COI - Hammer Trucking, Inc. - Expires 2022-08-0170
ACC)REP CERTIFICATE OF LIABILITY INSURANCE
DATE7/21/2DlYYYY)
7121 l2021
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 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
Noble West Insurance Services License #01310706
205 Natoma Street
Folsom CA 95630
CONTACT
PHONE FAX
E : 916-355-1300 A/C No): 916-355-1306
E-MAIL certificates@noblewest.net
PRODUCER D . HAMME-6
INSURERS AFFORDING COVERAGE
NAIC #
INSURED
Hammer Trucking, Inc.
PO Box 21
INSURER A: Great West Casualty Co.
11371
INSURER B :Travelers Insurance Group
25682
INSURER C :
Woodridge CA 95258
INSURER D
INSURER E
INSURER F :
COVERAGES CERTIFICATE NUMBER: 178815104 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
LTR
TYPE OF INSURANCE
ADDL
SUER
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
GENERAL LIABILITY
MCP51213C
8/1/2021
8/112022
EACH OCCURRENCE
$1,200,000
X COMMERCIAL GENERAL LIABILITY
DAMAGE ( RENTED
PREMISESS Ea occurrence)
$100,000
CLAIMS -MADE a OCCUR
MED EXP (Any one person)
$5,000
PERSONAL & ADV INJURY
$1,200,000
GENERAL AGGREGATE
$2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG
$ 2,000,000
X POLICY PRO LOC
$
A
AUTOMOBILE
LIABILITY
Y
MCP51213C
8/1/2021
8/1/2022
COMBINED SINGLE LIMIT
(Ea accident)
$1 200,OOD
ANY AUTO
BODILY INJURY (Per person)
$
ALL OWNED AUTOS
BODILY INJURY (Per accident)
$
X
SCHEDULED AUTOS
HIRED AUTOS
PROPERTY DAMAGE
(Per accident)
$
X
NON -OWNED AUTOS
$
$
X
Any Commercial Auto
UMBRELLA LIAR
EACH OCCURRENCE
$
HOCCUR
AGGREGATE
$
EXCESS LIAB
CLAIMS -MADE
DEDUCTIBLE
$
$
RETENTION $
WORKERS COMPENSATION
WC STATU OTH-
AND EMPLOYERS' LIABILITY Y/ N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
N / A
E.L. EACH ACCIDENT
$
E.L. DISEASE - EA EMPLOYE
$
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
B
Cargo
QT6601799N510TIL21
7/1912021
7119/2022
$1,000,000 See Description
A
Hired Auto Physical Damag
MCP51213C
8/1/2021
8/1/2022
$25,000 $2,500 Ded
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required)
**SYMBOL 50 - ANY AUTO EXCEPT A PRIVATE PASSENGER TYPE AUTO, VAN OR PICKUP"
Evidence of Insurance. Cargo valued up to $200,000 is subject to $2,500 deductible, cargo valued at
$200,001 to $1,000,000 is subject to $10,000 deductible.
Certificate holder is additional insured with regards to auto liabiltiy.
CERTIFICATE HOLDER 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.
City of Gilroy Public Works Dept.
7351 Rosanna Street
AUTHORIZED REPRESENTATIVE
Gilroy CA 95020
c01988-2009 ACORD CORPORATION. All rights reserved.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
CALIFORNIA EARTHQUAKE AUTHORITY
BASIC EARTHQUAKE POLICY HOMEOWNERS
DECLARATIONS
POLICY NUMBER: CSA0108785
POLICY PERIOD: 12:01 a.m. Pacific Time FROM: 05/10/2021 TO: 05/10/2022
NAMED INSURED AND MAILING ADDRESS:
DENISE CAMPAGNA
SAL CAMPAGNA
1534 ROSETTE WAY
GILROY, CA 95020-2619
The dwelling covered by this policy is located at the above address unless otherwise stated:
We provide coverage at the indicated limits of insurance, subject to the Deductible Clause:
COVERAGE:
A. DWELLING
B. EXTENSIONS TO DWELLING
C. PERSONAL PROPERTY
D. LOSS OF USE
OTHER COVERAGES:
BUILDING CODE UPGRADES
LIMIT OF INSURANCE:
Combined Single Limit:
$350,100
$5,000
$1,500
S 10.000
POLICY DEDUCTIBLE: $52,515 1( 5% OF THE `COVERAGE A: DWELLING"
AND "COVERAGE B: EXTENSIONS TO
DWELLING" COMBINED SINGLE LIMIT OF
INSURANCE)
(Note: Please read the DEDUCTIBLE CLAUSE
of this policy.)
POLICY PREMIUM:
$763.00
POLICY MODIFICATIONS REQUESTED BY YOU
NOTE: THIS POLICY MAY BE SURCHARGED
(Please read the Surcharge Clause of this policy)
Renewal
PLEASE READ YOUR POLICY
BEQ-313 DP (01/2019 edition) Page 1
Mortgagee/Lienholder/Additional Insured (Name and Address):
Loan Number: 000
CITY OF GILROY
7351 ROSANNA ST, GILROY, CA 95020-6141
BEQ-3B DP (01/2019 edition) Page 2