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HomeMy WebLinkAboutPetData - Insurance Certificate (2018)StateFarm e State Farm Lloyds PO Box 853925 Richardson, TX 75085 -3925 0 0 0 0 0 s AT1 M -08- 3864 -FC07 U F 002589 0004 CITY OF GILROY ITS OFFICERS & EMPLOYEES 7351 ROSANNA ST GILROY CA 95020 -6141 NOTICE OF REINSTATEMENT Office POLICY NUMBER 93 -TV- 3354 -6 REINSTATEMENT DATE FEB 07 2018 DATE PROCESSED JAN 25 2018 AMOUNT PAID No Amount Due PLEASE KEEP FOR YOUR RECORDS We are pleased to acknowledge receipt of the premium due on this policy. This policy will be continued in force subject to its printed terms and conditions upon the payment check clearing through your bank. Insured: PET DATA INC PO BOX 141929 IRVING TX 75014 -1929 Agent: MIKE BAKER CLU Telephone: (214) 780 -0900 01 2589 AIN 530 - 177.14 10 -07 -2013 (olf3072e) 001 Location: 8585 N STEMMONS FWY STE 1100N DALLAS TX 75247 -3822 SFPP No: 1238498908 INFOINC -01 SHEHNER AcoRO CERTIFICATE OF LIABILITY INSURANCE COVERAGES CERTIFICATE NUMBER! REVISION NUMRFR- 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. DATE 01 /31 /2018 Y) 01 /31 /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 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 License # OD28764 Orion Risk Management Insurance Services, Inc. 1800 Quail Street, Suite 110 Newport Beach, CA 92660 CONTACT NAME: PHONE Et): (949 263 -8850 FAX 949 263 -8860 ) (A/C, No):( 949) ADDRESS: INSURERS AFFORDING COVERAGE NAIC # 02101/2018 INSURERA:Federal Insurance Company 20281 $ 1'000'000 INSURED INSURERB:AXIs Insurance Company 37273 INSURER C: MED EXP (Any one person) INFOSEND, Inc. / Rezai and Son, LLC INSURER D: 4240 E. La Palma Ave Anaheim, CA 92807 INSURER E GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑ JEa LOC OTHER: INSURER F: $ 2,000'000 PRODUCTS - COMP /OP AGG COVERAGES CERTIFICATE NUMBER! REVISION NUMRFR- 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM /DDIYYYY POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR 36031149 02101/2018 0210112019 EACH OCCURRENCE $ 1'000'000 DAMAGE TO RENTED PREMISES Ea occurrence 1,000,000 $ MED EXP (Any one person) $ 10'000 PERSONAL & ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: POLICY ❑ JEa LOC OTHER: GENERAL AGGREGATE $ 2,000'000 PRODUCTS - COMP /OP AGG $ 2'000'000 $ A AUTOMOBILE X X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY X NON-OWNED ONLY 73587120 02/01/2018 02/01/2019 COMBINED SINGLE LIMIT Ea accident $ 1'000'000 BODILY INJURY Per person) $ BODILY INJURY Per accident $ Pe0acciden DAMAGE $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 79896856 02/01/2018 0210112019 EACH OCCURRENCE $ 5'000,000 AGGREGATE $ 51000'000 DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY OFFICERIMEMBEER EXCLUDED ECUTIVE F—] (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 71749812 0210112018 02/01/2019 X STATUTE EERH E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1'000'000 E.L. DISEASE - POLICY LIMIT 1,000,000 $ B B Errors & Ommissions Errors & Ommissions MCN00222831701 MCN00222831701 12101/2017 12/01/2017 12101/2018 12/01/2018 Limit Deductible 5,000,000 25,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is hereby named as an additional insured with regards to General Liability. Waiver of subrogation applies to workers compensation. City of Gilroy 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 TWOBROT -02 MMURCHISON CERTIFICATE OF LIABILITY INSURANCE COVERAGES CERTIFICATE NUMBER: REVIS!0N NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DATE 01 /31 /2018Y) 01 /31 /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 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 Cumbre Insurance .Services, LLC 4065 Mother Lode Drive Suite CONTACT Alaina Shortes- Bosold NAME: PHONE FAX (A/C, No, Ext): (A/C, No): E -MAIL alaina @cumbreins.com ADDRESS: Shingle Springs, CA 95682 INSURERS AFFORDING COVERAGE NAIC# INSURER A: Colony Insurance Company 39993 101 GL 0005336 -03 INSURED INSURER B: National Union Fire Insurance Company of Pittsburgh, Pa. 19445 INSURER C: Two Brothers Cathodic Services, Inc. INSURER D: 5361 Hilltop Road Garden Valley, CA 95633 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVIS!0N 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 IN SD SUBR WVD POLICY NUMBER POLICY EFF M /DD NYNI POLICY EXP (MM/DDNYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [X ] OCCUR X 101 GL 0005336 -03 02/03/2018 02/03/2019 EACH OCCURRENCE $ 1,000,000 DAMASETO a RENTED nce $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY 1 PE0 F—] LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPcE.R DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY B X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3,000,000 AGGREGATE $ EXCESS LIAR CLAIMS -MADE EBU 021521317 02103/2018 02/03/2019 DED RETENTION $ $ 3,000,000 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under N /A E.L. DISEASE - EA EMPLOYE $ DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Gilroy, its officers, officials and employees are named as an additional insured RE: Work performed by the insured when under contract. 10 days notice of cancellation for non - payment of premium. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy, its officers officials and employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD