DocuSign Envelope ID: 729781E0-AA01-428B-B77C-EB373E6A21D3 Exhibit A1
Exhibit A1
j\c:oRcf CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
12/14/2020
THIS CERTIRCATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIRCATE DOES NOT AFRRMATIVELY 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
Arthur J. Gallagher & Co.
Insurance Brokers of OA. Inc, LIC # 0726293
3697 Mt. Diablo Blvd. Suite 300
Lafayette OA 94549
ebNfAciY
NAME:
Pv.,. 925-299-1112 hoV. 925-299-0328
ADfMEss: iamie vaudes^aiq.com
tNSURER(S) AFFORDING COVERAGE NAICtf
INSURER A: Sentinel Insurance Company Ltd 11000
INSURED SCICONS-01
SCI Consulting Group
Consequence Properties
4745 Mangels Boulevard
Fairfield CA 94534-4319
INSURERS: Gemini Insurance Company 10833
INSURER c: Market Insurance Company 38970
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1179579654 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 POUCIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR TYPE OF INSURANCE
ADDL
IN8D
SUBR
WVD POUCY NUMBER
POUCY EFF
(MM®D/YYYY)
POLICY EXP
(MM4)D/YYYY) UMITS
A X COMMERCIAL GE>IERAL LIABILITY
)E 1 X 1 OCCUR
57SBARH8313 4/20/2020 4/20/2021 EACH OCCURRENCE $2,000,000
CLAIMS-MAI
DAMAGE TO RENTED
PREMISES lEa occurrence! $1,000,000
MED EXP (Any one person) $10,000
PERSONAL & ADV INJURY $2,000,000
GEN'L AGGREGATE LIMIT APPUES PER: GENERAL AGGREGATE $4,000,000 X POLICY 1 1 ® 1 1 LOG
OTHER:
PRODUCTS - COMP/OP AGG $4,000,000
$
A AUTOMOBILE UABtUTY 57SBARH8313 4/20/2020 4/20/2021 COMBINED SINGLE LIMIT (Ea accident) $2,000,000
X
ANY AUTO BODILY INJURY (Per person)$
OWNED
AUTOS ONLY
HIRED
AUTOS ONLY
sc
AL
.HEDULED
TOS
)N-OWNED
TOS ONLY
BODILY INJURY (Per accident)$
X NC
AL
PROPERTY DAMAGE
(Per accident) $
$
A X UMBRELJJVUAB
EXCESS UAB
X OCCUR
CLAIMS-MADE
57SBARH8313 4/20/2020 4/20/2021 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000
DED RETENTIONS $
c WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY y/N
ANYPROPRIETOR/PARTNER/EXECUTIVE | 1
OFFICEFVMEMBEREXCLUDED?
(Mandatory In NH) '
II yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
MWC000353310 4/20/2020 4/20/2021 y PER OTH-
STATUTE ER
EL. EACH ACCIDENT $1,000,000
E.L. DISEASE - EA EMPLOYEE $1,000,000
EL. DISEASE - POLICY LIMIT $1,000,000
B Service & Technical Professional
Uabillty • Claims Made
Retroactive Date: 12/17/1998
VCPL066555 12/17/2020 12/17/2021 Each Claim
Aggregate
Deductible
$2,000,000
$2,000,000
$25,000
description OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, AddlUcnal Remaifcs Schedule, may be attached If more space Is recjulred) Excess Liability coverage Is in excess of General Liability and Auto Liability Only The City of Alameda, its City Council, boards, commissions, officials, employees, and volunteers are included as additional insured per policy form SS0008 0405 attached. Primary & Non-Contributory Wording and Waiver of Subrogation for General Liability per attached form SS00080405. Workers Compensation Waiver of Subrogation per form WO 04 03 06 attached.
Written contract required.
10 Days Notice of Cancellation
City of Alameda
public Works Department
Alameda Point, Building 1
950 West Mali Square, Room 110
Alameda CA 94501-7558
USA
1 SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POUCY PROVISIONS.
AUTHORIZED REPRESENTATIVE
ACORD 25 (2016/03)
© 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
2* of 57 952
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