COI - Davaco LP - Expires 2021-11-01ACC oRCP CERTIFICATE OF LIABILITY INSURANCE
4.....---
UATE(MMIDDlYYYY)
10/30/2020
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(les) 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
Arthur J. Gallagher Risk Management Services, Inc.
1900 West Loop South, Suite 1600
Houston TX 77027
CONTACT
Stephanie Castle
FAX
PHONE8 713-358-5828 L(A/c, N):713-358-5829
Aormass: Stephanie Castle@ajg.com
INSURER(S) AFFORDING COVERAGE
NAIC if
INSURER A : Aspen American Insurance Company
43460
INSURED DAVAINC-0'I
Davaco LP
4050 Valley View Lane, Suite 150
Irving, TX 75038
INSURER B : Hartford Financial Services Group
29424
INSURER C: National Union Fire Insurance Company of Pittsburg
19445
INSURER: American International Group, Inca
INSURER B:
23841
INSURER F t
COVERAGES
CERTIFICATE NUM
4
85202
REVISION NUMBER:
THIS
INDICATED.
CERTIFICATE
EXCLUSIONS
INBR
LTR
IS TO CERTIFY THAT THE POLICIES
NOTWITHSTANDING ANY REQUIREMENT,
MAY BE ISSUED OR MAY
AND CONDITIONS OF SUCH
TYPE OF INSURANCE
OF INSURANCE
PERTAIN,
POLICIES.
C1aL
INSD
lei
WVO
LISTED BELOW HAVE BEEN ISSUED TO
TERM OR CONDITION OF ANY CONTRACT
THE INSURANCE AFFORDED BY THE POLICIES
LIMITS SHOWN MAY HAVE BEEN REDUCED BY
_._-._ .. _ __—_—___. _.__.._....,.....__ _,..Pmpicv EFF
POLICY NUMB ER (MM/UDNYYY)
THE INSURED
OR OTHER
DESCRIBED
PAID CLAIMS
POLICY GXp
(MM/DD/YYYY)
NAMED ABOVE FOR THE POLICY PERIOD
DOCUMENT WITH RESPECT TO WHICH THIS
HEREIN IS SUBJECT TO ALL THE TERMS,
LIMITS
X
COMMERCIAL GENERAL LIABILITY
61UEADF8281
11/1/2020
11/1/2021
EACH OCCURRENCE
$1,000,000
S
I CLAIMS -MADE I.X.i OCCUR
61UEADF9064
61UEADF9804
11/1/2020
11/1/2020
11/1/2021
11/1/2021
DAMAGE TO RENTED
PREMISEgsge_eeeeronco)-._..$300,00_O
MED EXP (Any one person)
_ _
$10,000
PERSONAL & ADV INJURY
$1,000,000
GEN'L
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
PRODUCTS COMP/OP AGO
$ 2,000,000
$2,000,000
0
AUTOMOBILE
x
LIABILITY
ANY AUTO
AUTOWNED
X
AUTOS LED
AUTOS
NON -OWNED
AUTOS ONLY
CA134'1400
11/1/2020
11/1/2021
COMBINED SINGLE LINII r
BODILY INJURY (Per person)
s1,000,000
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
(Per eroidentl_. u _•._ ._..__ _._,
$
_ .... ... __.... _,_ .... --_-__---
$
A
X
_.�
UMBRELLALIAB
EXCESS LIAR _ ..
1„____..._..........,__..____,.._.__.._..___.__.._,_._-.....
DM I I RETENTION$
X
O
OCCUR
CLAIMS -MADE
___..__._.........__.__..
CX004Q 20
11/1/2020
11/1/2021
EACH OCCURRENCE
$10,000,000
AGGREGATE
$10,000,000
D
D
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANYPRQPRIETOR/PAnTNER/EXECUTING
OFFICER/MEMBEREXCLUDED?
(Mandatory In NH)
If yes, describe under
OF OPERATIONS below
Y/N
N
N/A
WC012326696 - MA, WI, OH, Stop
GWpp
WCO12326695 - FL, OR
WC012326694-CA
WC012326693 - All Other States
61 UEADG2980 - Puerto Rica Stop
11/1/2020
11I1/2021
X
PE
TOTE
ERi
11/1/2020
11/1/2020
11/1/2020
11/1/2020
11/1/2021
11/1/2021
11/1/2021
11/1/2021
E.L. EACH ACCIDENT
El. DISEASE • EA EMPLOYEE
$1,000,000
$ 1,000,000
E.L. DISEASE • POLICY LIMIT
$ 1,000,000
C
Auto Physical Dames
ACV Subject to Deductible
CA1341490
11/1/2020
11/1/2021
Deductibles
See Below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace Is required)
Hired Auto Physical Damage Deductibles:
Hired or Borrowed Autos;
-Comprehensive: $2,500
-Collision: $2,500
FORMS/ENDORSEMENTS IF APPLICABLE:
See Attached...
CERTIFICATE HOLDER
CITY OF GILROY
7351 ROSANNA STREET
GILROY CA 121727
USA
CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED EPRESENTATIVB
m 1988.2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD
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AGENCY CUSTOMER ID: DAVAINC-01
LOC #:
ACORE,
ADDITIONAL REMARKS SCHEDULE
Page i of 1
AGENCY
Arthur J. Gallagher Risk Management Services, Inc.
POLICY NUMBER
CAR IEFI
NAIC CODE
NAMED INSURED
Davaco LP
4050 Valley View Lane, Suite 150
Irving, TX 75038
EPFE TIVE DATE:
ADDITIONAL REMARKS
THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM,
FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY IN URANCE
General Liability
*Form #HS2424 (09/19) — Contractors Broad Form Endorsement — Texas
-Per Project and Per Location General Aggregate Limits of Insurance — A separate Per Project General Aggregate
Limit or a separate Per Location General Aggregate Limit applies to each "project" or "location", whichever Is
applicable. The Per Project General Aggregate Limit and Per Location Aggregate Limit is equal to the amount of
the General Aggregate Limit shown in the declarations
• Form #HG0001 (09/16)— Commercial General Liability Coverage Form
-Other Insurance — Excess Insurance When You Add Others As An Additional Insured to This Insurance —
Primary and Non -Contributory to Other Insurance When Required by Contract
-Transfer of Rights of Recovery Against Others To Us — Waiver of Rights of Recovery (Waiver of Subrogation)
'Form #1H0307 (06/11) — Notice of Cancellation to Certificate Holder(s)
' Form #HS2483 (07/13) — Additional Insured — Owners, Lessees, or Contractors — Option IV
' Form #CG2404 (05/09)— Waiver of Transfer of Rights of Recovery Against Others to Us
Auto Liability
'Form #87950 (09/14) —
. Form #107414 (03/11)
Insured
' Form #62897 (06/95) —
*Form #CA0449 (11/16)
' Form #MCS90 (01/12)
Additional Insured — Where Required Under Contract or Agreement
— Limited Advice of Cancellation Provided Via E-Mail to Entities Other Than the First Named
Waiver of Transfer of Rights of Recovery Against Others to Us
— Primary and Non -Contributory — Other Insurance Condition
— MCS-90 Endorsement
Workers' Compensation
'Form #WC990045 (07/03) — Notice of Cancellation and Nonrenewal to Certificate Holder
'Form #WC000313 04/84) Waiver of Our Right to Recover From Others Endorsement
'Form #VVC340301(., (03/10) — Ohio Employers Liability Coverage Endorsement
' Form #WC994605 (06/16) — Washington Employers Liability Coverage Endorsement
'Form #VVC000303C (10/04) — Employers Liability Coverage Endorsement (All Other States)
'Form #AC0025 (02/95) — Employers Liability and Stop Gap Coverage Form (Puerto Rico)
CITY OF GILROY is additional Insured as respects general liability policy, pursuant to and subject to the policy's terms, definitions, conditions and exclusions
ACORD 101 (200 /01) 2008 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
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