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18-131 HNTB, Fencing for the Don Burnett Bicycle Footbridge DATE (MM/DD/YYYY) 12/03/2018 CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT 1-913-982-3650 PRODUCER Business Insurance Manager NAME: IMA, Inc. FAX PHONE 816-527-2511816-472-4060 (A/C, No): (A/C, No, Ext): E-MAIL businessinsurancemgr@hntb.com ADDRESS: 51 Corporate Woods 9393 W. 110th Street, Suite 600 INSURER(S) AFFORDING COVERAGENAIC # Overland Park, KS 66210 LIBERTY INS CORP42404 INSURER A : INSURED Liberty Mutual Fire Insurance Co. 23035 INSURER B : HNTB Corporation Liberty Mutual Insurance Corp 23035 INSURER C : INSURER D : 1735 Technology Drive, Suite 650 INSURER E : San Jose, CA 95110 INSURER F : 54679830 COVERAGESCERTIFICATE NUMBER:REVISION NUMBER: 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. ADDLSUBR INSRPOLICY EFFPOLICY EXP TYPE OF INSURANCELIMITS POLICY NUMBER LTR(MM/DD/YYYY)(MM/DD/YYYY) INSDWVD COMMERCIAL GENERAL LIABILITY AXTB7-641-433035-21901/01/20 01/01/191,000,000 EACH OCCURRENCE$ DAMAGE TO RENTED X 1,000,000 CLAIMS-MADEOCCUR$ PREMISES (Ea occurrence) 10,000 MED EXP (Any one person)$ 1,000,000 PERSONAL & ADV INJURY$ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE$ PRO- XX 2,000,000 POLICYLOCPRODUCTS - COMP/OP AGG$ JECT $ OTHER: COMBINED SINGLE LIMIT BAS2-641-433035-20901/01/20 01/01/19 AUTOMOBILE LIABILITY$ 2,000,000 (Ea accident) ANY AUTO X BODILY INJURY (Per person)$ OWNEDSCHEDULED BODILY INJURY (Per accident)$ AUTOS ONLYAUTOS NON-OWNED HIREDPROPERTY DAMAGE $ (Per accident) AUTOS ONLYAUTOS ONLY $ UMBRELLA LIAB EACH OCCURRENCE$ OCCUR EXCESS LIAB CLAIMS-MADEAGGREGATE$ $ DEDRETENTION$ PEROTH- WORKERS COMPENSATION X CWA7-64D-433035-66901/01/1901/01/20 STATUTEER AND EMPLOYERS' LIABILITY Y / N 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT$ N N / A OFFICER/MEMBER EXCLUDED? 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE$ If yes, describe under 1,000,000 E.L. DISEASE - POLICY LIMIT$ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Don Burnett Bicycle Footbridge Routine Inspection If required by a written agreement, the City of Cupertino, its City Council, boads and commissions, officers, employees and volunteers are additional insureds as respects general liability and automobile liability, subject to the terms, conditions and exclusions of the policies, and shall be considered primary insurance as respects the additional insureds and any other insurance or self-insurance maintained by the additional insureds shall be excess of this insurance and shall not contribute with it. If required by a written agreement, the insurers waive their rights of subrogation in favor of the City of Cupertino as respects general and automobile liability and workers' compensation, subject to the terms, conditions and exclusions of the policies. CERTIFICATE HOLDERCANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Cupertino ACCORDANCE WITH THE POLICY PROVISIONS. Rogert Lee 10300 Torre Avenue AUTHORIZED REPRESENTATIVE Cupertino, CA 95014 USA © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03)The ACORD name and logo are registered marks of ACORD ktoyne 54679830