MJR Electric - Insurance CertificateA ° CERTIFICATE OF LIABILITY INSURANCE
710/0842015
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 endorsements .
PRODUCER
FEDERATED MUTUAL INSURANCE COMPANY
HOME OFFICE: P.O. BOX 328
CONTACT
CO T C CENTER
A" No. Ext : 888- 333 -4949
FAX c No): 507- 446 -4664
ADDRESS: CLIENTCONTACTCENTER FEDINS.COM
CdIVATONNA, MN 55060
INSURER(S) AFFORDING COVERAGE
NAIC #
$1,000,000
INSURER A: FEDERATED MUTUAL INSURANCE COMPANY
13935
MED EXP (Any one person)
INSURED 315 -542 -1
INSURER B:
$1,000,000
MJR ELECTRIC INC
PO BOX 668
INSURER C:
GENERAL AGGREGATE
INSURER D:
GEN'L AGGREGATE. LIMIT APPLIES PER:
X POLICY J Cj
ECT LOC
MORGAN HILL, CA 95038
INSURER E:
-
--
INSURER F:
LIABILITY
ANY AUTO
ALL SED SCHEDULED
OS S
AUT
iNON -OWNED
HIRED AUTOS ,AUTOS
COVERAGES CERTIFICATE NUMBER: 138 REVISION NUMBER: 0
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 MAYBE 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
LTR
TYPE OF INSURANCE
OL
I S
SUBR
WVD
POLICY NUMBER
POLICY EFF
MID /Y. Y
POLICY EXP
/DDI YY
LIMITS
A
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ❑X OCCUR
Y
N
9080246
08/14/2015
08/14/2016
EACH OCCURRENCE
$1,000,000
DAMAGE TO RENTED
EM SES Ea occurrence
$100,000
MED EXP (Any one person)
.EXCLUDED
PERSONAL & ADV INJURY
$1,000,000
GENERAL AGGREGATE
$2,000,600
GEN'L AGGREGATE. LIMIT APPLIES PER:
X POLICY J Cj
ECT LOC
PRODUCTS - COMPIOP AGG
$2,000,000
A
AUTOMOBILE
X
LIABILITY
ANY AUTO
ALL SED SCHEDULED
OS S
AUT
iNON -OWNED
HIRED AUTOS ,AUTOS
N
N
9080246
08/14/2015
08/14/2016
COMBINED SINGLE LIMIT a
en
$1,000,000
BODILY INJURY (Per person)
BODILY INJURY (Per accident)
PROPERTY 'DAMAGE
(Per accident
A
X
UMBRELLA LIAB
EXCESS LIAR
X
OCCUR
CLAIMS -MADE
N
N
9080247
08/14/2015
08/14/2016
EACH OCCURRENCE
$5,000,000
AGGREGATE
$5,006,000
_DED
I I RETENTION
WORKERS COMPENSATION
ANO EMPLOYERS' LIABILITY y / N
ANY PROPRIETOR /PARTNER/EXECUTIVE ❑
OFFICER /MEMBER EXCLUDED?
(Mandatory In NH)
D -
yes, describe under
DESCRIPTION OF OPERATIONS below
N I A
STATU-
TORY UMITS
OTH-
ER
E.L. EACH ACCIDENT
E.L. DISEASE - EA EMPLOYEE
E.L DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, it more space is required)
RE: JOB ADDRESS: 400 MANTELLI DR GILROY CA 95020
CITY OF GILROY, ITS OFFICERS, OFFICIALS, AND EMPLOYEES ARE NAMED AS ADDITIONALLY INSURED
THE CERTIFICATE HOLDER IS.AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSORS
OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR GENERAL LIABILITY.
315 -542 -1
CITY OF GILROY
7351 ROSANNA ST
GILROY, CA 95020 -6141
1380
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
O 1988 -2010 ACORD CORPORATION. All rights reserved.
ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD