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COI - Mike O'Brien Specialized Hauling, Inc - Expires 2022-07-01r CC)Ra> CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 07/01/2021 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(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 CONTACT Carrisa Nowinski NAME: PH N Ext : (559) 225-1300 FAX No : (559) 225-8966 (AI5070 Cal -Valley Insurance Services, Inc. E-MAIL CarriGannralvallPyinsiiranr.P cnm ADDRESS: N. Sixth St. #155 INSURER(S) AFFORDING COVERAGE NAIC # License 40733383 INSURER A: Capitol Specialty Insurance Corp Fresno CA 93710 INSURED INSURER B : Canal Insurance Company Mike O'Brien Specialized Hauling, Inc INSURER C : Scottsdale Insurance Co. 41297 INSURER D : State Compensation Ins Fund 35076 1459 18th Street #162 INSURER E : Hartford Fire Insurance Company 19682 INSURER F : San Francisco CA 94107 COVERAGES CERTIFICATE NUMBER: TRUCK PACKAGE 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 ADDLISUBRI NSD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DDNYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS -MADE © OCCUR DAMAGE TO RENTED PREMISES Ea occurrence) S 250,000 MED EXP (Any one person) S 5,000 $1,000 deductible per claim PERSONAL & ADV INJURY S 1.000,000 A Y CS0281237805 07/01 /2021 07/01 /2022 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLICY PRO- JECT LOC PRODUCTS - COMP/OP AGG S 2,000,000 S OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident S 1,000,000 BODILY INJURY (Per person) S ANY AUTO B OWNED SCHEDULED AUTOS ONLY 25 AUTOS Y 13932500015 07101 /2021 07/01 /2022 BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident S HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY Uninsured motorist BI- S 60.000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ C EXCESS LIAB CLAIMS -MADE XLSo119783 07/01/2021 07/01/2022 DED RETENTION $ S D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? El (Mandatory in NH) N ! A 9242023-20 12/01/2020 12/01/2021 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1,000,000 It yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT S 1,000,000 E Motor Truck Cargo 51 MS FP2381 06/27/2021 06/27/2022 Per Conveya/$1,200,000 Trailer Interc/$50,000 Deduct/10,000 Deduct110,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is roquired) Certificate issued as evidence of coverage maintained by named insured. Certificate holder has been named additional insured. Endorsement to follow from the company. *10 day notice of cancellation for non payment of premium. GtKI IrIGAI t MULUtK GA1NGtLLA11UN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 J"s A. ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD