COI - Wiring Connection Inc. - Expires 2022-06-01--le
A� CERTIFICATE 4F LIABILITY INSURANCE
DATE(M7/2DIYYYY)
01 r2/022
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 terns 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
Brown & Brown Insurance Services of CA, Inc.
CONTACT Judith Villalobos
NAME:
PAHCNN Ext : (714) 221-1800 (AICFAX, No : (714) 221-4196
E-MAIL jvilialobos@bbsocal.com
ADDRESS:
2401 E. Katella Ave.
INSURER(S) AFFORDING COVERAGE
NAIC #
Suite 550
INSURER A: Middlesex Insurance Company
23434
Anaheim CA 92806
INSURED
INSURER B : Great American Insurance Company
16691
Wiring Connection Inc.
INSURER C : Sentry Insurance a Mutual Company
24988
INSURER D :
1718 W. 139th Street
INSURER E :
INSURER F :
Gardena CA 90249
r_nVFRAnFA CERTIFICATE NUMBER! 21/22 GL,Auto & UMB 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 CONTRACTOR 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 INSURANCEADD
INSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MM/DDIYYYY
POLICY EXP
MMIDD/YYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FX] OCCUR
A0125978003
06/01/2021
06/01 /2022
EACH OCCURRENCE
S 1,000,000
DAMAGE RENTED
PREMISES Ea occurrence
$ 500,000
MED EXP (Any one rson)
$ 15,000
PERSONAL & ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PRO-
JECT LOC
OTHER:
GENERAL AGGREGATE
$ 3,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
Employee Benefits
$ 1,000,000
A
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIRED X X NON -OWNED
AUTOS ONLY AUTOS ONLY
A0125978001
06/01/2021
06/01/2022
COMBINED SINGLE LIMIT
(Ea accident
$ 1,000,000
BODILY INJURY (Per person)
S
BODILY INJURY (Per accident)
S
PROPERTY DAMAGE
Per accident
$
$
B
X
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
TUU341547101
06/01/2021
06/01/2022
EACH OCCURRENCE
$ 5.000,000
AGGREGATE
$ 5,000,000
DED I X RETENTION S 10,000
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y 1 N
ANY PROPRIETORMARTNER/EXECUTIVE ❑
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
A0125978005
01/25/2022
01/25/2023
PER OTH-
X STATU TE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYEE
S 1,000,000
E.L. DISEASE - POLICY LIMIT
1,000,000
$
DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
City of Gilroy, its Officers, Officials, Representativess, Agents, Employees, and Volunteers are included as an Additional Insured, as respects to General
Liability, regarding operations of the Named Insured, as required by written contract, per policy form CG2012.
GAN
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 k—AlUo,
01988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD