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Home My WebLink AboutCity Rise, LLC 06.23.2026Iqr' THIS CERTIFICATE IS ISSUE AS A MATTER OF INFORMATION OI L CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND BELOW'. THIS CERTIFICATE OF INSURANCE DOtS NOT CONSTITU REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. .. . ...... .. JIM.PORTANT-* If the certificate holder Is an ADDITIO . NAL INSURED,, the If SUBROGATION IS WAIVEI)j subject to theterms 4nd conditions of ti this. rt I+ does nod confor rig hts. to the certificate holder IIS II of s PRODUCER AssuredPartners of California Insurance Servioes, LLC 1425 River Park Drive, Suite 226 Sacramento CA 95815 OM0776' INSURED CityRise,t LLC 686 E. Lo:6'keford Street Irl' ,CA 95240 E"I'l L I T Y I NPOSW A N C*0 E" DAT E (MMIDDIYYYY) 6/2312026 AND CONFERS NO RIGHTS UPON THE CERTIFIrCATE HOLDER. THIS EXTEND OR ALTER SHE HE COVERAGE AFFORDED BY THE POLICIES rE A CONTRACT BETWEEN THE ISSUING INSURIER(S), AUTHORIZED . ....... ....... .. ...... . .. ... .... — . . . . . . )ollcy(les) must have ADDITIONAL INSURED provisions. or be endorsod. ie policy, coram, policies- may require an endorsement. A statement on ich. endorsement(s)., ,Am Certificate Team PHONE 92700 XX 93 - 916-993-2683 916A&jN AIL cartificates.sweramento@ ORF -SS: _,gssq.redPartners.com PERSONAL &,. DV' INJURY $1100104000 INSURER A Admiral Ins, Co 24856 INSURES 8 StarStone National Incur snqeCompany__, 25406 IN,SUFMR C :_..Q8E Specift InsuranceCompany 11516 iNsuggn p Li!je, itual Flre Ins yrance Company 23035 8,GA800002262POO 181-25/2'026 6/23/2,027 WA- X A -NY Au'ro Nil $ COVERAGE$ ERTI 'IC "E.NUMOSER19 20,57592322 I, I 0111kin THIS IS TO CERTIFY THAT THE POLICIES OF IN SURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR INDICATED,NQTW1ITH$TAND-ING ANY REOUIREMENT, TERM -OR CONDITION OF ANY CONTRACT OR OTHER MAS CERTIFICATE BE ISSUED OR. MAY PERTAINO THE INSURANCE AFFORDED BY THE POLICIES DESORJF3��E-, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY FI BEEN REDUCED BY PAID CLAIME'E _j 1F. %_01P po" TYPEOFINSURANCE 0 w"POLICY NUMSER f MID /Y I Y) IRNA a X COMMERCIAL GENERAL LIABILITY y y SGL000022.62POO: 6,1251202re 6/2 "027r .5/2 F—v-1 CLAIMS -MADE J_ OCCUR UMBRELLA LIAO X OCCUR 142604098 61,25/2.1.026 6125/2027 EXCESS UAS r.1_,A1Mq.MADP AND OMPLOYERSf LIABILITY Y/N ANYPROPMETO F11PA1' 5TNE EXECUTIVE N /A ,OP,r!CE'R/M-EMBEFt,C,XCLUD'ED? El (Mandatory 1h NH-) If yes., describe under A I ProNs'sional. Llabili'ty, D Equipment'Floater 8 awilness Auto E000003473611 0/25PZ026 6/25/2027 Y=91465991016 6125/2026 6/25/2027 800000022.62POO 1 0/2,5/2020 8/2512027 DESCRIPTION OF OPERATION$ / 1.00ATIONS I VEHICLES (ACOAD 10%, Additional Remarks Sobedule, may baratftehed It more space Is re-qrUl Cyber Liability, - Car ier: Admiral Ins, Co 1 6 $25,000 1 ri , - NIAC 4: 24866,�- Poky #VWV86001389 - Effective:; /25/2026 - 6/25/2( a 'urance Company - NIAC * 37974 - Policy #EGLOO14474 - Effective: 6� PoIrlUtion Liability - C wrier: Mt. HaWley InrS $5,000,000 - Aggregate Limit: $5 000 0100 : RE:Encroachment Permit. Auto Lla6ili� Additional* Insured applies pe�r terms and conditions of the attached end( ;a p1plies.. per terms and on i` of the attached endorserrhent, Auto, Liability Wgiver of Subrogation apglles pertf ons en.dorsement, General Liability Additional Insured applies oer terms and condit'of the a 86e Attached,-... j rsement( 71", ERTIFICATE HOLDER CAKELLATION [*JaTJ�"*j 1:01 IN w1v ".D- NAMED ABOVE FOR THE POLICY PERIOD )00UMC_:rN`T WITH RESPECT �ro WHICH THIS D, HEREIN IS: SUBIJECT TO ALL. THE TERMS, EACH OCCURRENCE $ 1 1000t000 GEN'L AGGREGATE LIMIT APPLIES e POLK."Y 'T IK LOG 2, vrw.a$1vi0-0,000 MED EXP (Any _onepLrLo t, PERSONAL &,. DV' INJURY $1100104000 GENERAL AGGREGATE $. 100�000 PRODUCTS - OOMKOP ACpCi_12,Q 0 ---------- -------- AUTOMILE LI.ABILITY OB y y 8,GA800002262POO 181-25/2'026 6/23/2,027 WA- X A -NY Au'ro BODILY INJURY (Per awident) $ 4. Y'DAMAGE OWNED SO'HEDULED P1,00111slowDed. )001$5 Von EACH OCCURRENCE AUTO$ ONLY .,0 Aw I Q,5 AGGREGATE $209 000 _ HIRED NON -OWNED .......... . ....... I'll _._J_gL'TUTE E - AUTOS;rONLY AUTOS ONLY R.L. EACH ACCIDENT $ E.I.. DISEASE EA EMPLOYEE UMBRELLA LIAO X OCCUR 142604098 61,25/2.1.026 6125/2027 EXCESS UAS r.1_,A1Mq.MADP AND OMPLOYERSf LIABILITY Y/N ANYPROPMETO F11PA1' 5TNE EXECUTIVE N /A ,OP,r!CE'R/M-EMBEFt,C,XCLUD'ED? El (Mandatory 1h NH-) If yes., describe under A I ProNs'sional. Llabili'ty, D Equipment'Floater 8 awilness Auto E000003473611 0/25PZ026 6/25/2027 Y=91465991016 6125/2026 6/25/2027 800000022.62POO 1 0/2,5/2020 8/2512027 DESCRIPTION OF OPERATION$ / 1.00ATIONS I VEHICLES (ACOAD 10%, Additional Remarks Sobedule, may baratftehed It more space Is re-qrUl Cyber Liability, - Car ier: Admiral Ins, Co 1 6 $25,000 1 ri , - NIAC 4: 24866,�- Poky #VWV86001389 - Effective:; /25/2026 - 6/25/2( a 'urance Company - NIAC * 37974 - Policy #EGLOO14474 - Effective: 6� PoIrlUtion Liability - C wrier: Mt. HaWley InrS $5,000,000 - Aggregate Limit: $5 000 0100 : RE:Encroachment Permit. Auto Lla6ili� Additional* Insured applies pe�r terms and conditions of the attached end( ;a p1plies.. per terms and on i` of the attached endorserrhent, Auto, Liability Wgiver of Subrogation apglles pertf ons en.dorsement, General Liability Additional Insured applies oer terms and condit'of the a 86e Attached,-... j rsement( 71", ERTIFICATE HOLDER CAKELLATION [*JaTJ�"*j 1:01 IN w1v ".D- NAMED ABOVE FOR THE POLICY PERIOD )00UMC_:rN`T WITH RESPECT �ro WHICH THIS D, HEREIN IS: SUBIJECT TO ALL. THE TERMS, EACH OCCURRENCE $ 1 1000t000 2, vrw.a$1vi0-0,000 MED EXP (Any _onepLrLo t, PERSONAL &,. DV' INJURY $1100104000 GENERAL AGGREGATE $. 100�000 PRODUCTS - OOMKOP ACpCi_12,Q 0 COMj�Maa. Me BINED.81 L LIMI $ It 0001.000 13001LYINJURYi erpars on) $ BODILY INJURY (Per awident) $ 4. Y'DAMAGE $ P1,00111slowDed. )001$5 Von EACH OCCURRENCE $2,001101000 AGGREGATE $209 000 .......... . ....... I'll _._J_gL'TUTE E - R.L. EACH ACCIDENT $ E.I.. DISEASE EA EMPLOYEE $ E.L. DWEASE r POLICY LIMIT each Oce / A.0gre. gate 10001,000 1000000 at strophe Limit 214851250 PhYS1,001 Damage ACV ed) 27 - Limit of Ll*jllity - $1,0 0U00 - Retention - 25/2026 - 6/25/2027 - Each Occurrence Limit: rsement(s). Primary Worrding for Auto Liability rms and condltlws, of the atfached 5). Primary Word! ng for Gen 0'rel Ll abil ity I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Los Altos Hills 26379 Fremont Road0 Los Altos Hills CA 94022 AUTH RIZED REPRESENTATIVE A loll 0 0 1988.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are regIstered marks of AGGRO 295: 2 * of 19 AGENCY AssuredPartners of California Insurance Services, LLC POLICY NUBOR CARRIER 'AGEC Y CUSTOMER ID:,CIT Y'RIS-01 LOC #05 NAIL CODE NAMPED INSURED y lie,LLC 686 E. ckeford Street. Lot CA 952410 EFFECTIVEDAT64% Page i of i ACORD 101 (2008/01) L* 2008 ACORD CORPORATION. All rights reserved, The ACORD name and logo are registered marks of ACORD 295: 3 " of 19 Insured: City Rise, LLC COMMERCIAL AUTO LIABILITY CA 104 43 12 23 WAIVER OF TRArH0o"FER*k 0"'I RIGHTS OF RrECOVE:RY A& AUAINST OTHERS TO USI (WAIVER OF SIUBROGATION) IRED BY WRITTEN AUT0MATIC WHEN REOU CONTRACT GR AGREEMENT l III �Iillill 1111� 11;pi; I I 111 111 1111pliq With respect to: coverage provided by this endorsement, the provisions of the Coverage Form apply unless Modified by the endorsement. The Transfer Of RIghts Of RecoVery Against Others To: Us Condition does not apply to any person(s) or organization(s) for :whom you are required to waive subrogation with respect to' thwe : AUnder a wntten contract or agreenlent With such person(s) or organ"izat'lon(s); and S. Prior to the "accident" or the "lloss", CA 04 43 12 23 90 Insurance Services Office, Inc., 2022 Page I of I 295: 4 ' of 19 f"'ompanyo Starstone Naflonal Insurance Company Policy Number: SGA9,10002262P-00 %AV OK Endorsement Effective Date.* 06/25/2026 Insured: City Rise, LLC Endorsement Number: TBD ADDITIONAL INSURED IF REQUIRED BY CONTRACT This endorsement modifies insurance provided under the following,,, TIP: 9 WMAL M111, Paragraph A.1 �Who Is An Insured of SECTION 111 - COVERED AUTOS LIABILITY COVERAGE, is amended to include the followtingA person or organization with respect to the operation, maintenance or use of a cov,ered "auto", 0; a 1 1, itte provided tht you and such pers-on or organtzon have agreed undeon n wr r an express provisia, *tte i "insured contract", Wriften agreement or a written permitissued to you by a, governmental or public authorlty to add such person or organ ization to this policy as an Insure- d". (1) for "bodily injury" or "property damagel" c-aus-ed by an "accident' which takes place after;: (a You executed the Insured contract" or written agreement,, or (b) The permit has been issued to yout SSN CA SHEP 1006 CW 04 23, Includes copyrighted material of page 1 of I ISO Properties,, Inc..., with its permission. 295: 5 " of 19 1 ln.sured,: City Rise, LLC COMMERCIAL GENERAL LIABILITY CG 24 53 12 19 0-,%F oft oft , 'E"VEY WAIVErR OF V:F H RUV Amami, Nows AG"'AINS"T 0"'THERS TO` U0`bA`:(WA,lVER OF z5UBROGATION) AUTOMATIC I COMMERCIAL GENERAL, LIAR[LITY COVERAGE PART' ELECTRONIC DATA, LIABILITY.COVERAG,E:PART LIQUOR LIABILITY COVERAGf 'PART POLLUTION LIABILITY COVERAG8 PART DESIGNATED SITES POLLUTION: LIA134LITY LIMITED COVERAGE PART DESIGNATED SITES PROD:UCTS/COMPLETED OPERKrIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNOERGROUND STORAGE TANK POLICY DESIGNATED TANKS The following is addeed to Paragraph 6, Transt feer Of ROW Of Re,covery Against Others To Us of Seefion W"W"Conditionss. We waive any right of recovery against any person or organizatt"on, because of any paymont we make under this Coverage Part, to whom the Insured has waived Its right of recovery In a writton contract or agreement. Such waliver �by us applies only to the extent that the insured has walved its right of recovery against such pe- rson or organization prior to loss. CG 24 53 12 19 0, Insurance Services Offibe, Inc., 2018 Pop I of 1 295: 6 " of 19 Company,: State e National Insurance Company Insured: City Rise, LLC COMMERCIAL GENERAL LIABILITY CG20 39 12 19 i 11121mpq�:Vpi� IF A.. Section 11 — Who Is An Insured 'is amended to include as an additional insured any person or orguanizavon for whom You have performed operations when you and such person or organization have agreed in writing tin a con ra.. t or agreement that such person or organization be added as an additional insured on your policy, Such person or organization is -an additional insured only with respect to liability for "bodily in 41 9* 111 .jury" or "property dam-ag0 caused, in whole orin part, by "your work" performed. for that additional insured and Included In the "Products -completed operatilons hazard". However, the insurance afforded: to such additional insured.- 1. Only applies to the extent permitted by law-, andr 2. Will not be; rbroader than that which you are required by the contract or agreement to provide for such additional insured,, S. Wit,h respect to the 'insurance afforded to! these additional Insureds, the following additional exclusion applies: "Bodily Injuryff or 'Iproperty damage" arising OrUt Of t�he rendering of, or the failure to render, any professional arch Itect u ral engineering or 01 surveying services, including: 1. The preparing, approving, or failing to prepare or approve, maps, shlop drawings, opiniOns, reports-, surveys,, field orders, change orders or drawings and specifications; or 2, Supervisory, inspection, architectural or engineering acti i 'v,ties,,, This excluslon applieso even 'if the clairnsi against any insured allege negligence or other wrongdoing in the Slupervisloni h1ding, employment, trainin or monitoning of others by that insured if the. "occurrence" which caused the "bodily in' jury: or t1property dam age" Irnvolved the rendering of ior the tallure to render any protessional archifectural, engrineer'Ing Md services, C. With respect to the Insurance afforded to these; A C additional insureft, the following, is added -to M SectionLimits Of Insurance. The most we will pay on behalf of the additional A insured 'is the amount of Insurance: 1, Required by, the :contract or agreement you 4 L t f have entered into with the additional insured; or 2, Available under the applicable limits of insurance, 'whichever is less. This endorsement shall not Increase the applicable filmits of insurance. CG 20 39 121 0 Insurance Services Office, Inc -7 2018r Page 1 of 1 295: 7 " of 19 9 Insured: City Rise, LLC V V V, Im :COMMERCIAL GENERAL LIABILITY CG 20 33 12 19 1111pliq Ill ri��piiiiiip ipim� 1: 11111� 1'111111N� q mq:111 A. Section 11 ",- Who 1s An Jnsured Is amended to include as ian additional insured any person or organizat'lon for whom you are performing operations when you and such person or organ I Ization have ag.reed in writing in a contract or agreement that. such person or organization be added as an additional insured oh your policy. Such person or organization is an additional insurod only wi,*th respect to liability for "bodily juryproperty damage" or "personal and 6 A I. A J'J advertising injury caused, in whole or in part, by., 1. Your acts or omissions; or 2. The acts or omissions of those acting on your Vehalf in the:, performance of your ongoing operations for the additional insured,, However, the, Insurance affordad to such additional insured'.. 1. Only applies to. the extent per(nitted by law, ..J anu 2. Will not be broader than that which you are required by the -contract or agreement to provide for such additional "nsurod. a A person's or organ izatlofts status as an additional insured under this endorsement ends when your operations for that additional Insured are completed. COMM B. With respect to the insurance afforded to these additional insureds, the , following additional exclusions apply, CG 20 33 12 19 G Insurance Services Office, Inc., 2018 Pagel of2 296: 8 " of 19 Page 2 of 2 0 Insurance Services Office, Inc., 2018, CG 20 33 1219 295: 9 " of 19 Aft txmpany: Star ton National Insurance Company COMMERCIAL AUTO LIABILITY CA 04 49 11 16 ER 111111, 11119F 15 . . . . . . . . . . . . . . . . . . With respect to coverage provldedby this endorsement,, 'the provisions of the Coverage Form -apply unless modified by the endorsement. 'The following Is added to. the Other Insuranco Condition In the Auto: Dealers Coverage Form and supersedes any prov'sion to the contrary-, This Coverage Form's Covered Autos Liability Coverage and General L;Iability Coverages are primary I to and will not seek contribution from any other Insurance. available to an "'nsured" under 'your policy provided that* 1. Such "insured" Is a Named Insured under such 11 other 'insuraandnce, 2, You have agreed In writing In a contract or 0 agreement that this 'Insurance would be pr'mary and would not seek contr'bution from any other 'insurance available to such insured"M CA 04 49 11 16 0 Insurance Services Office, Inc.,, 2.016 Pago I of- 1 296: 10 * of 1 E Y_- i 'DATE (MM/0131i"" ACiORO CERTIFICATE OF LIABILITY INSURANCE y 6/23/2,026 TMS CERTIFICATE IS. ISSUED AS A MATT OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CSI TI DOES NOT AFFIRMATIVELY OR NEGATIVELY AMENDt 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: It the certificate holder Is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED: rovisions or be endorsed. p . If SUBROGATION IS WAIVED, subjeot the terms sand' conditions of the policy, certain policlos may require an ondorsement. A statement on I certificate does not confer right's to the certificate holder In lieu of suchendorsoment PRODUCS14 C 0 NALL Certificate Teem AssuredPartners of California Insurance Services, LLC 11 PHON . E River, Park Drive, Suite 226 _(6jQ0 N'0;. gxt)., 916:993-.2700 ,N 916-993-2683 Sacramento CA 95815 A'SS'.. pertlificates.sacramento isuredpartners.com Ill SUREA(S) AFFORDING COVERAGE NAIL # I irsa IN - URERA Admiral Ins. Co. 24856 Q INSURED 01TYRIS-01 INSURE14,13 SterStone National Insurance Co . mpany 26496: Cit'6y Rise, LLC Iy§URAF1' 0 Q18E Special!y 1psuranop, Com pany 115,15 (38E. Lockeford Street Lodi. CA 95240 iRyBsRt?L:._!�LbtrV Lit I Fire Incur anctg rn 230.35 _M_qa -_ INSURER to COVERAGE$ CERTIFICATE NUMBER; 1103064760 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR INDICATED, NOTWITHSI'ANDING3 ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR, OTHER POL CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE LIGIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY, HAVE BEEN REDUCED BY PAID CLAIMIE, LT1'R WOK WO'fi P'S �QY E 'KE10 I I YY?Yl TYPE OF INSURANCE INSD wya -POLICY LUMBO. JMM 8 X COMMERCIAL GENERAL LIABILITY y y OoGL90002262POO 6125/2026 6/2,51/2-027 CLAIM$ -MADE F -v--1 Lf_J OCCUR IJMBRE.LLALII x Occu R 142004098 CXCESS UA S : E CLAIMS -MAD RETCNT'10N S ARD 9NIPLOYEAWLIARILIT Y YIN ,ANYPROPRIETO.R/P-,ARTNER,/EXECUTIVE OFFICENMEMBERE"XCLUDED? Lj N /A (Mandatorqt!AVI) It Yes, desorlbe under A I Prafessfana[ Liability D Equipment f"leater B Susilness Auto 6/2-5/2026 1 6/2512027 612612026 1 6/2,5/2,027 E0000034,73611 6/2512026 1 0125/2027 Y122Z9146599-1 010 612512028 8125P.20227 SGA000002262POO 6/25/20-26 6125/2027 DESCRIPTION OF OPERATIONS / LOCATION / VEHICLE,$ .(ACORD 101, Additional Remarks Scheduleo may be atloohed If morn spode Is, requi Cyber Liability - Carrier: Admiral Ins. Co, - lA-C #: 2,4856, - Policy #WWS600130 - Effective: 6/25r2;026 -6/25/2f $25,000 Pollution Liabi%y - Carrier,, Mt. Hawley Insurance Company - NIAC #-. 37974 - Policy.#EGL0014474 - Effective: 6 $5,000,000 -. Aogreqate Limit: $5,000,000 RE: En roach Permit, Auto Liability �dditional Insured applies per ternis and conditions of th e attached applies per terros and conditions of the attached endorsement. Auto Uab.-Illty WaIver of Subrogation ap lies Pei" tf endorsement, General Llabi ity Additional Insured applies per t-erms and' conditons of the attealied enToOrsernent( See Attached... ERTIFICATE HOLDER CANCELLATION UffM,.. 'p,l , a . . . . . . . . . . . "M NAMED ABOVE FOR THE POLICY PERIOD 30CUMENTWITH RESPECTTO WHICH THIS HEREIN IS SUB JECTTO ALL THE TERMS, GEN'L AGQF3EGKrELIM1T APPLIES PER, POLICY 1:x7_1 LOO THE MED. EXP !Aq one person) $1 01:000 AUTOMOSILELIABILITY y y SGA90002262P00 X ANY AUTO PRODUCTS - COMPI AGO $2'.00LO1000 OWNED 80HEDULED ------- ----- Co XOMIT M". I N D, 8 TN 0-L '�L 0 AUT08 ONLYA'Q6T 0 8 BODtLYINJU IRY (Per person) $ HIRED N Sj- OWNED $ p R.OpL G Ell TY 01, AUTOS ONLY AUTOS ONLY s $5,000 $6,000 IJMBRE.LLALII x Occu R 142004098 CXCESS UA S : E CLAIMS -MAD RETCNT'10N S ARD 9NIPLOYEAWLIARILIT Y YIN ,ANYPROPRIETO.R/P-,ARTNER,/EXECUTIVE OFFICENMEMBERE"XCLUDED? Lj N /A (Mandatorqt!AVI) It Yes, desorlbe under A I Prafessfana[ Liability D Equipment f"leater B Susilness Auto 6/2-5/2026 1 6/2512027 612612026 1 6/2,5/2,027 E0000034,73611 6/2512026 1 0125/2027 Y122Z9146599-1 010 612512028 8125P.20227 SGA000002262POO 6/25/20-26 6125/2027 DESCRIPTION OF OPERATIONS / LOCATION / VEHICLE,$ .(ACORD 101, Additional Remarks Scheduleo may be atloohed If morn spode Is, requi Cyber Liability - Carrier: Admiral Ins. Co, - lA-C #: 2,4856, - Policy #WWS600130 - Effective: 6/25r2;026 -6/25/2f $25,000 Pollution Liabi%y - Carrier,, Mt. Hawley Insurance Company - NIAC #-. 37974 - Policy.#EGL0014474 - Effective: 6 $5,000,000 -. Aogreqate Limit: $5,000,000 RE: En roach Permit, Auto Liability �dditional Insured applies per ternis and conditions of th e attached applies per terros and conditions of the attached endorsement. Auto Uab.-Illty WaIver of Subrogation ap lies Pei" tf endorsement, General Llabi ity Additional Insured applies per t-erms and' conditons of the attealied enToOrsernent( See Attached... ERTIFICATE HOLDER CANCELLATION UffM,.. 'p,l , a . . . . . . . . . . . "M NAMED ABOVE FOR THE POLICY PERIOD 30CUMENTWITH RESPECTTO WHICH THIS HEREIN IS SUB JECTTO ALL THE TERMS, EAdH'OCCURRENCE $1,000,000 T, $100,000 MED. EXP !Aq one person) $1 01:000 .PERSONAL &.ADV INJURY $ 110OOtOOO GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMPI AGO $2'.00LO1000 ------- ----- Co XOMIT M". I N D, 8 TN 0-L '�L 0 s 10001,0100 , BODtLYINJU IRY (Per person) $ BOLy Df INJU BY (Per acoldent) $ p R.OpL G Ell TY 01, s $5,000 $6,000 EACH OCCURRENCE $2,000,000 AGGREGATE $ 2,000,000 JA E.L. EACH ACCIDENT $ .l.,.. DIS ASE- EA EMPLOYEE $ E1. WSEASE - POLICY LIMIT 11 Each Coo i Aggregate 100000011000000 CatQ$tfrophe LIMIt 21485 Physical Damage ACV ed) 2.7 - Limit of Liability - $1,000,000 - Retention - R5/2026 - 6/2512027 Each Occurrence Limit: rsement(s). Primary Wording -for to Liability r,ms and C6ndltions of the attached Primary Word, i ng for General Ll ability SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY -PROVISIONS. Town of Los Altos Hills 26379Fremont Road AUTHORIZED REPRESENTATIVE Los Altos Hills CA 94022 0 1988t-201 5 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD nam o and logo are registered marks of ACORD 295: 11 "' of 191 NRWFMPM-0�001 � AGENCY Assur edPartners of California Insurance Services, LLC POLICY NUMBER CARRIER AGENCY CUSTOMER ID: CITYRIS"01 LOC #0- � NAIC CODE NAMED INSURED 01�Rise, LLC 68 , E. Lockeford Street Lodi CA 95240 EFFECTIVE DATE: Page 1 Of 1 ACORD 101 (2006/01) 0 2008 ACORD CORPORATION., All rights reserved. The ACORD namo and logo are registered marks of ACORD 295: 12 * of 1 Ski Aft . "'tarstone National Insurance Company U011vinp%any: oc Insured: City Rise, LLC 11111 W -.- COMMERCIAL AUTO LIABILITY CA 104 43 12 23 "T' REC;OVERY WAIvER OF 1VRAN.brr"-=rT,R Avo%rr#* rRUGH V uc% O*qkr!! Imi AuWomb"09110" 0%GAT1j"%N) "No AftA1,N:S11%)T OTH"ERS TA"k Pp� (WAIVER Vir wF1v V :Y WRITTEN B AUTOMATIC WHEN REQUIR CONTRACT OR AGREEMENT ....... .... With respect to ooverage provided ;by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. The' Transfer Of Rights Of Recovery Against Mhers To Us Condition does not apply to any person(s) or organization(s) for whom you are required to waive subrogation with respect to the coverage provided under this Coverage Form,. bu) only to the extent that subrogatiOn is walved: A. Under a written contract or agreement with such person(s) or organization(s),, and M,Prior-accident" or the"loss". CA 04 43 12 23 0 Insurance Services Office, Inc., 2022 Page I of 1 295: 13 " of 191 CWt ompany.: Starstone National Insurance Company Policy Numberm, SGA90002262P-00 Endorsement Effective Date: 06/25/2026 lnsuredj,,# 01ty Rise, LLC Endorsement Number,: TBD AD"I"DITIONAL INSURED IF REQU:IRED BY CONTRACT �: I , I III 111 i lot This, endorsement modifies insurance provided under the following,. Paragraph A.1 Who Is An Insured of SECTION 11 -m COVERED AUTOS LIABILITY COVERAGE, Is amended to Include the followinga d, Any person or organization, with respect to the operation, maintenance or use of a covered "aut0", p "ded that you and such petson or organization have agreed under an eXrpress pro Won In a writtee rovil I V I "Insured contract", written agreement or a written permitissued to you by a governmental or pUblic authority to add such person or orgenlization to this pol1cy as an "Insureed". (1) for "bodily injury,' or "property damage" caused by an "accident" which takes place after: (a); You executed the "Insured contract" or written agreement; or (b) 'The permit ha8 been Issued to I , 'i I 1� 1177 11 1 11 1`1111iril , Jill 11111 [11 SSI CA SHED 1006 CW 04 23 Includes copyrighted material of Page I of I ISO Properties, Inc., with its permission. 295: 14 * of 1 S Amo Starstone National Insurance Company Insured: City Rise, LLC COMMERCIAL GENERAL LIABILITY CG 24.53 12 19 01VAIVER 'OF TRANSIDFEROF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SU:13140GATION) AUT01VIATIC 11111 111 111 1 Iigpp��I� � 11! M M COMMERCIAL GENERAL LIABILITY -CO:VER- AGE PART' ELECTRONIC DATA LIABILITYCOVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE, PAR T DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITE$'* PRODUCT'S/COMPLETED OPERATIONS LMBILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART MDERGROMD STORAGE TANK POLICY.DESIGNATED TANKS The following 'is added to Paragraph 8. Transfor Of R A Ighits OfRecovery Against Others To, Us of 0 Section IV --- Condiltion.s., We waive any right of recovery against any pe- r -son or Organization, bec-ause of any payment we make under this Coverage Part, to; whom the insured has wat : vea iTs right, of recovery in a written contract or agreement, Such walver by us appities only to the extent that the insured has waived its right of recover:y against such person or organization prior to loss. CG 24 63 12 19 0 Insurance Services Office, Inc., 2018 Page 1 of 1 295: 15 ' of 191 Insured: City Rise, LLC J ........ ........ COMMERCIAL GENERAL LIABILITY CG 20 39 12 19 lipmr; 11 111 11111 !� 11�! I [moo 1. Only applies 'to 'the extent perMitted by law, and Z. Will not be broader than that which you are required 'by the contract or agreement to 4 provide for such additional insured, 8,* With respect to 'the insuranoe afforded to these additional �insureds, the followihg additional exclusion applies: "Bodily injury" or Oproperty damage" arising out of the rendering of, or the failure to' render, any professional architectural, engineering or surveying services, including: 1, The preparing,. approving, or failing to prepare or approve, maps, shop :drawings, opin,ons, reports, surveys, field order%: change orders or drawings and speoffications; or 2. Supervisory inspection, architectural or engineering activit I iesP This exclusion applies even if 'the claims against any InSured allege negligence or other wrongdoing in the supervis'on, hir'%, employnient,, training or mopitorilng of others by that insured, if the If occurrence"' which caused the todily injury" or property damage"' Involved the rendering, of or the failure, to render any professional archltectural,, engineering or surveying services. C1. With respect to the 'Insurance afforded to these additional Insureds, the following, is added 'to 0 Section Ill — Limits Of InswanceP The most we will, pay on behalf of the additional insured 'I's the amount of 'insurance `' a ye contract or agreernent you have entered Into with the additional 'insured-, or 2, Available under the applicable limits, of insurance; whicheverl,s less, ThIs endorsement shall not increase the applicable fimits of insurancee CG 20 39 12 19 0 Insurance Services Office, Inc., 2018 Page 1 Of I 295: 16 * of 1c. .0% Lxmpany: Starstone National Insurance Company Al M -M: low MAT A. Section. H — Who Is An Insured Is arriended to include as an additional 'Insured any person or organization for; whom you are performing operations when you and such person or organization have agreed In writing in a contract or agreement that such person or organization be added as an additional insured on your policyi Such person or organization 'is an additional insured only with respect to liability for "bodily injUry", "property damage" or "persona -I and advertising injury" caused, 'in whole or'n par 1, Your acts or omissions; or 2. The acts or omissions ofthose acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the 'insurance afforded to such additional insured. - 1. Only applies to the extent permitted: by law, and 2. Will not be broader than that which you are required by the contract or iagreement to provide for such additional insured., A person's, or organization's status as an additional insured under this endorsement ends 0 when your operations for that additional insured are completed, COMMERCIAL GENERAL LIABILITY CG.20 33 12 19 8, With respect to the Inslurance afforded to these dsit additional insure, he following additional 0 exclusions applyA Thils insurance does not apply to. I 1. "Bodily 'injury",, "property damage" or personal and averttsing injury ansing out of the rendering of, or the failure to render, any professi onal architectural, engine- ering or surveyingsservices, Including,: a. The Preparing, approving, or falling to prepare or approve, maps, shop drawings, opinions, reports,, surveys, field orders, change orders or drawings and specific.ations, or b. Su 4 .pervisory, inspection, arch Itectural or R en,gineering activities. This exo1usion applies even if the claims against any InssUred allege negligence or, other wrongdoing in the supervision, hiring, employment, training or mom . toring of others by that insured, if the "occurrence" which caused the "bodily 'Injury" or "Property damage", or the offense which caused the "personal and advertising Injury"., Involved the rendering of or the: failure to render any professional arch iteotu ral , engineering or surveying services. CG 20 33 12 1-9 0 Insurance Services Office, Inc., 2018 Page 1 of 2 295: 17 "' of 191 r% dft ^ e 2", o 12", Op Insurance Services, Olfice, Inc., 2,018, Q" 20 33 12 19 295: 18 * of 19 company,, Starstone National Insurance Company Insured: City Rise, LLC '("W"OMMERCIAL AUTO LIABILITY CA 04 49 11 16 I With respect to coverage provided by -this endorsement, 'the provisions of the Coverage Form apply unlesS., modified by the endorsement. B. The following Is added to the Other Insurance Condition in the.Auto Dealers Coverage Form and 4 supersedes any provislonto the contrary: This Coverage Form's Covered Autos Liability Coverage and Generat Liability Coverages are primary to and will not seek contribution from any other insurance available, to an "'nsuredr": under your poficy provided that., 1. Such "Insured" 's a Named Insured under such other 'Insu rance; and 2. You have agreed In wMing in a contract or agreement that thl's Insurance would be primary and would not seek contribution from any other 'Insurance available to such ",insured". I CA 04 49 11 16 0 Insurance Services Office, Inc., 2016 page 1 of 1 295: 19 " of 191