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HomeMy WebLinkAboutGolden Gate Petroleum - Insurance CertificateACORLJ CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) . 9/30/2014 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(ies) must tie 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 Owen -Dunn Insurance. Services 1455 Response Road, Suite 260 Sacramento, CA 95815 CONTACT NAME: FAX PHONE 916 993 -2700 A/C No: 916 9932683 E- MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC p 10/1/2014 INSURERA: HDIrGerling America Insurance Co. 41343 www.owendunn.com 0522677 INSURED Bay Area Diablo Petroleum Co. dba: Golden Gate Petroleum INSURER B: National Union Fire Ins Co of Pittsburgh PA 19445 INSURER C MED EXP (Any one person) INSURER D 1340 Arnold Drive, Suite 231 Martinez CA 94553 INSURER E: $ 2,000,000 INSURER F :. GENERAL AGGREGATE $ 2.000.000 COVERAGES CERTIFICATE NUMBER: 21RIA941 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 PAIDCLAIMS. INSR -LTR - - _TYPE OF_INSURANCE ADDL SUBR POLICYNUMBER POLICY. EFF MMIDD/YYYY POLICY EXP (MMIDDIYYYYI LIMITS A �/ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FV_1 OCCUR EGGCD000061114 10/1/2014 10/1/2015 EACH OCCURRENCE $ 2,000,000 DAMAGE T' " NTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 0 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY [::] PRCT F.71 LOC OTHER: GENERAL AGGREGATE $ 2.000.000 PRODUCTS - COMP /OP AGG $ 2.000,000 $ A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS EAGCD000061114 10/1/2014 10/1/2015 O BIKED SINGLE LIMIT-: (Ea $ 2,000,000 BODILY INJURY (Per person) $ BODILY INJURY Per accident ! ) $ PROPERTY DAMAGE P r id n $ $ A B UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EXAGD0000061114 BE54196582 10/1/2014 I 10/1/2014 10/1/2015 10/1/2015 EACH OCCURRENCE_ $ 3,000,000 7 AGGREGATE _ $ 3,000,000 CEO ✓ RETENTION$10,000 B Ea OcC/A gre ate $ 5,000,000 A WORKERSCOMPENSATIIN YIN AND EMPLYERS! ANY �PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ (Mandatory In NH) H yes, describe under DESCRIPTION OF OPERATIONS below NIA EWGCDOOU061114 10/1/2014 10/112015 STATUTE H- E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS? LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: Agreement Services City of Gilroy is additional insured per terms & conditions of attached endorsements. VCR I IrIVA 1 C Mill -IJCR I.AN%.tLLA 1 IVN City of Gilroy 7351 Rosanna Street Gilroy CA 95020 ACORD 25 (2014/01) 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 Candace Alicea ©1988 -2014 ACORD CORPORATION. All riahts The ACORD name and logo are registered marks of ACORD CERT NO..: 21818241 CLIENT CODE: 310'73 Dawn Zychalski 9/30/2014 11:36:13 AM (PDT) Page 1 of 3