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HomeMy WebLinkAboutByron Epp - Insurance CertificateBRYON -1 OP ID: LB 144COR® CERTIFICATE OF LIABILITY INSURANCE DA09 Y) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, /25 /201 09/25/2017 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 have ADDITIONAL INSURED provisions or 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 909- 509 -8103 Homewell Insurance Serv, Inc 3401 Centre lake Drive Ste 410 CONTACT Aaron Brewart PHONE 909 - 509 -8103 FAX 909 - 257 -3027 (A/C, No, Ext) (A/C, No) Ontario, CA 91761 Aaron Brewart E -MAIL aaronghomewellins.com ADDRESS INSURERS AFFORDING COVERAGE NAIC # X INSURER A HDI Global Insurance Co. 41343 INSURED Byron Epp, Inc. 26062 Merit Circle Suite 107 Laguna Hills, CA 92653 INSURER B Nat[ Union Fire Ins Co of PA 19445 INSURER C Security National Insurance Co 19879 INSURER D pREMGETOaoccurrrece INSURER E MED EXP (Any one per son INSURER F COVERAGES CFRTIFICATF Nl]MRFR- RFViSInkI MI IMRPR• 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 TypE OF INSURANCE DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [ OCCUR X GK20X00067102 10/01/2017 10/01/2018 EACH OCCURRENCE $ 1,000,000 pREMGETOaoccurrrece $ 100,000 MED EXP (Any one per son $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY ❑ JET LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OPAGG $ 2,000,000 Emp Ben. _ $_ _ 1,000,000 OTHER A AUTOMOBILE LIABILITY EO aBIINdE�D SINGLE LIMIT $ 1,000,000 BODILY INJURY Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS GK20X00067102 10/01/2017 1010112018 Ix BODILY INJURY Per accident $ PROPERTY DAMAGE Per.cc T I $ HIRED NON-SMED AUTOS ONLY X AUTOS ONLY B UMBRELLA LIAR EXCESS LIAB _ X OCCUR CLAIMS -MADE GK20X00067102 10/01/2017 10/01/2018 EACH OCCURRENCE $ 4,000,000 X_ AGGREGATE $ 4,000,000 DED I X I RETENTION $_ _ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLU DED7 Y (Mandatory in Nli) -- If yes, describe under DESCRIPTION OF OPERATIONS below N1. SWC1167998 10/01/2017 10/01/2018 X PER OTH - -- STATUTE ER - E L EACH ACCIDENT 1,000,000 $ E L DISEASE - EA EMPLOYEEI S 1,000,000 E L DISEASE - POLICY LIMIT $ 1,000,000 A Contractors 10/01/2017 10/01/2018 Equipment 106,000 Equipment DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be aftached if more spaee Is required) *Cancellation provision reverts to 10 days for non - payment of premium. Re:City of Gilroy, PD City of Gilroy, its officers, officials and employees are included as additional insured with respects to the General Liability per form attached. CITYOGL 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. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER GK20X000671 02 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 Organization(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 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 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 I. 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) © Insurance Services Office, Inc , 2012 Page 1 of 2 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 © Insurance Services Office, Inc , 2012 CG 20 10 04 13 (Blkt) POLICY NUMBER GK20X000671 02 00 CA COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 (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) © Insurance Services Office, Inc, 2012 Page 1 of 1 BRYON -1 OP ID: LB 14.1 ® CERTIFICATE OF LIABILITY INSURANCE DATE Y) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 09 /25/201 09/25/2017 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 pollcy(ies) must have ADDITIONAL INSURED provisions or 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 909- 509 -8103 Homewell Insurance Serv, Inc 3401 Centre lake Drive Ste 410 CRMNTACT Aaron Breviart PHONE 909 - 509 -8103 FAX 909 - 257 -3027 (A/C. No, Ext) (A /C, No) Ontario, CA 91761 Aaron Brewart E -MAIL aaron Omewe ins.com RESS INSURERS AFFORDING COVERAGE NAIC # X INSURER A HDI Global Insurance Co. 41343 INSURED Byron Epp, Inc. 26062 Merit Circle Suite 107 Laguna Hills, CA 92653 INSURER B Natl Union Fire Ins Co of PA 19445 INSURER C • Security National Insurance Co 19879 INSURER D $ 100 +000 INSURER E $ 5 +000 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 DDL UBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE � OCCUR X GK20X00067102 10/01/2017 10/0112018 EACH OCCURRENCE $ 1 +000 +000 DAMAGE TO a occur ante $ 100 +000 MED EXP (Any one person) $ 5 +000 PERSONAL 8 ADV INJURY $ 1 +000 +000 GEN'L X AGGREGATE LIMIT APPLIES PER POLICY ❑ PRO- ❑ LOC JECT GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG 2,000,000 S Emp Ben. $ 1,000,000 OTHER A AUTOMOBILE LIABILITY EOa aBINEDtSINGLE LIMIT $ 1,000,000 BODILY INJURY Per erson $ AUTO OWNED SCHEDULED AUTOS ONLY AUTOS GK20X00067102 10101/2017 10/0112018 IxANY BODILY INJURY Per accident S PROPERTY AMAGE Per accident $ HIRED �( NON -AWNED AUTOS ONLY AUTOS ONLY B UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE GK20X00067102 10/0112017 10/01/2018 EACH OCCURRENCE $ 4,000 +000 X AGGREGATE $ 4,000 +000 DED I X I RETENTION $ 0 _ _ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED9 ❑Y (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA SWC1167998 10/01/2017 10101/2018 X PER OTH- A TE ER E L EACH ACCIDENT $ 1 +��� +��� EL DISEASE - EA EMPLOYEE $ 1 +000 +000 E L DISEASE - POLICY LIMIT-- 1'000,000 A Contractors 10/01/2017 10/01/2018 Equipment - 106,000 Equipment DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If 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. City of Gilroy Attn: Rick Brandin! 7351 Rosanna Street Gilroy, CA 95020 -6197 ACORD 25 (2016/03) 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 -2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD POLICY NUMBER GK20X000671 02 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 Organization(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 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional exclusions organization(s) shown in the Schedule, but only with apply, respect to liability for "bodily injury", "property damage" This insurance does not apply to "bodily injury" or or "personal and advertising injury" caused, in whole "property damage" occurring after or in part, by' 1. or acts or omissions, or 1. All work, including materials, parts or equipment furnished in connection with such work, on the 2. The acts or omissions of those acting on your project (other than service, maintenance or repairs) behalf, to be performed by or on behalf of the additional in the performance of your ongoing operations for the insured(s) at the location of the covered operations additional insured(s) at the location(s) designated has been completed, or above 2. That portion of "your work" out of which the injury However- or damage arises has been put to its intended use by any person or organization other than another 1. The insurance afforded to such additional insured contractor or subcontractor engaged in performing only applies to the extent permitted by law, and operations for a principal as a part of the same 2. If coverage provided to the additional insured is project 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 CG 20 10 04 13 (Blkt) © Insurance Services Office, Inc, 2012 Page 1 of 2 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of Insurance additional insureds, the following is added to Section shown in the Declarations, III — Limits Of Insurance: whichever is less If coverage provided to the additional insured is This endorsement shall not increase the applicable required by a contract or agreement, the most we will Limits of Insurance shown in the Declarations. pay on behalf of the additional insured is the amount of insurance 1. Required by the contract or agreement, or Page 2 of 2 © Insurance Services Office, Inc , 2012 CG 20 10 04 13 (Blkt) POLICY NUMBER GK20X000671 02 00 CA COMMERCIAL GENERAL LIABILITY CG 20 37 04 13 (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) © Insurance Services Office, Inc, 2012 Page 1 of 1