CAROLLO ENGINEERS, INC. 1ST AMENDMENT (#2022348)

DocuSign Envelope ID: 8708DDEE-1 C1 F-46AB-AECF-7DB43258624D .acoRO0 CERTIFICATE OF LIABILITY INSURANCE 7/4/2024 6/29/D6/29/ATE IDDIYYYY) 2023 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 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). PRODUCER Lockton Companies CONTACT 444 W. 47th Street, Suite 900 PHONE FAX Kansas City MO 64112-1906 EAIMAI�o. Eao: Not: (816)960-9000 ADDRESS: kcasu@lockton.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Zurich American Insurance Company 16535 INSURED CAROLLO ENGINEERS, INC. INSURER B: Travelers Property Casualty Company of America 25674 1-172725 2795 MITCHELL DR. INSURER C: Allied World Surplus Lines Insurance Company 24315 WALNUT CREEK CA 94598-1601 INSURER D: INSURER E: INSURER F: COVERAGES CFRTIFICATF NIIMRFR• I 707142 RFVISInkl hit IMRPI7• vvvvvvv 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. ILTR TYPE OF INSURANCE INSO SUER POLICY NUMBER Y EFF MMI TCDD YIYY LIMITS A COMMERCIAL GENERAL LIABILITY Y Y GLO 9730569 7/4/2023 7/4/2024 EACH OCCURRENCE $ 1.000.000 _T1Sl TE CLAIMS -MADE OCCUR PREMISES (Epyyywipiiy $ 1.000,000 _ MED EXP (Any oneperson) $ 25.000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2000,000 POLICY'_ SECT Ll LOC _ PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ A AUTOMOBILE LIABILITY Iii y BAP 9730571 7/4/2023 7/4/2024 OMBINEO SINGLE LIMIT $ (Ea accident) 23000 000 X ANY AUTO BODILY INJURY (Per person) $ XXXXXXX OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ XX X HIRED NON -OWNED AUTOS ONLY X AUUTOS ONLYY PPIK ii ROPERTY DAMAGE $ XXXXXXX _L -Acctdil DED: COMPICOLL $ 1,000 B X UMBRELLA LAB J{ OCCUR N N CUP-IS956429 7/4/2023 7/4/2024 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAB CLAIMS -MADE $ XXXXXXX DED 1 1 RETENTION $ A WORKERS COMPENSATION Y. TH- X STATUTE AND EMPLOYERS' LIABILITY YIN WC 9730570 7/4/2023 7/4/2024 EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTWEE.L. OFFICERIMEMBER EXCLUDED? F_N] N I A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DEes, SCRIPTION OF OPERATIONS below C PROFESSIONAL N N 0313-9010 7/4/2023 7/4/2024 EACH CLAIM: $2,000,000; LIABILITY AGGREGATE: $2,000,000 UNLIMITED PRIOR ACTS DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City Project #21166, PEAS Treatment & Wells Rehabilitation Project. Carollo Project #: 200752. City of Pleasanton, its officers, employees and agents are additional insureds as respects general liability and this covers*.c is primary and non-contributory, as required by written contract. Waiver of subrogation applies to general liability, auto liability, and workers compensation/employer's liability where allowed by state law and as required by written contract. (SEE ATTACHED.) %.CR I Ir i%,m I C RULUCR GANIaLLA I IUN gee Attacnments 17932688 City of Pleasanton City Manager P.O. BOX 520 Pleasanton CA 94566 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT ne 19RRLon15 ACORD CORPORATION All rinhta rPCPIVPrl ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD