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HomeMy WebLinkAboutByron Epp - Insurance CertificateBRYON -1 OP ID: CFIE 14C "MLm CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 09/29/2015 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(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'in1ieu of such endorsement(s). PRODUCER—q-, -•• Homewell Insurance Seiv,.lnc 3401 Centre lake Drive Ste 410 CONTACT NAME: aCONN xt E :90.9 -509 -8103 _ FAX No): 909- 257 -3027 - Ontario, CA 91761 .. Aaron Brewart E -MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC i1 10/01/2016'', INSURER A:HDI-Geriing American Ins 41343', INSURED Byron Epp, Inc. 26082 Merit Circle Suite 107 Laguna Hills, CA 92653 ' INSURER s: Natl Union Fire Ins Co of PA 19445 INSURER C: State Comp fns. Fund of CA 35076 PERSONAL & ADV INJURY INSURER D : GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ' X PRO LOC OTHER: INSURER E: $ 2,000,oO PRODUCTS - COMP /OP AGG_I INSURER F EBL $ 1,000,00 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 . ADDL SUBK POLICY NUMBER POLICY EFF MM/D nrf_yyy) I POLICY EXP (MMIDDAIn7n LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X GK20X000671 10/01/2015 10/01/2016'', EACH OCCURRENCE $ 1,000,000. PREMISES Ea occurrence $ - 100,00 - MED EXP (Anyone person) . _ $ 5,00 PERSONAL & ADV INJURY $. 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ' X PRO LOC OTHER: GENERAL AGGREGATE $ 2,000,oO PRODUCTS - COMP /OP AGG_I $_ _ - _- _ 2,000,00 , EBL $ 1,000,00 A AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS GK20X000671 1010112015 10/0112016 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 X BODILY INJURY (Per person) $ X BODILY INJURY (Per accident) _ $ PROPERTY DAMAGE Peraccident $ $ B X UMBRELLA LIAR EXcESs LIA6. X OCCUR CLAIMS -MADE EBU068023594 10101/2015 10/01/2016 EACH OCCURRENCE $ 4,000_,00_ _ AGGREGATE - $_ 4,000,00 DED I X I RETENTION $ 0, $ - C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF-OPERATIONS below _ _ NIA 9143070 1010112015 10/0112016 X I R R - 0TH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE $ 1,000,00 E.L. DISEASE - POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) "Cancellation provision reverts to 10 days for non- payment of premium. Certificate holder to be included as additional insured with respects to the General Liability per form attached. CITYGIL City of Gilroy Attn: Rick Brandini 7351 Rosanna Street Gilroy, CA 95020 -6197 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 ©1988 -2014 ACORD CORPORATION. All rights reservad ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GK20X000671 00 00 CA COMMERCIAL GENERAL LIABILITY CG 20 37 0413 (Blkt) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS /COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Blanket as required by written contract and effective Primary Insurance applies: It is agreed that such during the policy period as stated on the policy insurance as is afforded by this policy for the benefit declarations. of the additional insured shown shall be primary insurance, and any other insurance maintained by the additional Insured(s) shall be excess and noncontributory as respects any claim, loss or liability allegedly arising out of the operations of the named insured or its subcontractors, provided however that this insurance will not apply to any claim loss or liability which is determined to be solely the result of the additional insured's negligence or solely the additional insured's responsibility. This insurance also does not apply to any structure intended to be occupied as a private residence, not including apartments. 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard ". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and B. 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. 2. If coverage provided to the additional insured is This endorsement shall not increase the applicable required by a contract or agreement, the Limits of Insurance shown in the Declarations. 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 37 04 13 (Blkt) 0 Insurance Services Office, Inc., 2012 Page 1 of 1 POLICY NUMBER: GK20X000671 00 00 CA COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 (Blkt) 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 Or anization s Locations Of Covered Operations Blanket as required by written contract and effective Primary Insurance applies: It is agreed that such during the policy period as stated on the policy insurance as is afforded by this policy for the declarations. benefit of`the additional insured shown shall be primary insurance, and any other insurance maintained by the additional insured(s) shall be excess and noncontributory as respects any claim, loss or liability allegedly arising out of the operations of the named insured or its subcontractors, provided however that this insurance will not apply to any claim loss or liability which is determined to be solely the result of the additional insured's negligence or solely the additional insured's responsibility. Information r uired 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. include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is 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. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 04 13 (Blkt) C Insurance Services Office, Inc., 2012 Page 1 of 2 ;N 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 04 13 (Blkt)