CGRS - Insurance Certificate (2020)CGRSINC-01 LPREWITT
CERTIFICATE OF LIABILITY INSURANCE DAT4/9/2 D/YYYY)
4/9/2019
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 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).
CONTACT
PRODUCER
NA E: 1
PFS Insurance Group PHONE FAX
4848 Thompson Parkway Suite 200 WC, No, Ext): (970) 635-9400 (A/C, No);(970) 635-9401
Johnstown, CO 80534 AD RIEss: info@mypfsinsurance.com
INSURER(Sl AFFORDING COVERAGE NAIC #
INSURER A: Admiral Insurance Companv 24856
INSURED INSURERB;Allmerica Financial Benefit Insurance Companv 41840
C G R S, Inc. & CA TESTCO, LLC I INSURER C: Pinnacol Assurance Co 41190
1301 Academy Ct I INSURER D;The Hanover Insurance Companv 22292
Fort Collins, CO 80524
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 'OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
LTR TYPE OF INSURANCE INSD SWVo POLICY NUMBER (MMIDDII�1 (MM/LDDNYYY) LIMITS
A X COMMERCIAL GENERAL LIABILITY 1 000 OO
CLAIMS -MADE X OCCUR X
FEIECC1329006
3/1/2019 311/2020
EACH OCCURRENCE
DAMAGE TO RENTED
$ + 0 0
50,000
X Blanket Add'I Insd
PREMISES (Ea occurrence)
$
5 000
X Blkt Waiver of Subo
MED EXP (Anv one person)
PERSONAL & ADV INJURY
$ �
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY® PEC�- LOC
GENERAL AGGREGATE
PRODUCTS - COMP/OP AGG
$ 2,000,000
$ 2,000,0061
OTHER:
$
B
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,0001
X ANY AUTO X
AW4A232142
3/1/2019 3/1/2020
BODILY INJURY (Per person)
$
OWNED SCHEDULED
_ AUTOS ONLYNXAUTOS
BODILY INJURY (Per accident)
$ I
X H RED NON S%NNED
PROPERTYDAMAGEA!JTOS
ONLYAUTOS LY
(Per accident$
XBlanketAdd'I InsdBIN Waiver of
Su to
A
UMBRELLA LIAB H OCCUR
LIAB
FEIEXS1329106
3/1/2019 3/1/2020
EACH OCCURRENCE
$
$ 10,000,0001
EXCESS CLAIMS -MADE
I AGGREGATE
$ 10,000,0001
DED I X I RETENTION $ 0
I
C
WORKERS COMPENSATION
X I PER OTH-
STATUTE
$
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE N
EXCLUDED? NIA
4029480
1/1/2019 1/1/2020
ER
E.L. EACH ACCIDENT
$ 1,000,0001
Mandatory in NE)
I E.L. DISEASE - EA EMPLOYEE
1 OOO OOO
$ I
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,OOOI
D
Leased/Rented Equip
RH4A231842
3/1/2019 3/1/2020
$1,000 Deductible
200,000
A
Pollution/Profession
FEIECC1329006
3/1/2019 311/2020
Limit Per Claim
11000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required)
As required by written contract the following provisions apply subject to the policy terms, conditions, limitations and exclusions: The City of Gilroy, Its
officers, officials and employees are named as Additional Insured for ongoing and completed operations on a Primary and Non -Contributory basis under
General Liability and Automobile Liability. 30 Day Notice of Cancellation applies except 10 days for nonpayment of premium.
CERTIFICATE HOLDER
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
City of Gilroy, its officers officials and employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
y yACCORDANCE WITH THE POLICY PROVISIONS.
7351 Rosanna Street
Gilroy, CA 95020
AUTHORIZED REPRESENTATIVE
I 4_�
ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
A91 ftRAL t=Za", '
CGRS, Inc.
Endorsement Number: 35
111
This endorsement, effective 4/2/2019 attaches to and forms a part of Policy Number
FEI-ECC-13290-06, This endorsement changes the Policy. Please read it carefully.
In consideration of an additional premium of$150, 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 Gilroy it officers, officials and employees
7351 Rosanna St
Gilroy CA 95020
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(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:
1. In the performance of your ongoing operations; or
2. In connection with your premises owned by or rented to you.
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 you are
required by the contract or agreement to provide for such additional insured.
B. With respect to the insurance afforded to these additional insured, 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.
Copy. g.....Insuran..._....., 04
ri ht, ce Services Office, l CG 20 21.6 13