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15-122 Corinthian Decorative Finishes for Repair of floor in McClellan Ranch Environmental Education CenterDATE CERTIFICATE OF LIABILITY INSURANCE 7/31/ 0157/31/2015 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(les)must 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). PRODUCER CONTACT NAME:Heather Ricks Citadel Insurance Services,LC PHONE:801-610-2715 FAX:801-610-2701 826 E State Rd,Suite 100 EMAIL ADDR:hricks@citadelus.com American Fork,UT 84003 INSURERS AFFORDING COVERAGE NAIC INSURERA:Western Heritage Insurance Company 37150 INSURED INSURER B: Gregory Dixon INSURERC: Corinthian Decorative Finishes INSURER D:- 2184 Sutter St. #266 INSURER E: San Francisco,CA 94115 INSURER F: COVERAGES CERTIFICATE 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITSLTRINSRWVDMM/DDNYYY MM/DD/YYYY GENERAL LIABLITY SCP0967402-0345 1/14/2015 1/14/2016 EACH OCCURRENCE 1,000,000 X COMMERCIAL GENERAL LIABILITY X X DAMAGE TO RENTED PREMISES $50,000EAOCCURRENCE A CLAIMS-MADE F7X OCCUR MED EXP(ANY ONE PERSON) $5,000 PERSONAL&ADV INJURY 1,000,000 GENERAL AGGREGATE 3,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG 3,000,000 X POLICY PROJECT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident ANY AUTO BODILY INJURY(Per Person) ALL OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE(Per accident) AUTOS UMBRELLA OCCUR EACH OCCURRENCE LIAB EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION$ WORKERS COMPENSATION AND WC Statutory OTHER EMPLOYER'S LIABILITY Y/N LIMITS ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L.EACH ACCIDENT Mandatory in NH) E.L.DISEASE—EA EMPLOYEE If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE—POLICY LIMIT DESCRIPTION OF OPERATION I LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Operations necessary and incidental to decorative painting,decorative plastering,and wall stenciling.Coverage provides$10,000 Per Claim,to a$25,000 Aggregate Limit,for Client's property in the care,custody,and control of the IDAL Members. Additional Insured coverage is automatically provided to contractors when required in construction agreement with insured:City of Cupertino Public Works Projects,Manager 10300 Torre Ave.Cupertino,CA 95014,with Waiver of Subrogation,per attached endorsement. CERTIFICATE HOLDER CANCELLATION Attention:Carmen Lynaugh SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCALLED City of Cupertino BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL'•BE DELIVERED IN Public Works Projects Manager ACCORDANCE WITH THE POLICY PROVISIONS. 10300 Torre Avenue Cupertino,CA 95014 AUTHORIZED REPRESENTATIVE Anthony Eardley Western Heritage Insurance Company ATTACHED TO AND ENDORSEMENT EFFECTIVE DATEFORMINGAPARTOF NAMED INSURED AGENT NO. POLICY NUMBER 12:01 A.M.STANDARD TIME) SCP 0 9 6 74 0 2 08/01/20 14 Participating Members of the Stencil Artisans League,Inc 43050 The above information is required only when this endorsement is issued subsequent to preparation of the policy.) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS-AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ' This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II Who Is An Insured is amended to in- of, or the failure to render, any professional clude as an additional insured any person or organi- architectural, engineering or surveying services, zation for whom you are performing operations when including: you and such person or organization have agreed in a. The preparing, approving, or failing to prepare writing, and executed such a contract or agreement or approve, maps, shop drawings, opinions, prior to the time of an occurrence giving rise to a reports, surveys, field orders, change orders claim, that such person or organization be added as or drawings and specifications; and an additional insured on your policy. Such person or organization is an additional insured only with respect b. Supervisory, inspection, architectural or engi- to liability for "bodily injury," "property damage" or neering activities. personal and advertising injury" caused, in whole or in part, by: 2. "Bodily injury" or ,"property damage" occurring after: 1. Your acts or omissions; or a. All work, including materials, parts or equip- 2. The acts or omissions of those acting on your ment furnished in connection with such work, behalf; on the project (other than service, mainte- in the performance of your ongoing operations for the nance or repairs) to be performed by or on additional insured. behalf of the additional insured(s) at the site of the covered operations has been complet- B. With respect to the insurance afforded to these addi- ed; or tional insureds, the following additional exclusions b. That portion of"your work"out of which the in- apply: jury or damage arises has been put to its in- This insurance does not apply to: tended use by any person or organization 1. "Bodily injury," "property damage" or "personal other than another contractor or subcontrac- and advertising injury" arising out of the rendering for engaged in performing operations for a principal as a part of the same project. 08/01/2014 AUTHORIZED REPRESENTATIVE DATE Includes copyrighted material of ISO Properties,Inc.,with its permission. Copyright,ISO Properties,Inc.,2004 WHI 21-0517(07-08) Western Heritage Insurance Company ATTACHED TO AND ENDORSEMENT EFFECTIVE DATEFORMINGAPARTOF ( 12;01 A.M.STANDARD TIME) NAMED INSURED AGENT NO. POLICY NUMBER SCP 0 9 6 74 0 2 08/01/2014 Participating Members of the Stencil Artisans League,Inc 43050 The above information is required only when this endorsement is issued subsequent to preparation-of the policy.) THIS ENDORSEMENT CHANGES'THE POLICY. PLEASE READ IT CAREFULLY. LIMITED WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV— COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against an additional insured shown on form WHI 21-0479 or WHI 21-0516 but only with respect to liability for"bodily injury,""property damage"or"personal and ad- vertising injury"caused by: 1. The named insured's acts or omissions;or 2. The acts or omissions of those acting on the named insured's behalf; in the performance of the named insured's ongoing operations for the additional insured shown on form WHI 21-0479 or WHI 21-0516. All other Terms and Conditions of this Policy remain unchanged. 08/01/2014 AUTHORIZED REPRESENTATIVE DATE Includes copyrighted material of ISO Properties,Inc.,with its permission. Copyright,ISO Properties,Inc.,1992,2003 WHI 21-0493(08-08) 0/ M' t 1 U=K 111-ItrA I t U1- LIABI L1 I Y 1 NS U KANU: 07/28/2014 THIS SCERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THISHEPOLICES CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,.EXTEND OR ALTER THE COVERAGE AFFOR UED RER S TAUTHORIZIED BELOW. THIS CERTIFICATE OF INSURANCE DOES NOUTE A CONTRACT BETWEEN THE ISSUING INS REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. e pollcy(ies) must be endorsed. if ATION IS AIVED,subject to IMPORTANT: If the certificate holder is an ADDITIONAL INSURireED, endorsement. A statement o this certificatedoes not confer rights to the the terms and conditions of the policy,certain policies may req certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Antonio Guadarrama Rock 10 insurance Services PHONE o E>d:866-376-2510 FAX No):866-376-2511. P.O.Box 15608 E-MAIL San Diego,CA 92175 ADDREss:Antonio rock14insurance.com Antonio Guadarrama INSURER S)AFFORDING COVERAGE NAIC# INSURER A• Everest National Insurance Co. 10120 INSURED Corinthian Decorative Finishes INSURER B: Gregory Dixon INSURER C 2184 Sutter Street STE 266 San Francisco,CA 94115 INSURER D: INSURER E INSURER F COVERAGES CERTIFICATE 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 THISCERTIFICATEMAYBEISSUEDORMAYPERTAIN,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. INSR ADDL SUB POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMMR MMIDD GENERAL LIABILrrY EACH OCCURRENCE DAMAGE COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS-COMP/OP AGG $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO LOCJECT COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON-OWNED PER ACCIDENT HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DEDRETENTION$ WC STATU- OTH- WORKERS COMPENSATION TORY LIMITS ER AND EMPLOYERS'LIABILITY 7600013492141 07/29/2014 07/29/2015 E.L.EACH ACCIDENT 1,000,00 A OFFICERIMEMBER EXCLUDED? ECUTIVE Y N/A 1,000,00E.L.DISEASE-EA EMPLOYE $ Mandatory in NH) 1,000,00 If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) This document is for proof of coverage and/or bidding purposes only. Owner(s) excluded from WC coverage. CERTIFICATE HOLDER CANCELLATION PROOFOF SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Proof of Insurance ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 1 Antonio Guadarrama 1988-2010 ACORD CORPORATION. All rights reserved. rna: r nc .. Aub folic #:A3052580 Al Liberty_%4uEu-d COMPIMY s T w Agent-Information t_ Customer Information g Gregory Dixon BLUNCBLACIUIELD-IS - C 2283 Jackson.St 2 Trt IN PEAKS BLVD San Francisco;-CA.94115-1320 SAN FRANCISCO, CA 9411 4 Date Prepared..08i07/20I4 Phone Number:(415) 665-1440 Emil:blumblack2 xgn-ail, oni Policy Pei-iod.:05-107(2014 to 08l07f2015 Agent x:15®65 2004 V o1v VEHICLE COVERAGES Limits/.Deductibles V70 Fwd Bodily injury.Liability SO;000 pei person X269.50 100,000 per accident Property Damage Liability 50;000 per accident 243.50 Medical Payments 5,000 per.person 31:40 UninsurecUUnderinsured.Motorist Bodily Injury$50,000 per:person 71.20 100;000 per.accident Comprehensive 5250 vdfull glass 111.90 Collision 250 539,30 Waiver of Collision-Deductible Yes 20.60 Lass of Use 30 per clay 24.20 Anti-Fraud Fee Yes 1.60 Total Vehicle Premiums 1;313.20 DISCOUNTS SAIF ECO SAFETY. REWARDS Highly Educated Workers Good.Driver Account- Home Superior Good Driver Passive Restraint PREMIUMSUNIMARY Pi•erniunj Vehicle Coverages 1;313.2 0 Discounts& Safeco Safety Rewards Included orar total policy premium for 12 months-is 1931.3.20 Binder:Coverage is hound from the effective date listed above.The formai policy will supersede this.bimer.If you do not receive your policy within 30 days,please contact your independent Safeco agent. Safeco Insurance Company of America 1_