Loading...
AT&T (Sub-Contractors) - Insurance CertificateMCKI IINp -f11 I IAA ACORO� CERTIFICATE OF LIABILITY INSURANCE FDATE1(MM /DD/YYYY) 11/02/2017 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(ies) 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 License # 0504035 Pacific Diversified Insurance, Inc. 15005 Concord Circle, Suite 110 408 - 842 -2131 Morgan Hill, CA 95037 CONTACT NAM (A/C, No, Ext): (408) 842 -2131 FAX No):(408) 842 -0867 ADDRE : INSURERS AFFORDING COVERAGE NAIC # INSURER A: Evanston Insurance Co 10/15/2018 EACH OCCURRENCE INSURED INSURERB:Allied Insurance 10127 INSURER C: Kinsale Insurance Company 38920 Mc Kuin Pipeline INSURER D: State Compensation Ins Fund 35076 320 Hunter Lane Hollister, CA 95023 INSURER E: Navi ators Specialty Ins. Co. 36056 INSURER F: $ 2,000,000 PRODUCTS - COMP /OP AGG CnVFRAnFS CFRTIFICOTF NIIMRFR- RFVISIr)N Nl1MRFR- 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_X] OCCUR X 3C21415 10/15/2017 10/15/2018 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED occurrence) PR�EMISES (E. $ 300,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FX JECT F—] LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NoN (JMED AUTOS ONLY AUTOS ONLY ACP7865212974 10/1512017 10/15/2018 COMBINED SINGLE LIMIT Ont) 1,000,000 X BODILY INJURY Per person) $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ C UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE 01000573650 10/15/2017 10/15/2018 EACH OCCURRENCE $ 6,000,000 X AGGREGATE $ 6,000,000 DED I I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ ANY PROPRIETOR/PARTNER /EXECUTIVE ❑N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 9077394 -17 11/02/2017 11/02/2018 X PER OTH- E. L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ E POLLUTION COVERAGE SF17ECP3002091C 10/15/2017 10/15/2018 Occ: $5,000,000 /Agg 10,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) RE: AT &T Fiber cabling from Miller Ave. to CHP Ranch Site TEEC Building City of Gilroy, its officers, officials and employees are named as an additional insured with respects to the General Liability per the attached endorsement. City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 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 ACORD 25 (2016/03) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER- 3C21415 COMMERCIAL GENERAL_ LIABILITY CG 2010 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS ® SCHEDULED 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) Locations Of Covered Operations As required by written contract executed by both parties prior to loss Information required to complete this Schedule if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as -an additional insured the person( §) 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: 1. Your acts or omissions, or 2. The acts or- omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However; 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a 'contract or agreement, the insurance afforded to such additional insured will not be broader than that which youl are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This. insurance does not apply to "bodily injury' or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by.or on behalf of the additional insured(s) at the location of the covered operations has been completed, or CG 2010 0.413 0 Insurance Services Office, Inc., 2012 Page 1 of 2 2. That portion of 'your work" out of which the injury or damage arises has been put to, its intended use by any person or organization other than another contractor or subcontractor engaged in perforrriing operations for a principal as a part of the same project C. With respect to the insurance afforded 'to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured 'is the amount of insurance. 1. Required by the'contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 0 Insurance Services Office, Inc , 2012 CG 2010 0413 POLICY NUMBER. 3C21415 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE.POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURE® - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL-GENERAL LIABILITY COVERAGE.PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Or ariization s Location And Description Of Completed Operations As required by Written contract executed by both parties prior to loss ; applies to commercial work only 'Section Ill- Limits Of Insurance: with respect to liability for "bodily injury' or If coverage provided to the additional insured is "Property damage I caused, in whole or in part, by required by a contract or agreement, the most we Information re uired to.com" lete this Schedule if not,shown above, will be_shdwn in the Declarations. A. Section II — Who Is An Insured is amended to B. With ,respect to the insurance afforded to these include as an additional insured the person(s)'or 'additional insureds, the following is added to organization(s) shown in the Schedule, but only 'Section Ill- Limits Of Insurance: with respect to liability for "bodily injury' or If coverage provided to the additional insured is "Property damage I caused, in whole or in part, by required by a contract or agreement, the most we 'your work" at the location designated and 'this Will pay on behalf of the additional insured is -the described in the Schedule of endorsement amount of insurance performed for that-' additional insured and included in the "products- completed operations 1. Required by the cofract or agreement; or hazard" 2. Available under the applicable Limits of However. Insurance shown in the Declaratidris, 1. The insurance afforded_ to such additional whichever i,s less insured only applies to the extent permitted This endorsement shall not increase the applicable by law, and Limits'of^Insurance shown in the Declarations. Z If coverage provided to the additional insured is 'required by a contract, or agreement; the insurance afforded to such additional, insured will not be broader than 'that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 1