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Jake's Plumbing Service - Insurance Certificate (2019)1 ® I DATE (MM/DDIYYYY) A� L7 CERTIFICATE OF LIABILITY INSURANCE 11 /08/18 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). CONTACT PRODUCER NAME: PHONE FAX925-674-1663 Ferrante Insurance Services, Inc. I Mr. E:t,: 925-674-1755 Noll: 1401 Willow Pass Road Ste 105 I ADDRESS: cs(cDferranteinsurance.com Concord, CA 94520 I INSURER(SI AFFORDING COVERAGE NAIC # OD91034 I INSURERA: Lloyd's Synd 1991 AA1120142 INSURED INSURER B : Jake's Plumbing Services I INSURERC: I INSURER D : 10830 1st Street I INSURER E Gilrov, CA 95020 I 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. ADDLSUBR' . POLICY EFF ' POLICY EXP INSo TYPE OF INSURANCE II,ISD MD POLICY NUMBER (MM/DWYYYY� (MMIDD/YYYYI I LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR A _ Y GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO ❑ LOC JECT OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED _ AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY P AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE_ DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N / A OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below CISDTWO0380218 05/18/18 05/18/19 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 PREMISES (Ea occurrence) $ MED EXP (Any one person) $ 5,000 PERSONAL BADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OPAGG $ 2,000,000 COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) (EACH OCCURRENCE $ (AGGREGATE $ PER STATUTE I EERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Gilroy, its officers, officials and employees are named as additional insured per attached endorsement form #CG 20 10 10 01. Locations: PD lobby, Wheeler Lobby, Corporation Yard Hallway CERTIFICATE HOLDER CANCELLATION The City of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 7351 Rosanna St. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 7 12ED REPRESENTATIVE ©1988-2015�hCORD CORPORATIGN. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD A� ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/08/2018 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 CONT(NAME: Jenesse Corcoran Guardus Insurance Services, Inc. ((PA CNN . Fxtl: (408)201-9410 (.vc, No): (408)904-4707 281 E. Hamilton Ave. Suite 5 E-MAIL CAMPBELL CA 95008 ADDRESS: Jenesse@gsisteam.com I License #: OH81935 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Security National INSURED INSURER B: JAKE MARTINEZ DBA: JAKES PLUMBING SERVICES I INSURER C: 10830 FIRST STREET I INSURERD: GILROY, CA 95020 I INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: 00000000-0 REVISION NUMBER: 1 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 INSURANCE AINSD SUBRI WVD POLICY NUMBER (MM/DDYEFF 1 (MM/DCYEXP D//YYYY1 LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS EACH OCCURRENCE $ I DAMAGE TO RENTED -MADE OCCUR PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE sI POLICY ECT LOC PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY DSINGLE LIMIT (Ea accident) $ANY I O BODILY INJURY (Per person) $ OWNED OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE —I (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ I DED RETENTION$ $ A WORKERS COMPENSATION SWC1201315 AND EMPLOYERS' LIABILITY 08/23/2018 08/23/2019 X I PER I 1OTH- Y / N _ STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y N / A E.L. EACH ACCIDENT $ 1,000,000 (Mandatory In NH) If yes, describe under E.L. DISEASE - EA EMPLOYEE $ 1,000,000 D DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) PROOF OF INSURANCE 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 Street ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE (JC1) @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Printed by JC1 on November 08, 2018 at 01:13PM Cl CW A0210 11 CERTIFICATE OF INSURANCE This certificate Is Issued for Informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the temps, exclusions or conditions of such policies. Coverage Is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder. AMERICAN HOME SHIELD 860 RIDGE LAKE BLVD MEMPHIS, Tr; USA 381209434 Insurer Name: Allstate Insurance Company Named Insured: JACOB MARTTNEZ 10830 1ST ST GILROY CA 95020-9102 Automobile Liability Polic/ Number. 64 8536-72 5• 1 -Any Auto I 12 - Owned Autos Only 3 - Owned Priv. Pass. Autos Only 4 - Owned Autos Other Than Priv. 5 - Owned Autos Subject to 6 - Owned Autos Subject to a Compulsory UM Law Pass. Autos Only No Fault IX 7 - Specifically Described Autos 8 - Hired Autos Only 9 - Nonowned Autos Only Policy Effective Date : 09-26-201 8 I Policy Expiration Date: 99-26-2019 Limits of I $1, 000, 000 I Combined Single Limit (each accident) Insurance: I BI Per Person I BI Per Accident I PD Per Accident Description of Operations/ Locations/Vehicle s/Endorsements/ Special Provisions IInterested Party Type: Additional Insured - All Other I THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT, Producer. BLRRF. TNSURNANCF lGCY TNC Authorized Representative: Cl CW A0210 11 Date: 0?-_3-_0 Includes copyrighted material of Insurance Services Office, Inc., with its permission Allstate Insurance Company Page 1 of 1 Insured Full Copy UMR: B6991SCO2016S01 COMMERCIAL GENERAL LIABILITY POLICY NUMBER: CISDTwo03802 is CG 20 10 10 01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: City of Gilroy, its officers, officials and employees 7351 Rosanna St. Gilroy, CA 95020 Locations: PD lobby, Wheeler Lobby, Corporation Yard Hallway (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) A. Section II - Who Is An Insured is amended to include as an insured the person or organization shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. B. With respect to the additional insureds, added: 2. Exclusions insurance afforded to these the following exclusion is This insurance does not apply to "bodily in- jury" or "property damage" occurring after: (1) All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or (2) That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 10 01 Copyright ISO Properties, Inc., 2000 Page 1 of 1 0