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HomeMy WebLinkAboutWater Tech Specialties - Insurance Certificate,4corro® CERTIFICATE OF LIABILITY INSURANCE ��- D118/ /DD201/Y 7 5/18/7 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS N'O 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 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 Helen Brown NAME: PH - FAX, -6001 McGowan Insurance Group, Inc. 355 Indiana Avenue E:MaIL helenb @mcgowaninc.com Spite 200 INSURERS AFFORDING COVERAGE NAIC9 INSURERA:State National Insurance 12831 Indianapolis IN 46204 INSURED INSURERB:Chubb Insurance 12777 INSURER C:Re ublic Indemnity Company 43753 Water Tech Specialties, Inc. INSURERD:The Hanover Insurance Companv 2292 PO Box 32846 INSURER E: CLAIMS -MADE a OCCUR INSURER F: KEB0692648 San Jose CA 95152 .. COVERAGES CERTIFICATE NUMBER:17 -18 Liab 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 LTR TYPE OF INSURANCE ADDLSUBR POLICY NUMBER POLICY EFF MM/DD POLICY EXP M LIMITS GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 PREMISES $ 300,000 X COMMERCIAL GENERAL LIABILITY A CLAIMS -MADE a OCCUR KEB0692648 /15/2017 /15/2018 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 LIMIT APPLIES PER: PRODUCTS -- COMP /OP AGG $ 2,000,006 HAGGREGATE. POUCV PRO LOC $ AUTOMOBILE LIABILITY COMBINe IN LE LIMIT ddM) 1,000,000 D ANY AUTO X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED AUTOS AUTOS R1535101 /12/2017 /12/2018 NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE P r $ $ _ X UMBRELLA UAB X OCCUR EACH.000URRENCE $ 5,000,000 AGGREGATE $ 5,000 000 B EXCESS UAS CLAIMS -MADE DED I X I RETENTION$ 0 $ 9364-49-83 2/2/2016 2/2/2017 'WORKERS COMPENSATION - , WC ST X ATU- 0TH= TORY LIMITS AND EMPLOYERS' LIABILITY Y / N E.L. EACH ACCIDENT $ 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE N N/A C OFFICER/MEMBER EXCLUDED? (Mandat6ty 16 NH) 155421 -17 /12/2017 /12/2018 E.L. DISEASE- EA EMPLOYE $ 11000,000 If yes,. de scribe under E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION'_ OF OPERATIONS below A Product Pollution B0692648 /15/2017 /15/2018 Limit $ 1,000,000 D Property (BPP 6 BI) 516317437 /12/2017 /12/2018 BPPLimit$54,600 /aILimit $ 40,800 DESCRIPTION OF OPERATIONS /LOCATIONS! VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more apace Is required) CERTIFIATE HOLDER IS ADDITIONAL INSURED, PER FORM CG 20 26 (07/04}, WITH WAIVER OF SUBROGATION FORM CG 24 04 (05/09) AND COMPLETED OPERATIONS IS APPLICABLE, WHEN REQUIRED BY WRITTEN CONTRACT. City, of Gilroy, Its Officers and Employee 7351 Rosanna. Street Gilroy, CA 95020 ACORD 25 (2010105) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE. CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE_ WILL BE DELIVERED 1N ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M. McGowan /DANIEL o9"/ 'M ' qA "I✓ IN5025 (201005).01 The ACORD name and logo are registered marks of ACORD All rights reserved. ACC? " CERTIFICATE OF LIABILITY INSURANCE 6�16�2016Y) 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 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 McGowan Insurance Group, Inc. 355 Indiana Avenue Suite 200 Indianapolis IN 46204 CONTACT Helen Brown NAME: PHO "E (317) 464 -5000 FAX o: (317) 464 -5001 IC, EAI -ML helenb @mcgowaninc.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:State National Insurance 12831 INSURED Water Tech Specialties, Inc. PO Box 32846 San Jose CA 95152 INSURER B:Chubb Insurance 12777 INSURER C:Re ublic Indemnity Company 43753 INSURERD Allied Insurance 10127 INSURER E $ 1,000,000 INSURER F X COMMERCIAL GENERAL LIABILITY COVERAGES CERTIFICATE NUMBER:16 -17 Liab 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 LTR TYPE OF INSURANCE ADDLSUBR INSR WVD POLICY NUMBER POLICY EFF MM /DD/YYYY ), POLICY EXP (MMIDDrYYYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE PREMISES Ea occurrence) $ 300,000 A CLAIMS -MADE a OCCUR MEB0692648 6/15/2016 6/15/2017 MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS - COMP /OP AGG $ 2,000,000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident 1,000,000 X BODILY INJURY (Per person) $ D ANY AUTO BODILY INJURY (Per accident) $ ALL OWNED SCHEDULED ACP3007371176 9/14/2015 9/14/2016 AUTOS AUTOS PROPERTY DAMAGE $ NON -OWNED HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1 , 000 , 000 AGGREGATE $ 1,000,000 B EXCESS LIAB CLAIMS -MADE DED X RETENTION$ 0 $ 9364 -49 -83 12/2/2015 12/2/2016 WORKERS COMPENSATION X I WC STATU- 7TH_ TORY LIMITS 1� AND EMPLOYERS' LIABILITY Y I N E.L. EACH ACCIDENT $ 11000,000 ANY PROPRIETOR /PARTNER /EXECUTIVE C OFFICER /MEMBER EXCLUDED' N❑ (Mandatory in NH) N I A 9155421 -16 /12/2016 /12/2017 E . DISEASE - EA EMPLOYE $ 1,000,000 If yes, describe under i$ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1,000,000 A Product Pollution MEB0692648 _ 6/15/2016 6/15/2017 Limit $ 1,000,000 D Property (BPP & BI) ACPCPP3006618880 /12/2016 /12/2017 BPP Limit $56,200/ 81 Limit $ 40,800 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFIATE HOLDER IS ADDITIONAL INSURED, PER FORM CG 20 26 (07/04), WITH WAIVER OF SUBROGATION FORM CG 24 04 (05/09) AND COMPLETED OPERATIONS IS APPLICABLE, WHEN REQUIRED BY WRITTEN CONTRACT. GtKIIFIGAlt HOLDER CANCELLATION City of Gilroy, Its Officers and Employee 7351 Rosanna Street Gilroy, CA 95020 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 H M. McGowan /DANIEL r,' f "� 0/( - ",rV fi 'm/ A�,Urcu za (Zu-lu /va) © 1988 -2010 ACORD CORPORATION. All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD '4c ®ee °® CERTIFICATE OF LIABILITY INSURANCE F4/30/D M roD 20515 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) roust 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 McGowan Insurance Group, Inc. 355 Indiana Avenue Suite 200 Indianapolis IN 46204 CONTACT Daniel Gable PHONE (317) 464 -5000 FAX (3.1.7)464 -5001 MAIL .danlelg13mcgovaninc.com INSURER(S) AFFORDING COVERAGE POLICY NUMBER INSURERA:State National Insurance POLICY EXP INSURED Water Tech Specialties, Inc. PO Box 32846 $an Jose CA 95152 INSURERB,Chubb Insurance F2777 INSURERCRe ublic Indemnit -Com an. INSURERD:FSDERAL INSURANCE._COMPANY INSURER E: EACH OCCURRENCE INSURER F: DAMAGE TORENTE15— PREMISES rr COVERAGES CERTIFICATE NUMBER:15 -16 Liab 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. JNTSRR. TYPE OF INSURANCE B POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TORENTE15— PREMISES rr $ 300,000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE XOCCUR B0692648 /15/2015 /15/2016 MED EXP (Any one person) $ 10,000 PERSONAL 8 ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 2,000,000 ii POLICY 7 PRO LOC $ AUTOMOBILE.LIABILITY MBINED IN LE LIMIT Ea accident) BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS P id BODILY INJURY (Per accent ) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE P accident) $ , X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 B EXCESS LIAR CLAIMS -MADE DED I X I RETENTION $ 364 -49 -83 2/2/2014 2/2/2015 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OF EXCLUDED? N (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA 37599 -18 /12/2015 /12/2016 X WC STATU- 0TH - E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Product Pollution B0692648 /15/2015 /15/2016 Umit $ 1,000,000 Property (BPP 6 BI) CPCPP3006618880 /12/2015 /12/2016 BPP Limit $54,6001 BI Limit $ 40,800 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFIATE HOLDER IS ADDITIONAL INSURED, PER FORM CG 20 26 (07/04), WITH WAIVER OF SUBROGATION FORM CG 24 04 (05/09) AND COMPLETED OPERATIONS IS APPLICABLE, WHEN REQUIRED BY WRITTEN CONTRACT. City of Gilroy, Its Officers and Employee 7351 Rosanna Street Gilroy, CA 95020 10/05) 3kWL1 I Lei � I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Highum /DANIEL 1988 -2010 ACORD IN-R(125 r2nlnngi ni Tha ar:nRrl name and Inn^ am renictarzA martrc of ar'nRrl riaht_e reeerved r , WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 99 06 34 (Ed. 8-00) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - BLANKET 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 otherwise due. Person or Organization ANY PERSON OR ORG FOR WHOM THIS WAIVER IS REQUIRED 3 % of the total California Workers' Compensation premium Schedule Job Description ALL CALIFORNIA OPERATIONS This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The infomation below Is required only when this endorsement Is issuc3d subsequent to preparation of the policy.) Endorsement Effective 04 -30 -14 Policy No. NSD 5026438 00 Endorsement No. Insured FUCHS, HAMS ERIC (AN Premium $ INCL. Insurance Company INSURANCE COMPANY OF THE WEST Countersigned By WC 99 06 34 (Ed. 8-00) INsURM . 1% ° CERTIFICATE OF LIABILITY INSURANCE �� D�T19(AAMI014 6/13/2014 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(les) must 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 McGowan Insurance Group, Inc. 355 Indiana Avenue Suite 200 Indianapolis IN 46204 Adam MiholiC PHONE (3] 7) 4(4 -5000 FAX (317) 066 -5001 E-MAIL ADDRESS:adamm@zacg,bwanihc.com INSURERS AFFORDING COVERAGE NAICg INSURERA:State National Insurance 12831 INSURED Water Tech Specialties, Inc. 1590 Centre Pointe Drive ,Milpitas CA 95035 INSURER B :FEDERAL INSURANCE COMPANY 20281 . INSURER C: INSURER D: EACH OCCURRENCE INSURER E: EM ES - - n INSURER F: A COVERAGES CERTIFICATE NUMBER:14 -15 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 LTR TYPE OF INSURANCE ADDL SUOR POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 EM ES - - n $ 300,.000 A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR KEB0692648 6/15/2014 6/15/2015 MED EXP (Any one person) $ 10, 000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICY 7 PRO- JFCT X LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT fr za..'d.ntl BODILY INJURY (Per person) fli ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE (Par $ $ B X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1, 000,000 AGGREGATE $ 1,000,000 . EXCESS IJAB CLAIMS -MADE 93644965 /15/2014 6/15/2015 DED I X I RETENTION $ WORKERS. COMPENSATION I WC STATU' I OTW TORY I IMITA FR - AND EMPLOYERS' LIABILITY Y / N ANY 'PROPRIETOR /PARTNER/EXECUTIVE OFFICER/MEMBER'.EXCLUDED? ❑ N/A E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) It Yyes, describe under 0 RIPTION 0 0 ERATIONS below E.L. DISEASE - POLICY LIMIT $ A Product Pollution MEB0692648 6/15/2014 6/15/2015 Limit $ 11000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) CERTIFIATE HOLDER IS ADDITIONAL INSURED, PER FORM CG 20 26 (07/04), WITH WAIVER OF SUBROGATION FORM CG 24 04 (05/09) AND COMPLETED OPERATIONS IS APPLICABLE, WHEN REQUIRED BY WRITTEN CONTRACT. City of Gilroy, Its Officers and Employee 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 121711111/11151 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 Highum /ADAM (c7 1988 -2010 ACORD CORPORATION- All rights reserved. INS025 (201005).01 The ACORD name and logo are registered marks of ACORD