LN Curtis - Insurance Certificate (2020)DATE (MM/DDIYYYY)
ACC> & CERTIFICATE OF LIABILITY INSURANCE I 06/05/2019
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).
PRODUCER (CONTACT
MARSH RISK & INSURANCE SERVICES NAME:
345 CALIFORNIA STREET, SUITE 1300 I PA/C.NNo. Ext): I A/C, No):
CALIFORNIA LICENSE NO.0437153 E-MAIL
SAN FRANCISCO, CA 94104 ADDRESS:
Attn: sanfrancisco.cerfs@marsh.com; Fax: 212-948-0398 I INSURER(S) AFFORDING COVERAGE NAIC #
CN101797553-STND-GAWU-19-20 I INSURER A: Federal Insurance Company 20281
INSURED INSURER B : Great Northern Insurance Company 20303
L. N. Curtis & Sons, Inc.
Attn: John Viboch, CFO I INSURER C :
1800 Peralta Street
Oakland, CA 94607-1603 INSURER D
I INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER: SEA-003613478-02 REVISION NUMBER: 2
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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP
/YLIMITS
LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DDYYY)
A X COMMERCIAL GENERAL LIABILITY 36023726 04/01/2019 04/01/2020 EACH OCCURRENCE It 1000 000
CLAIMS -MADE F_x1 OCCUR
GEN'L AGGREGATE LIMIT APPLIES PER:
X
POLICY JE C
LOC
OTHER:
B AUTOMOBILE LIABILITY
X
ANY AUTO
OWNED
SCHEDULED
_
AUTOS ONLY
AUTOS
X
HIRED X
AUTOS ONLY
NON -OWNED
AUTOS ONLY
UMBRELLA LIAB OCCUR
EXCESSIL HCLAIMS-MADE
DED I I RETENTION $
A WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANYPROPRI ETOR/PARTNER/EXECUTIVE
OFFICER/MEMBEREXCLUDED? NI NIA
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
73583643 04/01/2019 04/01/2020
71737666 04/01/2019 04/01/2020
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 1,000,000
MED EXP (Any one person)
$ 10,000
PERSONAL & ADV INJURY
$ 1,000,000
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
PER PROJECT AGG
$ 5,000,000
COMBINED SINGLE LIMIT
(Ea accident)
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
$
(Per accident)
COMP/COLL DEDS:
$ 1,000
EACH OCCURRENCE
$
(AGGREGATE
$
X I SER TATUTE I I OERH
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
Re: Service performed on Hurst extrication tools.
City of Gilroy, its officers and employees are included as additional insureds for General Liability where required by written contract.
CERTIFICATE HOLDER CANCELLATION
Gilroy City Fire Department SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
7070 Chestnut Street THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Gilroy, CA 95020 ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh Risk & Insurance Services
Kirsten Thomson
@ 1988-2016 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
CHUBB* Liability Insurance
Endorsement
Policy Period APRIL 1, 2019 TO APRIL 1, 2020
Effective Date APRIL 1, 2019
Policy Number 3602-37-26 SFO
Insured L.N. CURTIS & SONS
Name of Company FEDERAL INSURANCE COMPANY
Date Issued APRIL 8, 2019
This Endorsement applies to the following forms:
GENERAL LIABILITY
Under Who Is An Insured, the following provision is added.
Who Is An Insured
Additional Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are
Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by
Or Organization this policy.
However, the person or organization is an insured only:
• if and then only to the extent the person or organization is described in the Schedule;
• to the extent such contract or agreement requires the person or organization to be afforded
status as an bmwed-,
• for activities that did not occur, in whole or in part, before the execution of the contract or
agreement; and
• with respect to damages, loss, cost or expense for injury or damage to which this insurance
applies.
No person or organization is an insured under this provision:
• that is more specifically identified under any other provision of the Who Is An Insured
section (regardless of any limitation applicable thereto).
• with respect to any assumption of liability (of another person or organization) by them in a
contract or agreement. This limitation does not apply to the liability for damages, loss, cost or
expense for injury or damage, to which this insurance applies, that the person or organization
would have in the absence of such contract or agreement.
Liability Insurance Additional Insured - Schedubd Person Or Organization continued
Form 80-022367 (Rev. 5-07) Endo ement page i
Liability Endorsement
(continued)
Under Conditions, the following provision is added to the condition titled Other Insurance.
• r •
Other Insurance -- If you are obligated, pursuant to a contract or agreement, to provide the person or organization
Primary, Nonconfributory shown in the Schedule with primary insurance such as is afforded by this policy. then in such case
Insurance —Scheduled this insurance is primary and we will not seek contribution from insurance available to such person
Person Or Organization or organization.
Schedule
Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with
such insurance as is afforded by this policy.
All other terms and conditions remain unchanged.
Autho ized Rsprosentative Q�N
Liability Insurance Addiffonallnsured - Scheduled Person OrOrganiiation kist page
Form 80-022367(Rev: 5-07) Endorsement Page 2