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Adams Ashby Group - Insurance Certificate (2020)
-�de DATE (MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 07/18/2019 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. THISERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REP RE E, a ATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: I certiwate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATIONIS WAIVED, sub)ect to tttt rts'and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not conf Its tp tlie''certificate holder in lieu of such endorsement(s). PRO CER ` ? Fs '=' L;UN IAL i USA RANCE AGENCY INC/PHS I NAME: 65812k6 PHONE (866)467-8730 FAX (877)905-2772 (AIC, No, Ext): (A/C, No): The Hartford Business Service Center 3600 Wiseman Blvd E-MAIL San Antonio, TX 78265 ADDRESS: INSURER(S) AFFORDING COVERAGE NAICU INSURED INSURER A: Sentinel Insurance Company Ltd. 11000 ADAMS ASHBY GROUP INC. I INSURER B : Continental Casualty Co. 770 L ST STE 950 INSURER SACRAMENTO CA 95814-3361 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. INSR TYPE OF INSURANCE AuuL 5uan POLICY NUMBER PUuCY EI-h POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYY) (MM/DDIYYYY) COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I X] OCCUR X General Liability A X GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑PRO LOC JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO ALL SCHEDULED A _ AUTOS AUTOS HIRED NON -OWNED X AUTOS X AUTOS _ UMBRELLA LIAR Ut,�Uhc EXCESS LIAR CLAIMS - MADE DED I RETENTION $ WtRIC IRS C MPENSAIIUN AND EMPLOYERS' LIABILITY ANY YIN PROPRIETOR/PARTNERIEXECUTIVE r NIA OFFICERIMEMBER EXCLUDED? E (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below 65 SBA NW6130 06/01/2019 06/01/2020 EACH OCCURRENCE $2,000,0001 DAMAGE TO RENTED $1,000,OOOI PREMISES (Ea occurrence) MED EXP (Any one person) $10,0001 PERSONAL & ADV INJURY $2,000,000 GENERAL AGGREGATE $4,000,000, PRODUCTS - COMP/OPAGG $4,000,000 C6mEiNED SINGLE LIMIT $2,000,000 (Ea accident) BODILY INJURY (Per person) 65 SBA NW6130 06/01/2019 06/01/2020 BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) EACH OCCURRENCE AGGREGATE ISTATUTE I IEERH E.L. EACH ACCIDENT E.L. DISEASE -EA EMPLOYEE E.L. DISEASE - POLICY LIMIT Professional Liability 65 KDG ZF8383 05/19/2019 05/19/2020 Each Occurrence $1,000,000 Aggregate $1,000,000 DESCRIPTION OF OPERATIONS /LOCATIONS /VEHICLES (ACO iD 101, Additional Remarks Schedule, may be attached If more space is required) Those usual to the Insured's Operations. Certificate holder is an additional insured per the Business Liability Coverage Form SS0008 attached to this policy. ty ' I&ICATE HOLDER CANCELLATION I o ilro I 8 OULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 7351 ROSANNA ST BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED GILROY CA 95020-6141 IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE --J'aezv, o CG1DZ2 izca%2� ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD THE HARTFORD Select Customer Insurance Center 3600 WISEMAN BLVD. SAN ANTONIO TX 78251 Policyholder, please call us at: (888) 242-1430 Agent, please call us at: (888) 242-1430 SERVICE.TX@THEHARTFORD.COM INSURANCE ENDORSEMENT ATTACHED *** PLEASE REVIEW THE CHANGE *** Enclosed is an endorsement for your business insurance policy. Please review it at your convenience. If you have questions or need to make further changes: Policyholder, please call us at: (888) 242-1430 Agent, please call us at: (888) 242-1430 between 7 A.M. and 7 P.M. CST. The premium billing will be mailed to you separately. You can expect to receive it soon. Thank you for allowing us to service your business needs. USAA INSURANCE AGENCY INC/PHS THE HARTFORD SELECT CUSTOMER INSURANCE CENTER The Hartford Hartford Fire Insurance Company and its Affiliates One Hartford Plaza, Hartford, Connecticut 06155 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY CHANGE This endorsement changes the policy effective on the Inception Date of the policy unless another date is indicated below: POIIcyNumber: 65SBANW6130 DX Named Insured and Mailing Address; ADAMS ASHBY GROUP, INC SEE FORM SS1235 770 L ST. STE 950 SACRAMENTO CA 95814 Policy Change Effective Date: 07/31/19 Effective hour is the same as stated in the Declarations Page of the Policy. Policy Change Number: 001 Agent Name: USAA INSURANCE AGENCY INC/PHS Code: 812846 POLICY CHANGES: SENTINEL INSURANCE COMPANY, LIMITED ANY CHANGES IN YOUR PREMIUM WILL BE REFLECTED IN YOUR NEXT BILLING STATEMENT. IF YOU ARE ENROLLED IN REPETITIVE EFT DRAWS FROM YOUR BANK ACCOUNT, CHANGES IN PREMIUM WILL CHANGE FUTURE DRAW AMOUNTS. THIS IS NOT A BILL. NO PREMIUM DUE AS OF POLICY CHANGE EFFECTIVE DATE FORM NUMBERS OF ENDORSEMENTS REVISED AT ENDORSEMENT ISSUE: IH12001185 ADDITIONAL INSURED - PERSON -ORGANIZATION PRO RATA FACTOR: 0.838 THIS ENDORSEMENT DOES NOT CHANGE THE POLICY EXCEPT AS SHOWN. Form SS 1211 04 05 T Page ool Process Date: 07/31/19 Policy Effective Date: 06/01/19 Policy Expiration Date: 06/01/20 POLICY NUMBER: 65 SBA NW6130 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON -ORGANIZATION COMMUNITY DEVELOPMENT COMMISSION OF THE CITY OF ROHNERT PARK 130 AVRAM AVE. ROHNERT PART, CA 94928 CITY OF TRACY 333 CIVIC CENTER PLAZA TRACY CA 95376 COUNTY OF TEHANA IT'S ELECTIVE OFFICIALS, 727 OAK STREET RED BLUFF, CA 96080 COUNTY OF YOLO 625 COURT ST STE 202 WOODLAND, CA 95695 OFFICERS, EMPLOYEES AND VOLUNTEERS VALLEY CONTRACTORS EXCHANGE 951 EAST 8TH ST. CHICO, CA. 95928 COUNTY OF NEVADA, AND ITS OFFICERS, AGENTS, EMPLOYEES & VOLUNTEERS 950 MAIDU AVE NEVADA CITY, CA 95959 RE: LOC 001 & 002 BLDGS 001 CALAVERAS HEALTH AND HUMAN SERVICES AGENCY ATTENTION: MARK KSENZULAK 509 EAST ST. CHARLES STREET SAN ANDREAS, CA 95249 Form M 12 00 11 85 T SEQ. NO. 003 Printed in U.S.A. Page 001 (CONTINUED ON NEXT PAGE) Process Date: 07/31/19 Expiration Date: 06/01/20 POLICY NUMBER: 65 SBA NW6130 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON -ORGANIZATION CITY OF GILROY ITS OFFICERS, OFFICIALS 7351 ROSANNA ST GILROY, CA 95020 THE CITY OF FORT BRAGG, AND VOLUNTEERS 416 N FRANKLIN STREET FORT BRAGG, CA 95437 AND EMPLOYEES ITS OFFICIALS, OFFICERS, EMPLOYEES, AGENTS, CITY OF ANGELS CAMP PO BOX 667 ANGELS CAMP CA 95222-0667 Form IH 12 00 11 85 T SEQ. NO. 003 Printed in U.S.A. Page 002 (CONTINUED ON NEXT PAGE) Process Date: 07/31/19 Expiration Date: 06/01/20 Ac o� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNMI �.. I 12116/2019 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(lies) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the tenns 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 Jeff Draper PHONE 530846-2749 I FAX 530846-5387 ` rl 1AIC. No. Extl: IA/C. Not: -- 300 SPRUCE ST SUITE B aoo IR,_ ___ s, leff.draper.gah7 @StateFarm.com GRIDLEY CA 95948 INSURER(S) AFFORDING COVERAGE NAIC d INSURER A. State Farm Fire and Casualty Company 26143 INSURED INSURER S ADAMS ASHBY GROUP INC INSURER C: 770 L ST SUITE 950 INSURERD: SACRAMENTO, CA 95814-3361 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. INSR ADDL SUBR POLICY EFF - POLICY EXP -- LTR TYPE OF INSURANCE I nJSD wvn POLICY NUMBER IMMIMIYYYYI I twwomYYYYI I LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE =OCCUR I I I GEE���N'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- ❑ LOC I OTHER: J❑CT AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY i UMBRELLALIAB OCCUR rEXCESS UAB I ; CLAIMS -MADE DED I I RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N A ANY PROPRIETOR/PARTNERIEXECUI OFFICERAI EMBER EXCLUDED7 I NIA (Mandatory, in NHI If yes, descuibe under DESCRIPTION OF OPERATIONS below EACH OCCURRENCE S UAMAUL I O HLN1 LU PREMISES (Ea occurrence) S MED EXP (Any one person) $ I PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS -COMPIOPAGG 13 Ig COMBINED SINGLE LIMIT (Ea accidentl I S I BODILY INJURY (Per person) S BODILY INJURY (Par accident) � $ (PROPERTY DAMAGE S (Per accident) S EACH OCCURRENCE Is (AGGREGATE Is I s OTH- IXI PER I I FIR 90 EH-K217-4 F 04/04/2019 04/04/2020 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE S 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL HE DELIVERED IN CITY OF GILROY ACCORDANCE WITH THE POLICY PROVISIONS. 7351 ROSANNA ST ENT E - GILROY, CA 95020 AUTHORIZED REPRES ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD ^001486 132849.12 03-16-2016