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HomeMy WebLinkAboutPremier Builders - Insurance CertificatePREMBUI -01 ETAYLOR ACOR ®" �� CERTIFICATE OF LIABILITY INSURANCE M(YY) 1014/2017 DATE (MM /DDMM/DD 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 Fresno CSG- Alliant Insurance Services, Inc. 9 E. River Park Place East Ste 310 Fresno, CA 93720 NAME CT Erin Taylor PHONE FAX A IC, No Ext (AIC, No) ADDRESS emtaylor @alliant.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Landmark American Insurance Company 33138 INSURED Premier Builders, Inc. 8021 Carmel St Gilroy, CA 95020 INSURER B: Nationwide Mutual Insurance Company 23787 INSURER C: StarStone National Insurance Company 25496 INSURER D • State Compensation Insurance Fund of California 35076 INSURER E INSURER F . B CCIVFRAGFS 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 I�TRR I TYPE OF INSURANCE IINSD�SWVD POLICY NUMBER MIOWDDY/YYYY I MM DDIYYYY LIMITS A I X I COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X 7351 Rosanna Street LHA139680 10101/2017 10/01/2018 EACH OCCURRENCE PREMISES i6RERTED PREMISES Ea occurrence $ 1,000,000 $ 50,000 MED EXP (Any one person) $ PERSONAL& ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER X POLICY = PRO- JECT ❑ LOC OTHER GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG S 2,000,000 I $ B AUTOMOBILE LIABILITY ALL OWNED SCHEDULED AUTOS AUTOS Ix ANY AUTO X NON -OWNED HIRED AUTOS AUTOS X ACP3036843837 09/09/2017 09/09/2018 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS LAB X OCCUR CLAIMS -MADE X 86671K173ALI 10/01/2017 10/01/2018 EACH OCCURRENCE $ 1,000,000 AGGREGATE Is 1,000,000 DED 1 1 RETENTION $ I $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNERIEXECUTIVE Y OFFICER/MEMBER EXCLUDED (Mandatory In NH) If Yes descnbe under DESCRIPTION OF OPERATIONS below NIA 9142711 -2017 - 10/0112017 10/01/2018 X PER OTH- STATUTE ER EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYEE $ 1,000,000 E L DISEASE -POLICY LIMIT J $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Pity of Gil ty Gilroy - y City Engineer THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PREMBUI -01 ETAYLOR '4� o CERTIFICATE OF LIABILITY INSURANCE DATE 10/4/2017rr) 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 Fresno CSG- Alliant Insurance Services, Inc. 9 E. River Park Place East Ste 310 CA 93720 NAME: Erin Taylor PHONE FAX lac. No, Ext). (A/C,_ No ADDRESS emtaylor @alliant.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA - Landmark American Insurance Company 33138 INSURED Premier Builders, Inc. 8021 Carmel St Gilroy, CA 95020 INSURERB - Nationwide Mutual Insurance Company 23787 INSURER C'StarStone National Insurance Company 125496 INSURER D -State Compensation Insurance Fund of California 135076 INSURER E' LHA139680 INSURER F 10/01/2018 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP LIMITS LT INSD WVD POLICY NUMBER MM/DD/vrYV MMIDDrrm A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE Al OCCUR X LHA139680 10101/2017 10/01/2018 DAMAGE TO RENTED PREMISES (E a occurrence) 50,000 $ MED EXP (Any one person) $ uPERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT F7 LOC PRODUCTS - COMP /OP AGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY CO Ea aMBccidINED ent S INGLE LIMIT I $ 1,000,000 BODILY INJURY (Per person) $ B A NY AUTO X ACP3036843837 09109/2017 09/09/2018 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPER accident) $ X X NON -OWNED HIREDAUTOS AUTOS $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 C X EXCESS LIAB CLAIMS -MADE X 86671K173ALI 10/01/2017 10/01/2018 AGGREGATE $ 1,000,000 DEO I I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y❑ (Mandatory In NH) N / A 9142711 -2017 10101/2017 10/01/2018 X STATUTE ERH E L EACH ACCIDENT $ 1,000,000 E L DISEASE - EA EMPLOYEE $ 1,000,000 (DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT I $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: Gilroy Senior Center Shade Structure Project, Project #16 -PW -230 The City, its officers, officials, employees, and volunteers are to be covered as additional insureds for liability coverage but only as respects the operations of the named insured. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City Of Gilroy ty - y City Engineer THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 ACORD 25 (2014/01) ©1988 -2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD PREMBUI -01 ETAYLOR .4CORO0 tft� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 10/412017 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 Fresno CSG- Alliant Insurance Services, Inc. 9 E. River Park Place East Ste 310 Fresno, CA 93720 NAME Erin Erin Taylor PHONE FAX (A/CNo Ext C. No E-MAIL emtaylor @alliant.com AD INSURER(S) AFFORDING COVERAGE NAIC # INSURERA •Landmark American Insurance Company 133138 INSURED INSURER B: Nationwide Mutual Insurance Company 123787 Premier Builders, Inc. 8021 Carmel St INSURER C: StarStone National Insurance Company 125496 INSURER D • State Compensation Insurance Fund of California 135076 Gilroy, CA 95020 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 ILTRR TYPE OF INSURANCE �SD I WVD I POLICY NUMBER MMIDCD) YYY MM/DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE T OCCUR LHA139680 10/01/2017 10/0112018 DAMAGE TO RENTED PREMISES (Ea occurrence $ 50,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 X POLICY ] PRO ❑ LOC JECT PRODUCTS - COMP /OP AGG $ 2,000,000 $ OTHER AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ B X ANY AUTO ACP3036843837 09/09/2017 09/09/2018 ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per acadent $ X X NON -OWNED HIRED AUTOS AUTOS Is UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 C X EXCESS LIAB CLAIMS -MADE 86671K173ALI 10/01/2017 10/01/2018 DIED RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED ❑ (Mandatory In NH) N/A 9142711 -2017 10/01/2017 10/01/2018 X PER OTH- STATUTE ER E L EACH ACCIDENT $ 1,000,000 E L DISEASE - EA EMPLOYEE $ 1,000,000 If yes descnbe under DESCRIPTION OF OPERATIONS below E L DISEASE - POLICY LIMIT I $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached H more space 1s required) City of Gilroy 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 Z ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD