CERTIFICATE OF LIABILITY INSURANCE

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1 A CC)RLY ke CERTIFICATE OF LIABILITY INSURANCE OP ID: RG DATE (MM/DD/YYYY) 03/20/14 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 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 Alcott Insurance Agency, Inc Idaho Street Sari Diego, CA James L. DeVito INSURED San Diego County Bicycle Coalition P.O. Box San Diego, CA CONTACT NAME: (Pkirr7o, E el) : ADDRESS: PRODUCER CUSTOMER ID //: SDCBC-1 INSURER(S) AFFORDING COVERAGE INSURER A : Philadelphia Insurance Comparyl INSURER B : INSURER C : INSURER D: INSURER B: INSURER F: FAX (A/C, No): COVERAGES CERTIFICATE NUMBER: REVISION N 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. INSR ADDL SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE j i VVVQ_ POLICY NUMBER AMM/DD/YYYYL (MM/DD/YYYYI LIMITS A GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY PHPK /01/13 07/01/14 CLAIMS-MADE X OCCUR MED EXP (Any one person) 6,000 PERSONAL & ADV INJURY 1,000,000 GENT. AGGREGATE LIMIT APPLIES PER: PRO- 1 POLICY JECT LOC AUTOMOBILE LIABILITY X _ X ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-OWNED AUTOS UMBRELLA LIAB EXCESS LIAB DEDUCTIBLE OCCUR CLAIMS-MADE PHPK /01/13 07/01/14 NAIC if _ EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) 100,000 GENERAL AGGREGATE 3,000,000 PRODUCTS - COMP/OP AGO 3,000,000 COMBINED SINGLE LIMIT (Ea eccideni) 1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE RETENTION WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS' LIABILITY TORY LIMITS ER Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N/A E.L. EACH ACCIDENT (Mandatory In NH) EL. DISEASE - EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below El DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) City of San Diego, its respective elected officials, officers, employees, agents and representatives are named as additional insured per form CG Event: CicloSDias on March 30, 2014 **Revises certificate issued 03/14/14** CERTIFICATE HOLDER CANCELLATION ACORD 26(2009/09) City of San Diego Purchasing & Contracting Department 1200 Third Avenue, Ste 200 San Diego, CA CITYOFS 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 REPRESENTATIVE frow O ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD

2 POLICY NUMBER: PHPK COMMERCIAL GENERAL LIABILITY CG THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) City of San Diego, its respective elected officials, officers, employees, agents and representatives Information required to complete this Schedule, if not shown above, will be shown In the Declarations, Section II Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or In part, by your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. CO ISO Properties, Inc., 2004 Page 1 of 1 0

3 DECLARATION OF CONTRACTOR RE: AUTOMOBILE INSURANCE COVERAGE Regarding the FY 2014 Agreement [Agreement] between the City of San Diego, a municipal corporation [City] and 5 c, 1/4-1 C\4;o [Contractor], Contractor declares as follows: 1. Contractor does not currently own any vehicles; 2. Contractor has obtained, and. shall maintain during the term of the Agreement, automobile insurance coverage for "hired autos" and "non-owned autos"; and 3. In the event Contractor subsequently acquires any vehicle(s) during the term of the Agreement, the Contractor shall immediately obtain, and provide to the City the required evidence of; automobile insurance coverage for "any auto," as required in Section 12.4 of the Agreem ent. For the purpose of this Declaration, automobile insurance coverage for "any auto," "hired autos," and "non-owned autos" are defined as follows: Any Auto: Coverage is provided for any auto, including autos owned by the insured, autos the named insured hires or borrows from others, and other non-owned autos used in the insured's business. Hired Autos: Coverage is provided only for autos leased, hired, rented, or borrowed for use in the named insured's business. Non-owned Autos: Coverage is provided only for autos not owned, leased, hired, or borrowed by the named insured. Coverage includes autos owned by the insured's employees or members of their households, but only while used in the named insured's business or personal affairs. Authorized Signer Name: Board Position: Signature: Date: (.4 ave? s

4 STATE COMPENSATION INSURANCE FUND P.O. BOX 8192, PLEASANTON, CA CERTHOLDER COPY CERTIFICATE OF WORKERS' COMPENSATION INSURANCE SD ISSUE DATE: GROUP; POLICY NUMBER: CERTIFICATE 'ID; 5 CERTIFICATE EXPIRES: / CITY OF SAN DIEGO SD 202 C ST SAN DIEGO CA This Is to certify that we have issued a valid Workers' Compensation Insurance policy in a form apprdved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEP EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 1,000,000 PER OCCURRENCE. ENDORSEMENT #2066 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER SAN DIEGO COUNTY BICYCLE COALITION SD PO BOX SAN DIEGO CA [PJP,CS] (REV ) PRINTED :

5 STATE COMPENSATION INSURANCE FUND P.O. BOX 8192, PLEASANTON, CA CERTIFICATE OF WORKERS' COMPENSATION INSURANCE POLICYHOLDER COPY SD ISSUE DATE: GROUP: POLICY NUMBER: CERTIFICATE ID: CERTIFICATE EXPIRES: / CITY OF SAN DIEGO SD 202 C ST SAN DIEGO CA This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated, This policy Is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of Insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative lhowta, F President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: 1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER SAN DIEGO COUNTY BICYCLE COALITION SD PO BOX SAN DIEGO CA [PJP,CS] REV PRINTED :

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