RD AN CE WITH THE PO L IC Y PR O VI SI ON S. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. T HIS C ERT IFICATE IS ISSUED AS A MATTER O F INFO RMATIO N ON LY AN D C O N FERS NO R IGH TS U PON TH E CERTIFIC ATE HO L DER.TH IS CERTIF IC ATE D O ES N OT AF F IR MATIVELY O R N EGAT IVELY AMEND ,EXTEND O R ALTER THE C OVERAGE AFFORD ED B Y TH E POLICIES BELO W.TH IS C ERTIFICATE O F INSUR AN C E D O ES N OT C ON STITUTE A CO NTRACT B ETW EEN TH E ISSUIN G IN SUR ER(S),AU THO RIZED REPRESENT ATIVE OR PROD U C ER,AN D TH E C ERTIFIC ATE HO L DER. IMPOR TANT:If th e c erti fi ca te hold er is an ADDITIO NAL IN SURED,th e policy(i e s)m us t have ADD IT ION AL IN SUR ED provisions or be endorsed. If SUB R O GAT ION IS WAIVED,s u b je ct to th e te rm s and c onditi ons o f th e p o licy,certa in p o licies m ay require an endorsem e nt.A sta te m ent on th is ce rti fi c ate does not confe r rights to th e certi fi cate hold er in lie u of s uch endorsem e n t(s ). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION ©1988-2 015 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registe red marks of ACORDACORD25(2 016/03) CERTIFICATE OF LIABILITY INSURANCE Policy Number: Eric Hom PO Box 1613 Pleasanton, CA 94566 Allen Insurance 185 Front Street, Ste. 204 Danville, CA 94526 (925)820-9090 Date Entered: (925)820-9028 City Serve of the Tri-Valley 12/28/2023 A NPP1616019A 01/26/2024 01/26/2025 3,000,000 Excluded Excluded 1,000,000 100,000 5,000 1,000,000 A NPP1616019A 01/26/2024 01/26/2025 B EIG 4602416 03 09/07/2023 09/07/2024 1,000,000 1,000,000 1,000,000 The City of Pleasanton, its officers, officials, employees and designated volunteers are to be covered as insureds in respects to liability arising out of activities performed by or on behalf of City Serve of The City of Pleasanton PO Box 520 Pleasanton, CA 94566 R. Casey Allen 25895 11512 12/28/2023 the Tri-Valley. LN Mendez nicole@alleninsurance.net A Professional E&O Liab.NPP1616019A 01/26/2024 01/26/2025 $1,000,000 $3,000,000 E&O Ea Incident E&O Aggregate United States Liability Insurance Co Employers Preferred Ins Co Docusign Envelope ID: 7731D973-D663-4223-9C8D-BF969D7E1D42