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4LEAINC-01 RICRFI
<br />/AICORO•
<br />V CERTIFICATE OF LIABILITY INSURANCE
<br />DATE (MM/DDM'YY)
<br />F 4/11/2016
<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 be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />PRODUCER License # OC41366
<br />Granite Professional Insurance Brokerage, Inc.
<br />6600 Koll Center Parkway #100
<br />Pleasanton, CA 94566
<br />CONTACT
<br />NAME: Stacy Rice
<br />PHONE F°x
<br />A/c No Etl: (925 ) 462-8400 A/c No : (925) 462-8888
<br />E-MAIL
<br />SS: Brice@graniteins.com
<br />INSURERS AFFORDING COVERAGE NAIC #
<br />INSURER A: Travelers Indemnity Co of Con 25682
<br />INSURED
<br />4LEAF, Inc.
<br />2110 Rheem Drive, Ste. A ✓
<br />Pleasanton, CA 94588
<br />INSURER B: American Fire & Casualty I R 1 24066
<br />INSURER C: National Union Fire Ins. Co PAI A 19445
<br />INSURER 0: State Compensation Ins. Fund 35076
<br />INSURER E: Evanston Insurance 35378
<br />INSURER F:
<br />I "V=Mf "nm I.PKIIFII=YIF NIIeaKFll• WG\/lwlflwl MIIKaOCO.
<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 INSURANCEADOLSUOR
<br />ISD
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MWDD
<br />POLICY EXP
<br />MM/DD
<br />LIMITS
<br />A
<br />X COMMERCIAL GENERAL LIABILITY
<br />CLAIMS -MADE OCCUR
<br />X
<br />X
<br />68080544948
<br />04/09/2016
<br />04/09/2017
<br />EACH OCCURRENCE $ 2,000,00
<br />PREMISES occurrence) $ 300,000
<br />MED EXP (Any one person) $ 5,00
<br />PERSONAL & ADV INJURY $ 2,000,00
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />X POLICY JECT � LOC
<br />GENERAL AGGREGATE $ 4,000,00
<br />PRODUCTS - COMP/OP AGG $ 4,000,00
<br />B
<br />OTHER:
<br />AUTOMOBILE LIABILITY
<br />X ANY AUTO
<br />X
<br />BAA(17)5"W228 ✓
<br />04/09/2016
<br />04/09/2017
<br />$
<br />COMBINED SINGLE LIMIT
<br />Ea accident $ 1,000,00
<br />BODILY INJURY (Per person) $
<br />ALL UTOOS SCHEDULED
<br />BODILY INJURY (Per accident) $
<br />HIRED AUTOS NON -OWNED
<br />AUTOS
<br />PROPERTY DAMAGE $
<br />Per accident
<br />X
<br />UMBRELLA LIAB
<br />X
<br />OCCUR
<br />EACH OCCURRENCE $ 5,000,000
<br />C
<br />EXCESS LIAB I
<br />CLAIMS -MADE
<br />EBU018256930
<br />04/09/2016
<br />04/09/2017
<br />AGGREGATE $ 5,000,00 0
<br />DED RETENTION $
<br />D
<br />WORKERS COMPENSATIONPER
<br />AND EMPLOYERS' LIABILITY Y / N
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />OFFICER/MEMBER EXCLUDED? �
<br />N / A
<br />9009868
<br />04/09/2016
<br />04/09/2017
<br />OTH-
<br />X STATUTE ER
<br />E.L. EACH ACCIDENT $ 1,000,000•
<br />E.L. DISEASE - EA EMPLOYE $ 1,000,00
<br />(Mandatory in NH)
<br />If yes, describe under
<br />E.L. DISEASE - POLICY LIMIT 1 $ 1,000,00
<br />DESCRIPTION OF OPERATIONS below
<br />E
<br />Professional Liab
<br />MAX7PL0002190
<br />04/11/2016
<br />04/11/2017
<br />Each Claim 2,000,000
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space is required)
<br />City of San Leandro, its officers, officials, employees, and volunteers are named as Additional Insureds on General Liability policy and Automobile Liability
<br />policy as per attached endorsements CGD3810907 and CA 88100113. Primary and Non -Contributory applies to General Liability policy as per attached
<br />endorsement CGD3810907. Waiver of Subrogation applies to General Liability policy as per attached endorsement CGD3810907.
<br />���iYL (i/Z�IvLty 5�
<br />City of San Leandro Division of Building and
<br />Safety Services ✓/
<br />835 East 14th Street '
<br />San Leandro, CA 94577
<br />t;ANt;tLLA I IUN
<br />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 />AUTHORIZED REPRESENTATIVE /
<br />©1988-2014 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
<br />
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