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JetMulch - Insurance Certificate (2019)JETMULC-01 MICHAELAI .d►` CERTIFICATE OF LIABILITY INSURANCE I DATE 02/251201 YY) 02/25/2019 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). License # OE67768 CONTACT Tor! Young PRODUCER NAME: IOA Insurance Services PHONE FAX LAIC, No, Ext): (925) 660-1397 (A/C, No): 3875 Hopyard Road I E-MAIL Tori.Young@ loausa.com Suite 200 ADDRESS: Pleasanton, CA 94588 I INSURER(SI AFFORDING COVERAGE NAIC # INSURER A: Wesco insurance Company 25011 INSURED INSURER B : Rockhill Insurance Company 28053 Jet Mulch, Inc INSURER C P.O. BOX 1667 I INSURER D Capitola, CA 95010 I 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 POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 'OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS. INSR ADDL SUBR POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE INSD WVD POLICY NUMBER ;MM/DD/YYYYI (MM/DD/YYYYI A X 6OMMEROAL GENERAL LIABILITY EACH OCCURRENCE $ 1'000,0001 LIR CLAIMS -MADE [X] OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY �X PRCT O- ❑ LOC JE OTHER: A AU 11110B'I'LE VABIL1TY X WPP144738802 04101/2018 04101/20191 DAMAGE TO RENTED PREMISES (Ea occurrence) $ X ANY AUTO WPP144738802 0410112018 04/0112019I OWNED SCHEDULED _ AUTOS ONLY AUTOS X HIAURED N NON -OWNED TOS ONLYAUTOS ONLY B UMBRELLA LAB I X I OCCUR X EXCESSLIAB I I CLAIMS -MADE FF01633402 0410112018 0410112019 DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ N IA (Mandatory in NH) EXCLUDED? If yes, describe under DESCRIPTION OF OPERATIONS below MED EXP (Anv one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT !Ea accident) $ BODILY INJURY (Per Derson) $ BODILY INJURY (Per accidents $ PROPERTY DAMAGE Per accident) $ Comp/Coll Ded $ EACH OCCURRENCE $ (AGGREGATE $ PER STATUTE I I OERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Playground Engineered Wood Fiber installation City of Gilroy, its officers, officials and employees are Additional Insured with respect to General Liability, as required by written contract. CERTIFICATE HOLDER CANCELLATION 100,0001 5,0001 1,000,0001 2,000,000I 2,000,0001 1,000,0001 I 1,0001 3,000,000i 3,000,000 j1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE City of Gilroy, its officers, officials and employees 7351 Rosanna Street IGilroySCA 950Pn ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:WPP1447388 02 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 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 Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations CITY OF GILROY, ITS OFFICERS, OFFICIALS AND All locations at which you are performing operations EMPLOYEES, 7351 ROSANNA STREET, GILROY, CA for any person or organization with whom or with 95020 which you have agreed in writing in a contract or agreement that such person(s) or organization(s) shall be included as an additional insured on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" This insurance does not apply to "bodily injury" or "property caused, in whole or in part, by: damage" occurring after: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its intended use by any person or organization insured only applies to the extent permitted by other than another contractor or subcontractor law; and engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 0 Insurance Services Office, Inc., 2012 CG 20 10 0413 A� ® CERTIFICATE OF LIABILITY INSURANCE I DATE (MMI DfY Y) 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 CONTI NAME: Cindy Beymer InterWest Insurance Serv., LLC (A/c.No):530-222-3771 License #0B01094 I PHONE Extl: 530-222-1737 I FAX 310 Hemsted Dr., Suite 200 I Mr- cbeymer@iwins.com Redding CA 96002-0935 I INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Benchmark Insurance Company 41394 INSURED JETMU-1 INSURER B Jet Mulch, Inc. PO Box 1667 INSURER C : Capitola CA 95010 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:27263751 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE iNSD WV❑ POLICY NUMBER (MM/DDIYYYYI (MMIDD/YYYYI I LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 0OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO- JECT LOC OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY UMBRELLA LAB OCCUR EXCESS LIAB HCLAIMS-MADE DED ,I l RETENTION $ A WORKERSCOMPENSATIDN AND EMPLOVIBIW WI'AMITY Y / N ANYPROPRI ETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below EACH OCCURRENCE $ DAMAGE To RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ COMBINED SINGLE LIMIT $ (Ea accident) BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accidenll I EACH OCCURRENCE $ AGGREGATE $ $ Y CST5012500 4/1/2018 4/1/2019 IX I PER STATUTE ORH I E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 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) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy, its officers, officials and employees ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy CA 95020 AUTHORIZED REPRESENTATIVE I w.j�1��, ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (ed. 4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA We ha\,e the right to reco`,er 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.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be y2.0_% of the California workers' compensation premium otherwise due on such remuneration. Schedule Person or Organization Job Description Any person or organization as required by written contract 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 Date: 4/1 /2018 Policy No. CST5012500 Endorsement No. Policy Effective Dates: 04/01 /2018 - 04/01 /2019 Premium $ Insured: Jet Mulch, Inc Carrier Name / Code: Benchmark Insurance Company A WC 04 03 06 (Ed. 4-84) Countersigned by Page 1 of 1