COI - Mark Nicholson, Inc. - Expires 2022-11-01DATE (MM/DDIYYYY)
,d►� RIB CERTIFICATE OF LIABILITY INSURANCE
11/2/2021
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).
CONTACT
PRODUCER NAME:
Pacific Diversified Insurance Services PHONE 408-842-2131
15005 Concord Circle c N PHONE,
FA1CC, No): 408-842-0867
E-MAIL
Suite 110 ADDRESS:
Morgan Hill CA 95037 INSURER(S) AFFORDING COVERAGE NAIC#
I in-AnsP#• nK07568 INSURER A: Financial Pacific Insurance Company 31453
INSURED MARKNIC-05 INSURER B :
Mark Nicholson, Inc. INSURER C :
701 McCray Street
Hollister CA 95023 INSURER D
INSURER E :
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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.
I�
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
POLICY EFF
MWDDIYYYY
POLICY EXP
MM/DD
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE OCCUR
60531839
11/1/2021
11/1/2022
EACH OCCURRENCE
$1,000,000
DAMAGE TO RENTED
PREMISES Ma occurrence
$ 100,000
MED EXP (Any one person)
$ 5,000
PERSONAL & ADV INJURY
$1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY JEC LOC
OTHER:
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG_
$ 2,000,000
$
A
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
NON -OWNED
X HIRED Ix
AUTOS ONLY AUTOS ONLY
60531839
11/1/2021
11/1/2022
COMBINED SINGLE LIMIT
Ea accident
$1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY DAMAGE
Per accident
$
A
X
UMBRELLA LIAR
EXCESS LIAR
X
I
OCCUR
CLAIMS -MADE
60531839
11/1/2021
11/1/2022
EACH OCCURRENCE
$1,000.000
AGGREGATE
$ 1,000.000
DSO RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y I N
ANYPROPRIETORIPARTNER/EXECU I IVE ❑
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
PER
STATUTE I I ERH
E.L. EACH ACCIDENT
_
$
E.L. DISEASE - EA EMPLOYEE
$
E.L. DISEASE -POLICY LIMIT
$
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
RE: The work performed by the named insured for the certificate holder.
CERTIFICATE HOLDER I.ANLor_LLA1IU14
City of Gilroy
Dept of Roads
7351 Rosanna Street
Gilroy CA 95020
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 REPRESENTATIVE
ACORD 25 (2016103)
v Iaoo-cv r a P%LF%JMu �.a�r�rvrv.►1 16JIV. Hn nynis reserves.
The ACORD name and logo are registered marks of ACORD