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DocuSign Envelope ID: E9C36B8D-E90E-4CE7-9DA5-BF39B42482B9
<br />ACCDOR" CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MMIDD/YYYY)
<br />5/8/2024
<br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
<br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
<br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
<br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
<br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed.
<br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on
<br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s).
<br />PRODUCER
<br />Andreini & Company -San Mateo
<br />220 West 20th Ave
<br />San Mateo CA 94403
<br />CONTACT
<br />NAME: Colleen Bradley
<br />PHONE FAX
<br />/c No Ext : 650-378-4283 A/C No): 650-378-4361
<br />WC,
<br />ADMDRESS: cbradley@andreini.com
<br />INSURER(S) AFFORDING COVERAGE
<br />NAIC #
<br />INSURER A: Indian Harbor Insurance Co.
<br />36940
<br />INSURED BAYCI-6
<br />Bay Cities Paving & Grading Inc.
<br />1450 Civic Ct, Bldg B, Ste 400
<br />INSURER B: Travelers Prop Cas Co of Amer
<br />25674
<br />INsuRERc: HDI Specialty Insurance Co.
<br />16131
<br />INSURERD:
<br />Concord CA 94520
<br />INSURER E :
<br />INSURER F :
<br />COVERAGES CERTIFICATE NUMBER:695102453 REVISION NUMBER:
<br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
<br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
<br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
<br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
<br />INSR
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />SUBR
<br />POLICYNUMBER
<br />POLICY EFF
<br />MM/DD/YYYY
<br />POLICY EXP
<br />MM/DDIYYYY
<br />LIMITS
<br />B
<br />X
<br />COMMERCIAL GENERAL LIABILITY
<br />Y
<br />VTC2JC03K990282TIL23
<br />10/1/2023
<br />10/1/2024
<br />EACH OCCURRENCE
<br />$2,000,000
<br />CLAIMS -MADE � OCCUR
<br />DAMAGE S(RENTED
<br />PREMISES Ea occurrence)
<br />$ 300,000
<br />MED EXP (Any one person)
<br />$ 5,000
<br />PERSONAL &ADV INJURY
<br />$2,000,000
<br />GENT
<br />AGGREGATE LIMIT APPLIES PER:
<br />GENERAL AGGREGATE
<br />$ 4,000,000
<br />POLICY PRO-
<br />JECT LOC
<br />PRODUCTS -COMP/OPAGG
<br />$4,000,000
<br />Employee Benefits
<br />$ 1,000,000
<br />OTHER:
<br />B
<br />AUTOMOBILE
<br />LIABILITY
<br />Y
<br />VTC2JCAP3K990294TIL23
<br />10/1/2023
<br />10/1/2024
<br />COMBINED SINGLE LIMIT
<br />Ea accident
<br />$2,000,000
<br />X
<br />BODILY INJURY (Per person)
<br />$
<br />ANY AUTO
<br />OWNED SCHEDULED
<br />AUTOS ONLY AUTOS
<br />BODILY INJURY (Per accident)
<br />$
<br />PROPERTY DAMAGE
<br />Per accident
<br />$
<br />HIRED NON -OWNED
<br />AUTOS ONLY AUTOS ONLY
<br />I
<br />$
<br />Hired Auto
<br />C
<br />UMBRELLALIAB
<br />X
<br />OCCUR
<br />CLXD6193700S
<br />10/1/2023
<br />10/1/2024
<br />EACH OCCURRENCE
<br />$5,000,000
<br />X
<br />AGGREGATE
<br />$ 5,000,000
<br />EXCESS LIAB
<br />CLAIMS -MADE
<br />DED RETENTION $
<br />$
<br />E
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />UB9N1787002325D
<br />10/1/2023
<br />10/1/2024
<br />X PER OTH-
<br />STATUTE ER
<br />E.L. EACH ACCIDENT
<br />$ 1,000,000
<br />ANYPROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICERIMEMBER EXCLUDED? ❑
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE
<br />$ 1,000,000
<br />(Mandatory in NH)
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />I
<br />I E.L. DISEASE - POLICY LIMIT
<br />$ 1,000,000
<br />A
<br />Pollution Legal Liab
<br />CE07421667
<br />10/1/2023
<br />10/1/2024
<br />Each Claim
<br />1,000,000
<br />Aggregate
<br />2, 000, 000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />RE: BCPG Job #4216 1 Hopyard Road & Owens Drive Intersection Improvements 1 CIP No. 15525
<br />City of Pleasanton, members of the City Council and their agents, servants and employees, is included as Additional Insured including Waivers of Subrogation
<br />apply with respect to General & Auto Liability as required by written contract. 30 Days' Notice of Cancellation applies per policy provisions.
<br />CERTIFICATE HOLDER CANCELLATION
<br />SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />City of Pleasanton
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />Attn: Public Works, Engineering
<br />AUTHORIZED REPRESENTATIVE
<br />P.O. Box 520
<br />Pleasanton CA 94566-0802
<br />©1988-2015 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
<br />
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