The URL can be used to link to this page

Cummins - Insurance Certificate (2020)SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 11/22/2019 Aon Risk Services Central Inc. 200 E Randolph St., Suite 0900 Chicago, IL 60601 317-841-6004 Old Republic Insurance Company 24147 Allianz Global Risks US Insurance Co 35300 Ace American Insurance Company 22667 A 1,000,000MWZY 302202-19 12/1/2019 12/1/2020 1,000,000 3 10,000 3 1,000,000 4,000,000 18,000,000 A MWTB 314312-19 12/1/2019 12/1/2020 5,000,000 3 3 3 Phy Damage Self Insured B USL 00126119 12/1/2019 12/1/2020 25,000,00033 25,000,000 A MWC 314311-19 12/1/2019 12/1/2020 3 1,000,000N 1,000,000 1,000,000 C Property PEX D37400233 008 8/1/2019 8/1/2020 Limit: $10,000,000 Special Form including Earthquake & Flood Leased/Rented Equipment PEX D37400233 008 8/1/2019 8/1/2020 Limit: $25,000,000 Richard Trakimas A. I. King Insurance Agency, Inc. cummins@aikinginsurance.com 3 Cummins Inc. 500 Jackson Street Mail Code 91676 Columbus IN 47201-6258 52544280 3 3 written contract and per policy terms and conditions. City of Gilroy 613 Old Gilroy Street Gilroy CA 95020 The City of Gilroy, its officers and employees are included as Additional Insureds with respects to General and Auto Liability when required by 52544280 | 19/20 GL AU UMB WC 19/20 PROP (Custom-Merged) | Shelly Pence | 11/22/2019 7:02:25 PM (EST) | Page 1 of 3 5(%081<&,/23 <7,/,%$,//$5(1(*/$,&5(002& *& <//8)(5$&7,'$(5(6$(/3<&,/23(+76(*1$+&71(0(652'1(6,+7 *&FQ,HFLII2VHFLYUH6HFQDUXVQ,IRHJD3 '(7$1*,6('±'(5861,/$12,7,''$ 12,7$=,1$*52521265(3 JQLZROORIHKWUHGQXGHGLYRUSHFQDUXVQLVHLILGRPWQHPHVURGQHVLK7 75$3(*$5(92&<7,/,%$,//$5(1(*/$,&5(002& (/8'(+&6 VQRLWD]LQDJU2U2VQRVUH3GHUXVQ,ODQRLWLGG$I2HPD1 ILHOXGHKF6VLKWHWHOSPRFRWGHULXTHUQRLWDPURIQ,VQRLWDUDOFH'HKWQLQZRKVHEOOLZHYREDQZRKVWRQ GHUXVQ,Q$V,RK:±,,QRLWFH6$RWGHGQHPDVL URVQRVUHSHKWGHUXVQLODQRLWLGGDQDVDHGXOFQL QLQZRKVVQRLWD]LQDJUR\OQRWXEHOXGHKF6HKW \WUHSRUS\UXMQL\OLGREURI\WLOLEDLORWWFHSVHUKWLZ \UXMQLJQLVLWUHYGDGQDODQRVUHSURHJDPDG URVWFDUXR\\EWUDSQLURHORKZQLGHVXDF URVWFDHKWURVQRLVVLPRJQLWFDHVRKWIRVQRLVVLPR IODKHEUXR\QR VQRLWDUHSRJQLRJQRUXR\IRHFQDPURIUHSHKWQ, UR UR\EGHQZRVHVLPHUSUXR\KWLZQRLWFHQQRFQ, XR\RWGHWQHU UHYHZR+ ODQRLWLGGDKFXVRWGHGURIIDHFQDUXVQLHK7 \EGHWWLPUHSWQHW[HHKWRWVHLOSSD\OQRGHUXVQL GQDZDO VLGHUXVQLODQRLWLGGDHKWRWGHGLYRUSHJDUHYRFI, HKWWQHPHHUJDURWFDUWQRFD\EGHULXTHU GHUXVQLODQRLWLGGDKFXVRWGHGURIIDHFQDUXVQL HUDXR\KFLKZWDKWQDKWUHGDRUEHEWRQOOLZ RWWQHPHHUJDURWFDUWQRFHKW\EGHULXTHU GHUXVQLODQRLWLGGDKFXVURIHGLYRUS %HVHKWRWGHGURIIDHFQDUXVQLHKWRWWFHSVHUKWL: RWGHGGDVLJQLZROORIHKWVGHUXVQLODQRLWLGGD HFQDUXVQ,I2VWLPL/±,,,QRLWFH6 VLGHUXVQLODQRLWLGGDHKWRWGHGLYRUSHJDUHYRFI, HZWVRPHKWWQHPHHUJDURWFDUWQRFD\EGHULXTHU HKWVLGHUXVQLODQRLWLGGDHKWIRIODKHEQR\DSOOLZ HFQDUXVQLIRWQXRPD URWQHPHHUJDURWFDUWQRFHKW\EGHULXTH5 IRVWLPL/HOEDFLOSSDHKWUHGQXHOEDOLDY$ VQRLWDUDOFH'HKWQLQZRKVHFQDUXVQ, VVHOVLUHYHKFLKZ HKWHVDHUFQLWRQOODKVWQHPHVURGQHVLK7 HKWQLQZRKVHFQDUXVQ,IRVWLPL/HOEDFLOSSD VQRLWDUDOFH' FQ,VQLPPX&<=:0 llA snosrep ro snoitazinagro sa deriuqer yb tcartnoc rotnemeerga Cummins Inc. 12/01/2019 to 12/01/2020 MWZY 302202-19 52544280 | 19/20 GL AU UMB WC 19/20 PROP (Custom-Merged) | Shelly Pence | 11/22/2019 7:02:25 PM (EST) | Page 2 of 3 POLICY NUMBER: COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Endorsement Effective Date: SCHEDULE Name Of Person(s) Or Organization(s): Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II – Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I – Covered Autos Coverages of the Auto Dealers Coverage Form. MWTB 314312 19 Cummins Inc. 12/01/2019 - 12/01/2020 12/01/19 All Persons or Organizations as Required by Contract or Agreement Cummins Inc. MWTB 314312-19 Cummins Inc. 12/01/2019 to 12/01/2020 52544280 | 19/20 GL AU UMB WC 19/20 PROP (Custom-Merged) | Shelly Pence | 11/22/2019 7:02:25 PM (EST) | Page 3 of 3