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HomeMy WebLinkAboutGraham Prewett - Insurance CertificateAC "RV' CERTIFICATE OF LIABILITY INSURANCE DATE(MM /DD/YYYY) � - 02/01/2018 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 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 GENERAL NAME: AU Insurance Services - 10825 Old Mill Rd PHONE (A/C, No, Ext): ( 877 ) 234 -442 0 FAX (A/C,No): (877)234 -4421 E -MAIL ADDRESS: Omaha, NE 68154 (877)234 -4420 PRODUCER CUSTOMER ID# INSURER(S) AFFORDING COVERAGE NAIC # $ INSURED INSURER A: California Insurance Co. 38865 Graham Prewett, Inc. dba Graham Prewett, Inc. INSURER B: INSURER C: $ 2773 N Business Park Ave INSURER D: GENERAL AGGREGATE Ste 102 Fresno, CA 93727 -8662 CTL 1273 1420968 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 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 ADD INSR SUB WVD POLICY NUMBER POLICY EFF MM /DD/YYYY POLICY EXP (MMIDDNYYY) LIMITS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY �1 CLAIMS MADE u OCCUR 1-1 F-1 EACH OCCURRENCE $ DAMAGE TO RENTED r $ MED EXP an one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY JECT LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCHEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT Ea accident $ ❑ ❑ BODILY INJURY Per person) $ BODILY INJURY Per accident $ PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LI.48 EXCESS LIAB OCCUR CLAIMS MADE ❑ El EACH OCCURRENCE $ AGGREGATE g DEDUCTIBLE RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under SPECIAL PROVISIONS below NIA 7 3- 5 2 1 9 9 6- 0 1- 0 3 02 �01�2018 02�01�2019 X WC STATU- OTH- E.L. EACH ACCIDENT $ 1, 000, 0 0 0 E.L. DISEASE - EA EMPLOYEE S 11 000,000 E.L. DISEASE - POLICY LIMIT 1 $ 1, 000, 0 0 0 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach Acord 101, Additional Remarks Schedule, if more space is required) The blanket waiver applies to all operations for City of Gilroy, its officials, employees and voluteers for whom the named insured has agreed by written contract to furnish this waiver. RE: #15 -AS -221 Re- Roofing Project for City / SCRWA Buildings CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna St Gilroy, CA 95020 Attn: Project Manager 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 OD78336 r.a URV ca (wUyrUUl Vlyt5t5 -ZUU9 AL;UKU I;UKYUKAIIUN. All rights reserved WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 01 03 03 WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT 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, but this waiver applies only with respect to bodily injury arising out of the operations described in the Schedule where you are required by a written contract to obtain this waiver from us. This endorsement shall not operate directly or indirectly to benefit anyone not named in the Schedule. The premium for this endorsement is shown in the Schedule. Schedule 1. () Specific Waiver Name of person or organization: (,) Blanket Waiver Any person or organization for whom the Named Insured has agreed by written contract to furnish this waiver. 2. Operations: 3. Premium 2500 The premium charge for this endorsement shall be of the premium developed on payroll in connection with work performed for the above person(s) or organization(s) arising out of the operations described. 4. Minimum Premium 5. Advance Premium This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. Endorsement Effective 02/01/18 Policy No.73- 521996 -01 -03 Endorsement No. 8 Insured Graham Prewett, Inc. Premium $ 2,500.00 Insurance Company California Insurance Company Countersigned by / ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 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 CONTACT NAME: AU Insurance Sex-vices ao No, Ext): 877 234 -4420 (A/C• No): (877)234-4421 10825 Old Mill Rd E -MAIL Omsha, NE 68154 ADDRESS: PRODUCER CUSTOMER ID # (877)234-4420 INSURER(S) AFFORDING COVERAGE NAIC A' INSURED INSURER A: California insurance Co. 38865 Graham Pxewett, Mw. INSURER B: dba Graham Prewett, Inc. INSURER C: 2773 N Business Park Ave Ste 102 INSURER D: Fresno, CA 93727 -8662 INSURER E: CTL 1273 1132434 INSURER F: COVFRArFS CFRTIFICATF NIIMRFR- RFVIRION NIIMRFR- 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 / YM AUTHO RIZED REPRESENTATIVE OD78336 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MEND MM/D LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS ❑ ❑ PREMISES (Ea occurrence) $ MED EXP An one person) $ MADE OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES ER: POLICY n PROJECT LOC PRODUCTS - COMP /OP AGG $ $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO ❑ ❑ (Ea accident) $ BODILY INJURY Per person) $ ALL OWNED AUTOS BODILY INJURY Per accident $ SCHEDULED AUTOS PROPERTY DAMAGE Per accident $ HIRED AUTOS $ NON -OWNED AUTOS UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAR CLAIMS -MADE F] F-1 DEDUCTIBLE $ RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR /PARTNER! EXECUTIVE OFFICER /MEMBER ® N/A 73- 521996 -01 -01 102/01/2016 �D2 /Di /2017 X WC STATU- OTH- T R I ITS ER E.L. EACH ACCIDENT $ 11000,000 EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE 1 $ 1,000,000 If yes, describe under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 E DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach Acord 101. Additional Remarks Schedule, if more space is required) The blanket waiver applies to all operations for City of Gilroy, its officials, employees and volutsers for whom the named insured has agreed by written contract to furnish this waiver. RR: N15 -A8 -221 Re- Roofing Project for City / SCRWA Buildings rFRTIFI!`ATF Nnl nFR rANrFI I ATInN (it/ of auxtry SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 7351 ROSaI318 St Gi.1ZlOy', CA 95020 Attn' Pro; EXPIRATION DATE THEREOF, NOTICE WILL THE POLICY PROVISIONS. BE DELIVERED IN ACCORDANCE WITH / YM AUTHO RIZED REPRESENTATIVE OD78336 ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD ©1988 -2009 ACORD CORPORATION. All rights reserved. ACORDa � CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 1/26/2015 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(ids) 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 endorsem13nt(s). - PRODUCER : -' " Names G. Parker .Insurance Associates License #0554959 P O BOX 3947 Fresno CA 93650 CONTACT Carrie Stubblefield GISR NAME: PHONE (559) 222 -7722 FAX (559) 222 -1724 AIC Nit- ftrrieStubblefield @jgparker.com INSURERS AFFORDING COVERAGE NAIC # INSURERA:State Compensation Ins Fund 35076. INSURED Graham Prewett Inc 2773 N Business Park Ave #102 Fresno CA 93727 INSURER B : INSURER C: INSURER D: INSURER E:. $ 1 INSURER COMMERCIAL GENERAL LIABILITY COVERAGES -- CERTIFICATE NUMBER:15 -16 we 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 O_ F SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. - -- - - - -- - - -- _.. _ - ---- - INSR LTR TYPE OF INSURANCE ADD BR POLICY NUMBER POLICY POUCYEFF MM POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY AMAI c $ CLAIMS -MADE '❑ OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS : COMP /OP AGG $ .�_.......,._ POLICY ., .PRO•. .. - ,LOC -_ .. _... - - AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident --', BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS ": BODILY INJURY (Per accident) $ HIRED.`ALITOS NON -OWNED AUTOS PROPERTY DAMAGE (Per acci en $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE DED I I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN y % WCSTATU- OTH- ANY PROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBER'.EXCLUDED? (Mandatory 16AH) N/A 000822 - 501705 -2014 /1/2015 /1/2016 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1 000,000 If yes. describe under E.L. DISEASE - POLICY LIMIT $ 1. 000. 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Job #15 -AS -221 Re- Roofing Project for City / SCRWA Buildings Waiver of Subrogation in favor of City of Gilroy, its officials, employees and voluteers per 10217 7 -2014 attached L;tK I lrl(sA I t nuLUtK john.greer @ci.gilroy.ca.us City of Gilroy 7351 Rosanna St Gilroy, CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIESIBE,CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. J Parker III /CARRIE �rie7s�'� �•y ©1988 -2010 ACORD CORPORATION. All rights reserved. INS025 minnsi m Tho AtIoRn namo nnA lnnn ara ranieforarlmarke of Arnpi 1 ENDORSEMENT AGREEMENT WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE FEBRUARY 1, 2015 AT 12.01 A.M. AND EXPIRING FEBRUARY 1, 2016 AT 12.01 A.M. ALL EFFECTIVE DATES ARE AT 1201 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME GRAHAM- PREWETT INC 2773 N BUSINESS PARK AVE STE 102 FRESNO, CA 93727 REP 04 822 -14 501705 RENEWAL NE 0- 52 -02 -40 PAGE 1 OF 1 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 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: v4 AUTHORIZED REPRESENT IVE SCIF FORM 10217 (REV.7 -2014) JANUARY 26, 20115 ,/ AL - . A PRESIDENT AND CEO 2572 OLD DP 217