COI - W.C. Drilling, Inc. - Expires 2023-01-01�►� o® CERTIFICATE OF LIABILITY INSURANCE
DATE /30120 r1
1230/2Q21
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 Mindy Krieger
NAME:
Brown & Brown Insurance Services of California, Inc
PHONE (800) 733-3131 1 FAX
A/C Na E . A/C No):
3697 Mt. Diablo Blvd, Ste 100
ADNIAIL DRESS: mkdeger@bbnca.com
INSURER(S) AFFORDING COVERAGE
NAIC p
Lafayette CA 94549-3745
INSURER A: Evanston Insurance Company
INSURED
INSURER B : Vantapro Specialty Insurance Company
W.C. Drilling, Inc.
INSURER C :
PO BOX 254
INSURER D :
INSURER E .
Pinole CA 94564
INSURER F :
COVERAGES CERTIFICATE NUMBER: 22/23 Master REVISION N"MRFR-
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.
NSR
LTR
TYPE OF INSURANCE
ADDLSUBR
INSD
WVQ
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE FX] OCCUR
EACH OCCURRENCE
$ 1,000,000
PREMISES Ea occurrence
$ 50,000
MED EXP (Any one person)
$ 5,000
PERSONAL &ADV INJURY
$ 2,000,000
A
Y
MKLV5ENV103395
01/01/2022
01/01/2023
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY N JECT LOC
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OP AGG
$ 2,000,000
S
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
Ea accident)$
1,000,000
BODILY INJURY (Per person)
$
ANYAUTO
B
OWNED SCHEDULED
AUTOS ONLY AUTOS
5087-0795-01
01/01/2022
01/01/2023
BODILY INJURY (Per accident)
S
X HIRED IXNON-OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY DAMAGE
Per accident
S
$
XI
UMBRELLA LIAB
HCLAIMS-MADE
OCCUR
EACH OCCURRENCE
$ 5,000,000
AGGREGATE
$ 5,000,000
A
EXCESS LIAR
MKLV5EFX100882
01/01/2022
01/01/2023
DEO I X RETENTION S 0
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETORIPARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
N / A
PER OTH-
STATUTE I ER
E.L. EACH ACCIDENT
$
E.L. DISEASE - FA EMPLOYEE
$
(Mandatory in NH)
If ya=, descri'x undo:
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$
A
Pollution Liability
Retro Date 1/1/2001
MKLV5ENV103395
01/01/2022
01101/2023
Per Claim
Aggregate
2,000,000
Included
Retention
10,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
The City of Gilroy is included as Additional Insured if required by written contract and per form CG2010/CG2037 attached to the General Liability policy with
respect to their interest in liability arising from the operations of the Named Insured
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
@ 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD