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SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br />ACCORDANCE WITH THE POLICY PROVISIONS.
<br />INSURER(S) AFFORDING COVERAGE
<br />INSURER F :
<br />INSURER E :
<br />INSURER D :
<br />INSURER C :
<br />INSURER B :
<br />INSURER A :
<br />NAIC #
<br />NAME:CONTACT
<br />(A/C, No):FAX
<br />E-MAILADDRESS:
<br />PRODUCER
<br />(A/C, No, Ext):PHONE
<br />INSURED
<br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES
<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 />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 />OTHER:
<br />(Per accident)
<br />(Ea accident)
<br />$
<br />$
<br />N / A
<br />SUBR
<br />WVD
<br />ADDL
<br />INSD
<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 />$
<br />$
<br />$
<br />$PROPERTY DAMAGE
<br />BODILY INJURY (Per accident)
<br />BODILY INJURY (Per person)
<br />COMBINED SINGLE LIMIT
<br />AUTOS ONLY
<br />AUTOSAUTOS ONLY
<br />NON-OWNED
<br />SCHEDULEDOWNED
<br />ANY AUTO
<br />AUTOMOBILE LIABILITY
<br />Y / N
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY
<br />OFFICER/MEMBER EXCLUDED?
<br />(Mandatory in NH)
<br />DESCRIPTION OF OPERATIONS below
<br />If yes, describe under
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />$
<br />$
<br />$
<br />E.L. DISEASE - POLICY LIMIT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. EACH ACCIDENT
<br />EROTH-STATUTEPER
<br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />EXCESS LIAB
<br />UMBRELLA LIAB $EACH OCCURRENCE
<br />$AGGREGATE
<br />$
<br />OCCUR
<br />CLAIMS-MADE
<br />DED RETENTION $
<br />$PRODUCTS - COMP/OP AGG
<br />$GENERAL AGGREGATE
<br />$PERSONAL & ADV INJURY
<br />$MED EXP (Any one person)
<br />$EACH OCCURRENCE
<br />DAMAGE TO RENTED $PREMISES (Ea occurrence)
<br />COMMERCIAL GENERAL LIABILITY
<br />CLAIMS-MADE OCCUR
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />POLICY PRO-JECT LOC
<br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY)
<br />CANCELLATION
<br />AUTHORIZED REPRESENTATIVE
<br />ACORD 25 (2016/03)
<br />© 1988-2015 ACORD CORPORATION. All rights reserved.
<br />CERTIFICATE HOLDER
<br />The ACORD name and logo are registered marks of ACORD
<br />HIRED
<br />AUTOS ONLY
<br />8/3/2026
<br />Cavignac
<br />451 A Street,Suite 1800
<br />San Diego CA 92101
<br />Certificate Department
<br />619-234-6848 619-234-8601
<br />certificates@cavignac.com
<br />Beazley America Insurance Company,Inc.16510
<br />SANDCIV-01 The First Liberty Insurance Corporation 33588SandisCivilEngineersSurveyorsPlanners
<br />3007 Douglas Boulevard,Suite 105
<br />Roseville,CA 95020
<br />Liberty Insurance Corporation 42404
<br />Liberty Mutual Fire Ins Co
<br />Liberty Mutual Group 51116
<br />1218248853
<br />D X 1,000,000
<br />X 1,000,000
<br />15,000
<br />X XCU Included 1,000,000
<br />2,000,000
<br />X
<br />Y Y TB2Z91482050026 3/3/2026 3/3/2027
<br />2,000,000
<br />B 1,000,000
<br />X
<br />Y Y AS6Z91482050016 3/3/2026 3/3/2027
<br />C X X 7,000,000TH7Z914820500563/3/2026 3/3/2027
<br />7,000,000
<br />X 0
<br />E XYWC2Z914820500363/3/2026 3/3/2027
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />A Professional Liability C36AB6260301 3/3/2026 3/3/2027 Each Claim
<br />Aggregate
<br />$5,000,000
<br />$7,000,000
<br />RE:SANDIS Project Number/Name:#MA101 /Design Professional Service Agreement.Additional Insured coverage applies to General Liability and
<br />Automobile Liability for City of Pleasanton,its officers,employees and agents per policy form.Primary coverage applies to General Liability and Automobile
<br />Liability per policy form.Waiver of subrogation applies to General Liability,Automobile Liability,and Workers Compensation per policy form.Excess/Umbrella
<br />policy follows form over underlying policies:General Liability,Auto Liability &Employers Liability (additional insured and waiver of subrogation apply when
<br />afforded on underlying policies).Professional Liability -Claims made form,defense costs included within limit.If the insurance company elects to cancel or
<br />non-renew coverage for any reason other than nonpayment of premium,they will provide 30 days’notice of such cancellation or nonrenewal.
<br />City of Pleasanton
<br />Attn:Engineering Department
<br />P.O.Box 520
<br />Pleasanton CA 94566
<br />Docusign Envelope ID: 5D3CCE19-B708-80B8-82CF-86F56E0B2B92
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