Loading...
HomeMy WebLinkAboutCOI - Alpha Technologies Services, Inc. - Expires 2027-06-10SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2016 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY A 06/10/2026 06/10/2027 X 25,000 C 20699 4,000,000 SCFC7281194A (WI) 22667 10,000,000 A X D 06/10/2027 X ACE Fire Underwriters Insurance Company 06/10/2026 CN102741033--GAWUX-26-27 1,000,000 43575 CLE-006810981-18 06/10/2026 X 4,000,000 06/09/2026 X 06/10/2027 Beazley Insurance Company, NAIC 37540 3 06/10/2027 2,000,000 X 1,000,000 1,000,000 A 06/10/2027 06/10/2026 X 20702 ISAH11351955 10,000 06/10/2026 WLRC72811938 (AOS) SCFC72811951 (AZ, GA, OR) X XEUG72582652005 1,000,000 Professional Liability City of Gilroy, its officers,officials and employees are included as additional insureds under the General Liability, Automobile Liability and Umbrella Liability Policies, ATIMA, as respects for work, supply and/or services being provided or performed by or on behalf of the Named Insured as per written contract, purchase order or agreement and subject to the terms and conditions of the policies. Term: 8/29/21 – 7/30/22 ACE Property and Casualty Insurance Company 3767 Alpha Way Alpha Technologies Services, Inc. Bellingham, WA 98226 2,000,000 ACE American Insurance Company X 30 South 17th Street Marsh USA LLC Philadelphia, PA 19103 HDOG75475421 Indemnity Insurance Company of North America Y Gilroy, CA 95020 City of Gilroy 7351 Rosanna Street 06/10/2026 B 3,000,000 Policy # C2753B210301 Contractual Liability X X 10,000,000 06/10/2027 ACORD 101 (2008/01) The ACORD name and logo are registered marks of ACORD © 2008 ACORD CORPORATION. All rights reserved. THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER:FORM TITLE: ADDITIONAL REMARKS ADDITIONAL REMARKS SCHEDULE Page of AGENCY CUSTOMER ID: LOC #: AGENCY CARRIER NAIC CODE POLICY NUMBER NAMED INSURED EFFECTIVE DATE: Marsh USA LLC� � CARRIER: ASCOT INSURANCE COMPANY� � �� �� 1ST LAYER EXCESS – QUOTA SHARE $10M X $10M� �� �� CONTINUED FROM DESCRIPTION SECTION: �� Limit: $2,000,000 SIR $100,000�� POLICY TERM: 06/10/2026 - 06/10/2027� Total $50M� $5,000,000 AGGREGATE LIMIT� POLICY: G48634552 003� POLICY TERM: 06/10/2026 - 06/10/2027� � � � � 2ND LAYER EXCESS $15M X $20M� 2 Philadelphia Certificate of Liability Insurance POLICY: EXC 5888596� POLICY: USL03154226� � $15,000,000 EACH OCCURRENCE LIMIT� POLICY TERM: 06/10/2026 - 06/10/2027� CARRIER: INDEMNITY INSURANCE COMPANY OF NORTH AMERICA � 3RD LAYER EXCESS – QUOTA SHARE $15M X $35M� POLICY: EXNA2610000034-06� $5,000,000 EACH OCCURRENCE LIMIT� � $15,000,000 AGGREGATE LIMIT� $10,000,000 EACH OCCURRENCE� 25 � �� CARRIER: ALLIANZ GLOBAL RISKS US INSURANCE COMPANY� $5,000,000 EACH OCCURRENCE LIMIT� 3767 Alpha Way� Alpha Technologies Services, Inc.� Bellingham, WA 98226 $5,000,000 AGGREGATE LIMIT� � 2 CN102741033 $10,000,000 AGGREGATE� POLICY TERM: 06/10/2026 - 06/10/2027� CARRIER: GREAT AMERICA SPIRIT INSURANCE COMPANY�