Loading...
Causey Consulting - Insurance Certificate (2019AC R" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 16.� 11 /20/2018 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 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 CONTACT I NAME: Hiscox Inc. d/b/a/ Hiscox Insurance Agency in CA I AH/CNN . Extl: (888) 202-3007 AFAX /C, No): 520 Madison Avenue I a oRlE 32nd Floor ss: contact@hiscox.com UR N ISERS AFFORDING COVERAGE NAIC # New York, NY 10022 _ _ _aj.) FR _ _ _ INSURER A: Hiscox Insurance Company Inc 10200 INSURED INSURER 8 Causey Consulting INSURER C 733 Cree Court Walnut Creek, CA 94598 I INSURER D INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR TYPE OF INSURANCE NSD SWVD POLICYNUMBER UBR POLIC1rEFF r'MIDOfY Y LIMITS (MM/DD/YYYY) (MM/OD/YYYY) COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PROJECT ❑ LOC OTHER: AUTOMOBILE LIABILITY _ ANY AUTO ALL OWNED SCHEDULED _ AUTOS AUTOS NON -OWNED HIREDAUTOS AUTOS UMBRELLA LIAB OCCUR EXCESS LIAB HCLAIMS-MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRI ETOR/PARTNER/EXEC UTIVE OFFICERIMEMBER EXCLUDED? ❑ NIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below A Professional Liability N Y UDC-1534926-EO-18 EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ CUMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ EACH OCCURRENCE AGGREGATE ER OT STATUTE I I EERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT $ 01/23/2018 01/23/2019 Each Claim: $ 1,000,000 Aggregate: $ 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Service agreement: Sewer System Management Plan Revision City of Gilroy, its officers, officials, and employees are named as certificate holder subject to policy's terms and conditions. CERTIFICATE HOLDER CANCELLATION City of Gilroy, its officers, Officials, and employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 Rosanna Street Gilroy, CA 95020 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE a% F� /Rr��+�. I @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE 12/06/20 8 ' 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 be endorsed. If SUBROGATIONIS 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 (CONTACT R C FISCHER & COMPANY/WALNUT CREEK NAME: 57101256 THE HARTFORD BUSINESS SERVICE CENTER 3600 WISEMAN BLVD SAN ANTONIO, TX 78265 INSURED PAUL CAUSEY DBA CAUSEY CONSULTING 733 CREE CT WALNUT CREEK CA 94598-4427 PHOE (A/C, o, Ext); (866) 467-8730 (A/CC, No); (888) 443-6112 E-MAIL ADDRESS: INSURER A: INSURER B : INSURER C : INSURER D INSURER E INSURER F : INSURER(S) AFFORDING COVERAGE The Sentinel Insurance Company 111 NAIC# COVERAGES CERTIFICATE NUMBER: 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 POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH DOLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE I ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP I LIMITS LTR INSR WVD (MM/DDIYYYY) (MMIDDIYYYY) COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X General Liability I X A GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO � LOC JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO A ALL OWNED SCHEDULED AUTOS _ AUTOS X HIREDAUTOS X NON -OWNED AUTOS UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE DED RETENTION $ ViOh'kER CO PENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YIN OFFICER/MEMBEREXCLUDED? (Mandatory NIA in NH) If yes, describe under DESCRIPTION OF OPERATIONS below EACH OCCURRENCE $2000 0001 DAMAGE TO RENTED $1 000 000 PREMISES (Ea occurrence) MED EXP (Any one person) $10,000 57 SBM ZE5184 12/01 /2018 12/01 /2019 I PERSONAL & ADV INJURY 2.000.000 GENERAL AGGREGATE 14,000,000 Ij PRODUCTS - COMP/OPAGG $4,000,000 COMBINED SINGLE LIMIT (Ea accident) $2,000,000 BODILY INJURY (Per person) 57 SBM ZE5184 12/01/2018 12/01/2019 I BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE (AGGREGATE (PER STATUTE I IOERH E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE E.L. DISEASE - POLICY LIMIT I DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (AC )RD 101, Additional Remarks Schedule, may be attached if more space is required) Those usual to the Insured's Operations. Service Agreement: Preparation of Sewer System Management Plan City of Gilroy, its officers, officials and employees is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. CERTIFICATE HOLDER CANCELLATION CITY OF GILROY SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 ROSANNA ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GILROY CA 95020-6141 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD HISCOX INSURANCE COMPANY INC. 40 HISCOX Endorsement 11 NAMED INSURED: Causey Consulting E5000.1 Additional Insured Page 1 of 1 In consideration of the premium charged, it is understood and agreed that the Policy is amended as follows: In Clause VI. DEFINITIONS, paragraph V., "'You' or'Your'," is amended to include the following at the end thereof: You or Your shall also include the below listed "ADDITIONAL INSURED(S)," but only for the Wrongful Acts of those contemplated in paragraphs 1., 2. or 3. of the definition of "'You' or 'Your"': ADDITIONAL INSURED(S) City of Gilroy, its officers, officials, and employees 7351 Rosanna Street Gilroy, CA 95020 All other terms and conditions remain unchanged. Endorsement effective: January 08, 2019 Endorsement No: 11 By: Kevin Kerridge (Appointed Representative) Policy No.: UDC-1534926-EO-18 DPL E5000 CW (01/10) Acb)? ® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD(YYYY) �.�.•-'' I 01/04/2019 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 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 l:l/N1Hl: i NAME: Hiscox Inc. d/blal Hiscox Insurance Agency in CA I MnILp Ext): (888) 202-3007 FAX No): 520 Madison Avenue I ADDRESS: contact@hiscox.com 32nd Floor I INSURER(S) AFFORDING COVERAGE NAIC4 New York, NY 10022 _ INSURERA; Hiscox Insurance Company Inc 10200 INSURED INSURER B INSURER C: INSURER D: INSURER E : Walnut Creek CA 94598 I INSURER F : COVERAGES CERTIFICATE NUMBER: 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 POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADOL SUBR POLtCY EFF ' POLICY�*P LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER (MMIDDIYYYY) (MMIDDIYYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACI-IgC�t1HREJ�'CE $ DAMA"E" E TED CLAIMS -MADE OCCUR I PREMISES fine occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ Causey Consulting 733 Cree Court GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JECT LOC OTHER: AUTOMOBILE LIABILITY _ ANY AUTO ALL OWNED SCHEDULED _ AUTOS AUTOS NON -OWNED HIREDAUTOS H AUTOS UMBRELLA LIAB H OCCUR EXCESS LAB CLAIMS -MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNERIEXECUTIVE ❑ NIA OFFICERIMEMBER EXCLUOEDT (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Professional Liability A I GENERALAGGREGATE $ PRODUCTS - COMP/OPAGG $ COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTYDAMAGE$ (Per_ accident)__ $ I EACH OCCURRENCE $ AGGREGATE $ PER I I ERµ E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE- POLICY LIMIT $ Y Y UDC-1534926-EO-19 01/23/2019 01/23/2020 Each Claim: $ 1,000,000 Aggregate: $ 2,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Addlllonal Remarks Schedule, may be attached if more space is required) City of Gilroy, Sewer System Management Plan Revision, It's officers, officials, employees are named as additional insured CERTIFICATE HOLDER CANCELLATION City of Gilroy, California 7351 Rosanna Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Gilroy, CA 950202 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD HISCOX INSURANCE COMPANY INC. ETA H 1SCOX Endorsement 8 NAMED INSURED: Causey Consulting E5000.1 Additional Insured Page 1 of 1 In consideration of the premium charged, it is understood and agreed that the Policy is amended as follows: 1, In Clause VI, DEFINITIONS, paragraph V., "'You' or'Your'," is amended to include the following at the end thereof: You or Your shall also include the below listed "ADDITIONAL INSURED(S)," but only for the Wrongful Acts of those contemplated in paragraphs 1., 2. or 3. of the definition of "'You' or 'Your"': ADDITIONAL INSURED($) City of Gilroy, its officers, officials, and employees 7351 Rosanna Street Gilroy, CA 95020 All other terms and conditions remain unchanged. Endorsement effective: January 23, 2019 Endorsement No: 8 By: Kevin Kerridge (Appointed Representative) Policy No.: UDC-1534926-EO-19 DPL. E5000 CW (01/10)