Loading...
Cornerstone Environmental Contractors - Insurance Certificate (2020)DATE(MM/DD/YYYY) �,,.�.,.... CERTIFICATE OF LIABILITY INSURANCE I 04/26/2019 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 2 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). c PRODUCER CONTACT Aon Risk Services, Inc. of Hawaii NAME: PHONE 201 Merchant Street (A/C. No. (808) 533-4900 EXt) : FAX No.): (808) 540-4301 Suite 2400 E-MAIL Honolulu HI 96813 USA ADDRESS: C 2 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Great Divide Insurance Co 25224 Cornerstone Environmental contractors INSURER B: Nautilus Insurance Company 17370 Inc. P.D. Box 5127 INSURER C: This insurance is issued pursuant to the California Insurance Coca, Concord CA 94524 USA INSURER D: Section 176U through 178u, and Is placea in an insurer or insurer not holdina a Certificate of Authoritv from or reaulated by the INSURER E: California Insurance Commissioner. INSURER F: COVERAGES CERTIFICATE NUMBER: 570076042667 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. Limits shown are as requested INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE I INSD WVD /Y POLICY NUMBER (MM/DDYYYI (MM/DD/YYYYI LIMITS B X COMMERCIAL GENERAL LIABILITY Y ECP2028687-10 03/29/2019 03/29/2020I EACH OCCURRENCE $1,000,000 RENTED $lOO,000 CLAIMS -MADE X❑ OCCUR DAMAGE TO R I PREMISES (Ea occurrence) MED EXP (Any one person) $ 5 , 000 PERSONAL & ADV INJURY $1, 000, 000 � GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $2 , 000, 000 � POLICY ❑PRO- ❑ LOC JECT I PRODUCTS - COMP/OP AGG $ 2 , 000 , 000 ti OTHER: 0 0 A AUTOMOBILE LIABILITY BAP2028683-10 03/29/2019 03/29/2020 COMBINED SINGLE LIMIT $1, 000, OOO I- LO (Ea accident) X ANYAUTO BODILY INJURY ( Per person) Z OWNED SCHEDULED BODILY INJURY (Per accident) — AUTOS ONLY AUTOS X HIREDAUTOS X NON -OWNED PROPERTY DAMAGE — ONLY AUTOS ONLY (Per accident) y0—. B UMBRELLALIAB OCCUR FFX2028688-10 03/29/2019 03/29/2020 EACH OCCURRENCE $5,000,000X EXCESS LIAB CLAIMS -MADE H I AGGREGATE $ 5 , 000 , 000 DED I IRETENTION A WORKERS COMPENSATION AND WCA2028685-10 03/29/2019 03/29/2020 X I PER STATUTE I IOTH- EMPLOYERS' LIABILITY Y / N ER ANY PROPRIETOR / PARTNER / EXECUTIVE E.L. EACH ACCIDENT $1 000 000 OFFICERIMEMBER EXCLUDED? N / A (Mandatory in NH) I E.L. DISEASE -EA EMPLOYEE $1, 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1, 000, 000 —_ B Env Contr Poll ECP2028687-10 03/29/2019 03/29/2020 Contr Pollution Aggl $2,000,000 Each Pollution Cond- $1,000,000 Ded Each Pollution i $5,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) &-r City of Gilroy, its officers, officials and employees is included as Additional Insured as required by written contract, but limited to the operations of the named insured under said contract with respect to the General Liability policy. Thirty (30) 40-- days written notice applies. -� a� J ou_ -- s CERTIFICATE HOLDER CANCELLATION Je SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City Of Gilroy AUTHORIZED REPRESENTATIVE its officers, officials and employees 7351 Rosanna Street Gilroy CA 95020 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read it carefully. AD°OITIONAL INSURED OWNERS, LESSEES OR CONTRACTORS SCHEDULEp PERSQN OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Gilroy, its officers, officials and employees. Job Description/Location: All Projects Who is An Insured (Section II) is amended to include as an insured any 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: 1. Your acts or omissions, or the acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional insured; or 2. Your work at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the products -completed operations hazard. With respect to damages caused by your work, as described above, the coverage provided hereunder shall be primary and not contributing with any other insurance available to those designated above, but only when required by written contract or agreement. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. ENV 2154 B 06 18 Page 1 of 1 ENDORSEMENT This endorsement forms a part of the policy to which it is attached. Please read it carefully. CHANGE ENDORSEMENT Policy Number Endorsement Effective Date: Endorsement Number ECP2028687-10 4/29/2019 3 INSURED'S NAME AND ADDRESS: Cornerstone Environmental Contractors, Inc. 4050 Pike Lane Suite B Concord, CA 94520 In consideration of no change in premium, it is hereby agreed and understood that the above referenced policy is amended as follows: Effective 04/29/2019, added endorsement ENV 2154 B 06 18, in favor of the City of Gilroy. ALL OTHER TERMS AND CONDITIONS OF THE POLICY SHALL APPLY AND REMAIN UNCHANGED. ENV CHANGE 08 16 Page 1 of 1 AGENCY CUSTOMER ID: 570000078408 LOC #: �. ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY NAMED INSURED Aon Risk services, Inc. of Hawaii Cornerstone Environmental Contractors POLICY NUMBER See Certificate Number: 570076042667 CARRIER I NAIC CODE see Certificate Number: 570076042667 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. POLICY POLICY INSR ADDL SUBR POLICY NUMBER EFFECTIVE EXPIRATION LIMITS LTR TYPE OF INSURANCE INSD WVD DATE DATE (MM/DD/YYYY) (MM/DD/YYYY) OTHER B Env Contr Prof ECP2028687-10 03/29/2019 03/29/2020 Prof Liab $2,000,000 Aggregate Prof Liab $1,000,000 Each claim Ded Each $10,000 Claim ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD