HomeMy WebLinkAboutGolden State Flow Measurements - Insurance Certificate (2018)®
CERTIFICATE OF LIABILITY INSURANCE
DATE (MWDDNYYY)
11/15/17
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
HERITAGE WEST INSURANCE
2365 E1 Camino Ave Ste G
Sacramento, CA 95821
T
NAME:
PHONE FAX
°Ext (916)488-9945 A,C,N °):(916)488 -9948
E�I�
ADDRESS:
-
INSURER(S) AFFORDING COVERAGE
NAICA
11/24/17
11/24/16
INSURER A: LIBERTY MUTUAL INS CO
EACH OCCURRENCE
INSURED GOLDEN STATE FLOW MEASUREMENT INC
INSURER B:
DAMAGE 'U IENILU
PREMISES (Ea occurrence )
INSURER C:
_
4821 GOLDEN FOOTHILL PKWY
INSURER D:
GEN'L
X
EL DORADO HILLS, CA 95762
INSURER E:
$ 2,000,000
AGGREGATE LIMIT APPLIES PER:
POLICY CI JECOT CI LOC
OTHER:
INSURER F
_
PRODUCTS - COMPIOP AGG
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.
ILTR
TYPE OF INSURANCE
IINNSD
WVD
POLICY NUMBER
POLICY IDDNYYY
MM/DDYIYYYY
LIMITS
A
X
COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE CI OCCUR
X
BZS56812549
BZS56812549
11/24/17
11/24/16
11/24/18
11!24/17
EACH OCCURRENCE
$ 2 000 000
DAMAGE 'U IENILU
PREMISES (Ea occurrence )
0
MED EXP (Any one person)
$ 10,000
GEN'L
X
PERSONAL &ADV INJURY
$ 2,000,000
AGGREGATE LIMIT APPLIES PER:
POLICY CI JECOT CI LOC
OTHER:
GENERAL AGGREGATE
$ 4,000,000
PRODUCTS - COMPIOP AGG
$ 4,000,000
DEDUCTIBLE
$ 0
AUTOMOBILE
X
X
LIABILITY
ANYAUTO
ALL OWNED SCHEDULED
AUTOS
HIRED AUTOS X NON -OWNED
AUTOS
BAW56409802
11/1/1711/1/18
I
Ea accident INGLE IT
$ 1,000,000
BODILY INJURY (Per person)
$
BODILY INJURY (Per accident)
$
PROPERTY ent DAMAGE
Per accid
$
$
A
X
UMBRELLA LIAB
EXCESS LIAR
X
I OCCUR
CLAIMS -MADE
ESA56812549
(FOLLOWS FORM)
11/24/17
11/24/16
11/24/18
11/24/17
EACH OCCURRENCE
$ 2,000,000
AGGREGATE
$ 2,000,000
I X
DED RETENTIONS 0
$
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE (YIN
OFFICERIMEMBER EXCLUDED? I I
(Mandatory in NH) L—
If
DESCRIPTION OF OPERATIONS below
NIA
XWS56812549
XWS56812549
12/1/1712/1/18
12/1/1612/1/17
X R -
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYER
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 1,000,000i
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
ALL CALIFORNIA OPERATIONS.
CERTIFICATE HOLDER rANr.FI I ATInN
CITY OF GILROY, ITS OFFICERS,
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
OFFICIALS AND EMPLOYEES
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
735 ROSANNA ST
GILROY CA. 95020
AUTHORIZED REPRESENTATIVE
I
U 1988 -2014 ACORD CORPORATION. All rights reserved.
ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD
608 POLICY NUMBER: BZS56812549 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):
Location(s) Of Covered Operations
CITY OF GI:LROY, ITS OFFICERS, OFFICIALS
WHERE REQUIRED BY WRITTEN CONTRACT
AND EMPLOYEES
Information re uired to complete this Schedule, if not shown above, will be shown in the Declarations.
A_ Section 11 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 Copyright, ISO Properties, Inc., 2004 Page 1 of 1 11