Loading...
COI - Davaco LP - Expires 2023-11-01ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDnyyY) 1 10/27/2022 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 Arthur J. Gallagher Risk Management Services, Inc. 1900 West Loop South, Suite 1600 Houston TX 77027 NAMEA T Stephanie Castle FAz :713-358.5829 PHONE . 713-358-5828 No E-MAIL ADDRESS: Stephanie Castle@ajg.com INSURERS AFFORDING COVERAGE NAIC9 INSURER A: Aspen American Insurance Company 43460 INSURED DAVAINC41 coLP 050 4050Valley View Lane, Suite 150 INSURERS: National Union Fire Insurance Company Of Pittsburg19445 INSURER C:Hartford Accident and Indemnit Company 22357 INSURER D: AIU Insurance Company 19399 Irving, TX 75038 INSURER E: Commerce and Industry Insurance Company 19410 INSURER F: COVERAGES CERTIFICATE NUMBER: 722449717 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 LTA TYPE OF INSURANCE AODLSUBR POLICY NUMBER POLICY EFF MM/OMW POLICY EXP MWDD/YY LIMITS C X COMMERCIAL GENERAL LIABILITY 61UEAAU6KTG 1111/2022 11/1/2023 OCCURRENCE $11000.000 CLAIMS -MADE � OCCUR ISES Eao r n a $300.000 EXP (An one .1 s10000 ONAL& AOV INJURY [F� $1,000,000GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ®jEa a LOC RAL AGGREGATE $2.000,000 UCTS-COMP/OP AGG 52,000,000 OTHER: S B AUTOMOBILE LIABILm CA1341490 11/1/2022 11/1/2023 COMBINED SINGLE LIMIT Ea acddent S1,000.000 BODILY INJURY (Par person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLYMAUTOS BODILY INJURY Par oxidant)$ X PPTY Pgtracatl n�AMAGE $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLAUAB OCCUR CXOD4QQ22 11/1/2022 11/1/2023 EACH OCCURRENCE $10.000,000 N AGGREGATE $10.000,000 EXCESS LIAR CLAIMS -MADE DIED I I RETENTION$ $ D E D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETORIPARTNEWEXECUTIVE OFFICER/MEMBEREXCLUDED7 NIA WC 013751716 WC 013751717 WC 013751718 11/1/2022 11/1/2022 11/1/2022 11/1/2023 11/1/2023 11/1/2023 PER TH- STATUTE ER E.L. EACH ACCIDENT $1,000,000 E.L DISEASE - EA EMPLOYEE $1,000,000 (Mandatory In NH) If yyea, describe wrier DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT — $1,000,000 B Auto Phyysical Damage ACV Su Jed to Deductible CA1341490 11/1/2022 11/1/2023 Deductibles See Below DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more apace is required) �P`�„--, Hired Auto Physical Damage Deductibles: Hired or Borrowed Autos: NOV �� Z�ZZ -Comprehensive: $2,500 -Collision: $2,500 FORMS/ENDORSEMENTS IF APPLICABLE: GILROY CITY CLERICS OFFICE See Attached... CITY OF GILROY 7351 ROSANNA STREET GILROY CA 121727 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. � b ! Q 1988.2015 ACORn CORPORATION. All riOMs reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD Arthur J. Gallagher Risk Management Services, Inc. Six Desta Dr., Ste. 5900 Midland TX 79705 MDG2022 00001097 02 11111,111111111114 CITY OF GILROY 7351 ROSANNA STREET GILROY, CA 121727 We are providing you with a Certificate of Insurance confirming our client's coverage. Want to get certificates of insurance faster? "Go Green with Gallagher" by receiving digital copies of certificates via e-mail in the future. Or, do you no longer require a certificate of insurance for our client? Please contact us at COI.UpdateMyEmail@AJG.com and provide the following information for processing: 1. Confirmation that a certificate of insurance is no longer required; or 2. E-mail address to send future certificates of insurance in lieu of U.S. Mail delivery 3. Insured Code: DAVAINC-01 4. This Certificate Number: 722449717 To learn more about the Insurance and Risk Management Services offered by Gallagher, please visit us at www.ajg.com/us/about-us/how-we-work/core-360. Gallagher does not share your e-mail as detailed in our privacy policy found at https:// www.ajg.com/us/privacy-policy/. AGENCY CUSTOMER ID: DAVAINC-01 LOC #: ,aco ADDITIONAL REMARKS SCHEDULE �" Page 1 of 1 AGENCY Arthur J. Gallagher Risk Management Services, Inc. NAMED INSURED Davaco LP 4050 Valley View Lane, Suite 150 Irving, TX 75038 POLICY NUMBER CARRIER NA1C CODE EFFECTIVE DATE: REMA ITHIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, I FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE General Liability -Form #HS2424 (12/20) - 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 #IH0307 (06/11) — Notice of Cancellation to Certificate Holder(s) •Form #HS2483 (07/13) — Additional Insured — Owners, Lessees, or Contractors — Option IV •Form OCG2404 (05/09) — Waiver of Transfer of Rights of Recovery Against Others to Us Hired Non -Owned Auto Liability •Form #87950 (09/14) — Additional Insured — Where Required Under Contract or Agreement -Form #107232 (03/11) — Limited Advice of Cancellation To Entities Other Than The First Named Insured •Form #62897 (06/95) — Waiver of Transfer of Rights of Recovery Against Others to Us -Form #74445 (10/99) — Insurance Primary As To Certain Additional Insureds •Form #MCS90 (04/21) — Endorsement for Motor Carrier Policies of Insurance for Public Liability under Sections 29 and 30 of the Motor Carrier Act of 1980 FORM MCS-90 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 #WC340301 C (03/10) — Ohio Employers Liability Coverage Endorsement -Form #WC000303C (10/04) — Employers Liability Coverage Endorsement (All Other States) 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 (2008/01) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT!! This endorsement, effective 12:01 A.M. 11 /01 /2021 forms a part of Policy No. CA 134-14-90 issued to DAVACO, LP By NATIONAL UNION FIRE INSURANCE COMPANY OF PITTSBURGH, PA THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. LIMITED ADVICE OF CANCELLATION TO ENTITIES OTHER THAN THE FIRST NAMED INSURED This policy is amended as follows: In the event that the Insurer cancels this policy for any reason other than non-payment of premium, and 1. the cancellation effective date is prior to this policy's expiration date; 2. the First Named Insured is under an existing contractual obligation to notify a certificate holder when this policy is canceled (hereinafter, the "Certificate Holders)") and has provided to the Insurer, either directly or through its broker of record, either: (a) the name of the entity shown on the certificate, a contact name at each such entity and the U.S. Postal Service address of each such entity; or (b) the email address of a contact at each such entity; and 3. the Insurer received this information after the First Named Insured receives notice of cancellation of this policy and prior to this policy's cancellation effective date, via an electronic spreadsheet that is acceptable to the Insurer, the Insurer will provide advice of cancellation (the "Advice") to such Certificate Holders within 30 days after the First Named Insured provides such information to the Insurer; provided, however, that if a specific number of days is not stated above, then the Advice will be provided to such Certificate Holder(s) as soon as reasonably practicable after the First Named Insured provides such information to the Insurer, Proof of the Insurer emailing or mailing the Advice, using the information provided by the First Named Insured, will serve as proof that the Insurer has fully satisfied its obligations under this endorsement. This endorsement does not affect, in any way, coverage provided under this policy or the cancellation of this policy or the effective date thereof, nor shall this endorsement invest any rights in any entity not insured under this policy. The following Definitions apply to this endorsement: 1. First Named Insured means the Named Insured shown on the Declarations Page of this policy. 2. Insurer means the insurance company shown in the header on the Declarations Page of this policy. All other terms, conditions and exclusions shall remain the same. A-7�-� - Authorized Representative 107232 (03/11) Page 1 NOTICE OF CANCELLATION AND NON -RENEWAL TO CERTIFICATE HOLDER This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 11 /01 /2021 forms a part of Policy No. WC 013-751-691 Issued to DAVACO, INC. By COMMERCE AND INDUSTRY INSURANCE COMPANY This endorsement, modifies Insurance provided under the fallowing: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY W We shall provide written notice in accordance with state law in the event this policy is cancelled or nonrenewed, for any reason other than non payment of premium, to those entities set out in the schedule below. Schedule Notice will be mailed to: AS REQUIRED BY WRITTEN CONTRACT To the attention of: Contract, Permit or Job Number: .r • WC990045 Countersigned by______________________________ (Ed. 07103) SPECIMEN Authorized Representative NOTICE OF CANCELLATION AND NON -RENEWAL TO CERTIFICATE HOLDER This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 11 / 01 / 2021 forms a part of Policy No. WC 013-751-692 Issued to DAVACO , LP By A I U INSURANCE COMPANY This endorsement, modifies Insurance provided under the following: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY We shall provide written notice in accordance with state law in the event this policy is cancelled or nonrenewed, for any reason other than non payment of premium, to those entities set out in the schedule below. Schedule Notice will be mailed to: AS REQU I RED BY wR I TTEN CONTRACT To the attention of: Contract, Permit or Job Number: WC990045 Countersigned by______________________________ (Ed. 07/03) DRAFT Authorized Representative NOTICE OF CANCELLATION AND NON -RENEWAL TO CERTIFICATE HOLDER This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 11 /01 /2021 forms a part of Policy No. WC 013-751-693 Issued to DAVACO, INC. By AIU INSURANCE COMPANY This endorsement, modifies Insurance provided under the following: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY r We shall provide written notice in accordance with state law in the event this policy is cancelled or nonrenewed, for any reason other than non payment of premium, to those entities set out in the schedule below. Schedule Notice will be mailed to: AS REQUIRED BY WRITTEN CONTRACT To the attention of: Contract, Permit or Job Number: go - � � P �t - �� te---Qt WC990045 Countersigned by______________________________ (Ed. 07/03) SPECIMEN Authorized Representative NOTICE OF CANCELLATION AND NON -RENEWAL TO CERTIFICATE HOLDER This endorsement changes the policy to which it is attached effective on the inception date of the policy unless a different date is indicated below. (The following "attaching clause" need be completed only when this endorsement is issued subsequent to preparation of the policy). This endorsement, effective 12:01 AM 11 /01 /2021 forms a part of Policy No. WC 013-751-694 Issued to DAVACO, INC. By COMMERCE AND INDUSTRY INSURANCE COMPANY This endorsement, modifies Insurance provided under the following: WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY We shall provide written notice in accordance with state law in the event this policy is cancelled or nonrenewed, for any reason other than non payment of premium, to those entities set out in the schedule below. Schedule Notice will be mailed to: AS REQUIRED BY WRITTEN CONTRACT To the attention of: Contract, Permit or Job Number. WC 99 00 45 (Ed. 07103) Countersigned by______________________________ SPECIMEN Authorized Representative POLICY NUMBER: 61 UEA DF8281 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for nonpayment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. B. If this policy is cancelled by the Company for nonpayment of premium, or by the insured, notice of such cancellation will be provided within (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Form IH 03 07 06 11 Page 1 of 1 © 2011, The Hartford POLICY NUMBER: 61 UEA DF9064 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO CERTIFICATE HOLDER(S) This policy is subject to the following additional Conditions: A. If this policy is cancelled by the Company, other than for nonpayment of premium, notice of such cancellation will be provided at least thirty (30) days in advance of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. B. If this policy is cancelled by the Company for nonpayment of premium, or by the insured, notice of such cancellation will be provided within (10) days of the cancellation effective date to the certificate holder(s) with mailing addresses on file with the agent of record or the Company. If notice is mailed, proof of mailing to the last known mailing address of the certificate holder(s) on file with the agent of record or the Company will be sufficient proof of notice. Any notification rights provided by this endorsement apply only to active certificate holder(s) who were issued a certificate of insurance applicable to this policy's term. Form IH 03 07 06 11 Page 1 of 1 0 2011, The Hartford . d LV9600 L601UU 90 9U ODUUUU -k a) a3 c m C c� U) 4-3 w 30 V♦ O p N a) O 3 "low W O a) = c a� �'O J ❑ CL w L- v U C. J CL ca O o aUi �' U c, c �_ _0 Cg ar c o U E E ctsg ca c2 U v ❑ �' 15 —-2 O-t a)Q C C 3 U V Q U a.-. 0 o 0 V U -Qp O 'a tm -- W � . OC c_ O U d a).� to C y ~"-�ca ..0 .4—U-- «. cm ca N d a) O Q 'C EwL. -U=V — Q Ia) O EW p 'a �i r♦ V U :(a O U V N L cQU)A a ~ O C V M U O V O - .0 Q N � � 0 CO) w ~ a) ccoc a -0 a Q- cav•��cuE E2'3 o � z J c E o N a-i cU U N� � c U- _ W 3 A c — U p 'Cu .c a� (� o � � a " .r o Q F- Z Z .� •+ Ea aD�a .6- W W r 0 �C°'r30 L0 'd Q' > ca N N Q_ G U t V°Q��'0 c0i�3 "-' A c E 0: LL cQ'�o�0 m E a> "r U O cu N N Z W W N N CL C(a O U c >� +� V~ Z Q ca �' 0 Cc a) E AA yr cn�(D�a�a3i cn�V Z Na `-�v�°o `=-co IL� � a m t0 a a M O S E 0 LL rif l J