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'ACORD CERTIFICATE OF LIABILITY INSURANCE OP ID A2 DATE (MM/DD/YYYV) MIGIN-1 02 25 09 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Cook Insurance Services ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE McDermott-Costa Co . ,Inc . HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR 276 Dolores Ave ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. San Leandro CA 94577 '. Phone: 510-352-2731 Fax: 510-352-8272 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA. Hartford F1re Ins. Co. 19682 INSURER B'. everea[ Kacional insurance co 10120 MOOre Ia.COfanO Goltsman, InC dba: MIG _ INSURER C'. xar[eord casualty insurance co 29424 800 Hearst Avenue _ INSURER D Berkeley CA 94710 INSURER E. ' C.tlVFR-C.FS 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 DOCUMEN T WITH RESPECT TO WHICH THIS CERTIFICATE MAV BE ISSUED OR MAV PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY NAVE BEEN REDUCED BY PAID CLAIMS. __.. _._- -T--_. _.. _ -_ LTR INSR TYPE OF INSURANCE POLICY NUMBER _. - --pp71E UM/DD/YY GATE MM/DD/YV LIMITS GENERAL LUIBILITY ~ I EACH OCCURRENCE $ lOOOOOO RAwnBIUTV 57UUNUN8227 A ' X 'COMMERCIAL GENE 'DAMAGE7IIRERTEO i 04/01/08 04/01/09 PREMISES (Eaoccumncel _ f _ __ 300000 ' ~~~' CLAIMS MADE j[ OCCUR ' J ~' ~ MED EXP (Any one person) $ SOOO 'I II" i ~ PERSONAL SADV INJURY f lOOOOOO --_._...__ _ I I i ~' ~ - I, GENERAL AGGREGATE __ f _ 2000000 _ - _ GEN'L AGGREGATE LIMIT APPLIES PER.' PRODUCTS-COMP/OP AGG $ 2000000 )(~ POLICY Ir~ PRO- '1~- ~ LOC ' I JECT '~ AUTOMOBILE LIABILITY I _ I ' ', COMBINED SINGLE LIMIT $ lOOOOOO ANV AUTO 57UUNUN8227 C ~ - 04/01/08 ~ 04/01/09 ', (Ea aeatlenp 1 I I ' TALL OWNED AUTOS ~ I ~' ~ BODILY INJURY f ~ SCHEDULED AUTOS ', (Per person) HIRED AUTOS '' $ '~ I ~ - , DODILV INJURY $ I }( NON-OWNED AUTOS ' , (Per accltlani) ~ - I '' PROPERTY DAMAGE $ (Per accitlenll I GARAGE LIABILITY I '. AUTO ONLY - EA ACCIDENT $ ~ ~~ ANV AUTO I ', OTHER THAN EA A~ $ ( ", ~ I ~ AUTO ONLY. AGG $ EXCES&UMBRELLA LIABILITY I - ~ EACH OCCURRENCE _ _ 8 J OCCUR _ CLAIMS MADE i, AGGREGATE - , f . _ _ _.. s I DEDUCTIBLE `~ I~ ~ ~ S - ~~ RETENTION Y ~ ~ S '~ WORKERS COMPENSATN)N AND ~ I I X TORY LIMITS L ER ~ I EMPLOYERS' LIABILITY B ANY PROPRIETOR/PARTNER/E%ECUTIVE S9000OO4S4O71 _ -_ ~I O4~OS~OS '' 0401 X09 I EL_EACH ACCIDENT _ _ _ f - _ _- lOOOOOO '', OFFICER/MEMBER EXCLUOED9 E.L DISEASE-EA EMPLOVEEI f lOOOOOO ~ H yea, tleaai W unOx SPECIAL PROVISIONS below 'EL. DISEASE-POLICY LIMIT '. f lOOOOOO OTHER '. i ' i DESCRIP710N OF OPERATIONS /LOCATIONS / VEHN:LE9 /EXCLUSIONS ADDED BV ENDORSEMENT I SPECIAL PROVISK)NS Re: MIGM20061 -Pleasnton Youth Master Plan Update. Certificate Holder, its officers, employees and agents are named additional insured per form HG00010605, including Primary Wording. Work ers Compensation Waiver of Subrogation per attached. + except 10 days for non-payment of premium. V CR I IfIVA 1 C fIVLYCR CPLEASA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL +3O DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Clty Of Pleasanton IMPOSE NO OBLIGATK)N OR LIABI TY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Maria Lara I^ 123 Main Street REPRESENTATNES. Pleasanton CA 94566 AUTHORIZED REP Tq E '~ •!`(lOn 1F HAM/D-1