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COI - Temp Power Systems - Expires 2024-10-01.. , TEMPPOW-01 JLOPEZ I ACORD'' CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) ~ 9/25/2023 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 22-~If_cT_ Jessicil _Lopez Commercial The Brokerage r.JJ8~o, Ext): (94_9)_ 287-5677 ........ •• FAX The Brokerage, an Alera roup Company __ (A/C,No): 20261 SW Acacia St, Suite 200 li>Mo'N~ss, jle>l)f!~@the~rok~l'cl{leins.cort(_ Newport Beach, CA 92660 _IIIIS_UREll(S) AJ'Jf)_RDJIIIG COVE:11119_E __ NAIC# ---- ---------LNSUl{ER A, T_oldo Marin~ Specialty Insurance Company 23850 INSURED 1r,isuREIIB:~ATIQfllW.IDE MUfU_AL INSUl!t\NCE COMPANY:23787 Temp Power Systems JNsu111:R c .= Travelers Casualty an~ Surety C<>mpany ··• 19038 22516 Avenida Empresa INSURER D :JCW -INSURANCE COMPANY OF THE WEST ;27847 Rancho Santa Margarita, CA 92688 INSURER E: - INSURER F: COVERAGES CERTIFICATE NUMBER• 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. 1~:: i TYPE 0-FINSU~;~E --!tt\WJiW:Jtl P~LICY NUMBER [ ,tghl%M~~\ ,tgfJiYv~~~\ ; LIMITS A , X 1. COMMERCIAL GENERAL LIABILITY 1 1. i 7 CLAIMS-MADE i X 1 OCCUR i ! I i -- ii GEN'L AGGREG;;~-~IMIT APPLIES PER: 't • i i x· 7 PRO-1-1 1 POLICY l . ! JECT . ' LOC I I OTHER: B I AUTOMOBILE LIABILITY ! X j ANY AUTO . -• i OWNED i-; AUTOS ONLY : ~lf/oDs ONL y ' SCHEDULED AUTOS , NON-OWNED . , AUTOS ONLY C X UMBRELLA LIAB X i OCCUR : ! .. EXCESS Ll:B _ ··-, CLAIMS:~/\DE: ' i DED I ' RETENTION$ D WORKERS COMPENSATION I AND EMPLOYERS' LIABILITY iPPK2607285 1 ACP 3110291755 1 i iCUP-1W792130-23-NF ! i I x iwsD 5062304 02 · ANY PROPRIETOR/PARTNER/EXECUTIVE y ./ N, ' : PJI~~il;f~,~~lli' EXCLUDED? N 7 A· \ If yes, describe under 'DESCRIPTI0N OF OPERATIONS below : I 10/1/2023 10/1/2024 1 1/8/2023 1/8/2024 EACH OCCURRENCE : DAMAGE TO RENTED : PREMISE$ (E1a..occurrence) M~Q EXP (A11y one.r,er.son) : PERSCJN6~ &/>JJV JNJURY $ i $ GENERAL/\GQ[\E_<3ATE : $ PRODUC:Hl_c_COMP/OP AGG .. $ I . $ fE~~~i~~~tflNGLE LIMIT $ . BODILY INJURY_(Per person) t $ BOQIL'i'INJUBY (Per ?CQident). $ PROPERTY DAMAGE . (Per acgid.<>Qt) . EACH OCCUR[\E:NCE _ 10/1/2023 I 10/1/2024 AGGRE:<3£\TE _ $ I 10/1/2023 I : j X ~ ~l~TUT.E . I gJH- 101112024 : E.L.E_Ac;f:1 ACCIPENT .. .. : $ E.L. DISEASE -EA EMPLOYEE, $ E.L. DISEASE -POLICY LIMIT $ 1,000,000 1,000,000 10,000 -1,000,000 ••• 2,000;000 2;000,000 1,000,000 5,000,000 -5,ooo,ooo 1,000,000 1,000,000 1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: Track #IN-2898 • City of Gilroy, CA, WCWV Waiver of Subrogation for Workers' Compensation: See Attached Endorsement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna St. ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE C4? ...__,, ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: TEMPPOW-01 JLOPEZ ------------------ LO C #: 1 ------- ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED Commercial The Brokerage Tem1> Power Systems 22516 Avenida Empresa POLICY NUMBER Rancho Santa Margarita, CA 92688 SEE PAGE 1 CARRIER i NAIC CODE SEE PAGE 1 isEE P 1 EFFECTIVE DATE: SEE PAGE 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance Cancellation: *Should this policy be cancelled before the expiration date, The Brokerage, an Alera Group Company will mail 30 (thirty) days written notice to those Certificate Holders which require such action per contract or agreement.• *Except 10 Days Notice of Cancellation for Non-Payment of Premium. ACORD 101 (2008/01) © 2008 ACORD CORPORATION, All rights reserved, The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT· BLANKET WC 99 06 34 (Ed. 8-00) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us). The additional premium for this endorsement shall be 2 % of the total California Workers' Compensation premium otherwise due. Person or Organization ANY PERSON/ ORG WHEN REQUIRED BY WRITTEN CONTRACT Schedule Job Description ALL CA OPERATIONS This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 10/01/2023 Policy No. WSD 5062304 02 Insured TEMP POWER SYSTEMS Insurance Company INSURANCE COMPANY OF THE WEST Endorsement No. Premium$ INCL, Countersigned By ____________ _ WC 99 06 34 (Ed. 8-00) INSURED