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HomeMy WebLinkAboutSabah International - Insurance CertificateA� ®® CERTIFICATE OF LIABILITY INSURANCE 64TE(MM/DD/YYYY) 16/27/2017 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 Woodruff - Sawyer & Co. 50 California Street, Floor 12 San Francisco CA 94111 NAMEAc" Sindy Lara P " °NE 415 -402 -6659 FAX 415- 989 -9923 E-MAIL ADDRE.S. slara @wsandco.com INSURERS AFFORDING COVERAGE NAIC # Y INSURER A: Travelers Prop Casualty Co of Amen 125674 7/112017 INSURED SABAINT -01 INSURER B: Tokio Marine Specialty Insurance Co 123850 Sabah Intemational Incorporated INSURER C: Greenwich Insurance Company 22322 5925 Stoneridge Drive Pleasanton, CA 94588 INSURER D AMA PREM SES Ea occurrence INSURER E INSURER F $Excluded CCIVFROGFS CFRTIFICOTF NIIMRFR. 251073920 RFVISInN 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM /DD POLICY EXP MM/DD LIMITS B X COMMERCIAL GENERAL LIABILITY Y PPK1672612 7/112017 7/1/2018 EACH OCCURRENCE $1,000,000 CLAIMS -MADE F OCCUR AMA PREM SES Ea occurrence $100,000 MED EXP (Any one person) $Excluded PERSONAL BADVINJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 POLICY a] PRO-- � LOC JECT PRODUCTS - COMP /OP AGG $2,000,000 $ OTHER A AUTOMOBILE LIABILITY DT810366K488217 7/1/2017 7/1/2018 CO acadent $1,000.000 X BODILY INJURY (Per person) $ ANY AUTO AUT OWNED SCHEDULED BODILY INJURY (Per acadent) $ NON -OWNED HIRED AUTOS AUTOS PROPER IDAMAGE (Parer $ B UMBRELLA LU1B X OCCUR PUB589303 7/1/2017 7/1/2018 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 X EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTIVE UB366K29071726G 7/1/2017 7/1/2018 X PER OTH- STATUTE ER E L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N / A E L DISEASE - EA EMPLOYEO $1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE -POLICY LIMIT I $1,000,000 C Professional 8 Pollution LJab. PECO03225407 7/1/2017 7/1/2018 Per Claim $1,000,000 Aggregate $2,000,000 SIR $25,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space Is required) All Services /maintenance work at the Gilroy Police Department, 7301 Hanna Street, Gilroy, CA 95020. City of Gilroy, its officers, officials and employees are additional insured per forms attached. (;tK I Wl(;A I t MULLItK I;AN(;tLLA 1 IUN City of Gilroy, its officers, officials and employees 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. ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER PPK1672612 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 Organization(s): Locations Of Covered Operations City of Gilroy, its officers, officials and employees All Services /maintenance work at the Gilroy Police Department, 7301 Hanna Street, Gilroy, CA 95020 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", "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) desig- nated above B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER PPK1672612 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Or Or anization s : Location And Description Of Completed Operations City of Gilroy, its officers, officials and employees All Services /maintenance work at the Gilroy Police Department, 7301 Hanna Street, Gilroy, CA 95020. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- at the location designated and described in the dude as an additional insured the person(s) or or- schedule of this endorsement performed for that ad- ganization(s) shown in the Schedule, but only with ditional insured and included in the "products -com- respect to liability for "bodily injury" or "property pleted operations hazard ". damage" caused, in whole or in part, by "your work" CG 20 37 07 04 Copyright, ISO Properties, Inc., 2004 Page 1 of 1 UNIFORM AC40RIDO CERTIFICATE OF LIABILITY INSURANCE - DATE (MM /DDNYYY) 2/8/2017 _ 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 poli .Ales) 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 Woodruff = Sawyer & Co. 50 California Street, Floor 12 San Francisco CA 94111 CONTACT NAME: Sind Lara PHONE, 415 -402 -6659 FAX . 415- 989 -9923 E -MAIL _ ADDRESS. slara @wsandco.com INSURERS AFFORDING COVERAGE NAIC # 7/1/2018 INSURER A :Travelers Prop Casualty Co of Ameri 25674 $1,000;000 INSURED SABAINT -01 INSURER 'B: :Tokio Marine Specialty Insurance Co 23850 INSURERC:Greenwich Insurance Company 22322 Sabah International Incorporated 5925 Stoneridge Drive Plea. santon, CA 94588 INSURER D :. PERSONAL B&ADVINJURY $1,000,000 GEN'L AGGREGATE 'LIMIT APPLIES PER: POLICY `j �T F__] LOC OTHER: GENERAL AGGREGATE INSURER .E : PRODUCTS - COMP /OPAGG INSURER'F: $ CAVFROGFS CFRTIFICAT'E NUMBER! 1790106751 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 SHOW_ N MAY HAVE, BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF IN SD WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM1DD/YYYY .:LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR Y PPK1511131 7/1/2018 7/1/2017 EACH OCCURRENCE. $1,000;000 PREMISES Ea occurrence) $100;000 MED EXP (Any one person) $ PERSONAL B&ADVINJURY $1,000,000 GEN'L AGGREGATE 'LIMIT APPLIES PER: POLICY `j �T F__] LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP /OPAGG ..$2,000;000 _- $ A AUTO MOSILELIABILITY X ii ANY AUTO ALL SCHEDULED A HIRED AUTOS NON -OWN DT810366K488216 7/1/2016 7/1/2017 Ea accident I $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident), $ AMAGE Pe�accidenl0 $ B UMBRELLA uAB EXCESS LIAB 1 X OCCUR CLAIMS -MADE PUB545023 7/1/2016 7/1/2017 EACH OCCURRENCE $5,000,000 X AGGREGATE $5,006,660 DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER/EXECUTIVE OFFICER /MEMBER EXCLUDED' (Mandatory In NH) If yes; describe under DESCRIPTION OF OPERATIONS below N/A DTJUB366K290716 7/112016 7/1/2017 X STA UTE ERH E`L. EACH ACCIDENT $1,000,000' EIL. DISEASE - EA EMPLOYEE $9,000;000 E:L. DISEASE- POLICY LIMIT $1,000;000 C Professional & Pollution Liab. PECO03225406 7/1/2016 7/1/2017 Per Claim $1,000,000 Aggregate $2,000,000 SIR $25,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached B more space Is required) REPLACES CERTIFICATE ISSUED ON 02/07/17. All Services /maintenance work at the Gilroy Police Department, 7301 Hanna Street, Gilroy, CA 95020. City of Gilroy, its officers, officials and employees are additional insured per forms attached. City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIESBE.CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVr810Ns. REPRESENTATIVE RA' ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PPK1511131 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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 Organ lzation (s): Locations Of Covered Operations City of Gilroy, its officers, officials and employees All Services /maintenance work at the Gilroy Police Department, 7301 Hanna Street, Gilroy, CA 95020 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", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts 'oromissions; 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 C ISO Properties, Inc., 2004 Page 1 of 1 0 POLICY NUMBER: PPK1511131 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Operations City of Gilroy, its officers, officials and employees All Services /maintenance work at the Gilroy Police Department, 7301 Hanna Street, Gilroy, CA 95020. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to in- at the location designated and described in the dude as an additional insured the person(s) or or- schedule of this endorsement performed for that ad- ganization(s) shown in the Schedule, but only with ditional insured and included in the "products -com- respect to liability for "bodily injury" or "property pleted operations hazard ". damage" caused, in whole or in part, by "your work" CG 20 37,07 04 Copyright, ISO Properties, Inc., 2004 Page 1 of 1 UNIFORM