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HomeMy WebLinkAboutInnovative Claims Solution - Insurance Certificate (2019)AC" " CERTIFICATE OF LIABILITY INSURANCE DATE DD /YWY) E (MMI E(MM/ CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 018 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 CONTACT NAME: Connie Lundquist Andreini & Company - Stockton PHONE FAX 2431 W. March Lane, Suite 300 A N E. fl, 877- 469 -0507 AC, No): 650-378-4361 ADDRESS: clundquist@andreini.com Stockton CA 95207 INSURER(S) AFFORDING COVERAGE NAIC # $1,000,000 INSURER A : Federal Insurance Company 20281 INSURED INNOV -5 INSURER B Innovative Claim Solutions Inc DAMAGE TO RENTED Attn: Gary Archibald INSURER C INSURER D 11344 Coloma Rd., Suite 745 Gold River CA 95670 INSURER E INSURER F: $1,000,000 COVERAGES CERTIFICATE NUMBER: 391954778 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 ADDL SUBR POLICY NUMBER MM DD //YYYY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY 35754610 4/1/2018 4/1/2019 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED CLAIMS -MADE %� OCCUR PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY F—] P'o_ LOC PRODUCTS - COMP /OP AGG $ Inc/ Agg $ OTHER: A AUTOMOBILE LIABILITY 73513506 4/1/2018 4/1/2019 COMBINED SINGLE LIMIT Ea accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X IAUTOS HIRED X NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ A X UMBRELLALIAB 1 X OCCUR 79797000 4/1/2018 4/1/2019 EACH OCCURRENCE $5,000,000 AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED X RETENTION $ 0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ OFFICER /MEMBER EXCLUDED? ❑ NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional Liability 81722762 4/1/2018 4/1/2019 Professional Limit $3,000,000 A Fidelity Limit 81815467 4/1,2018 4/1/2019 Fidelity Limit $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Gilroy, its officers, respentatives, agents and employees are included as additional insured as respects to the General Liability as their interest may appear per the attached Blanket Additional Endorsement Form #80 -02- 2367(05/07) where required by written contract. This insurance is primary and non- contibutory per the attached form #17 -02 -3080 (04/01). CERTIFICATE HOLDER CANCELLATION ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gilroy HR Director /Risk Manager 7351 Rosanna Street Gilroy CA 95020 AUjHORIZE^D REPRESENTATIVE ©1988 -2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD C H U B B` Liability Insurance Endorsement Policy Perron APRIL 1, 2018 TO APRIL 1, 2019 Effective Date APRIL 1, 2018 Policy Number 3575 -46-10 NVCE Insured INNOVATIVE CLAIM SOLU'rioNS INC. Name of Company FE -DERAL LIISURAN(T COMPANY Date Issued JANUARY 5, 2018 This Endorsement applies to the following form.. GENERAL LIABILfFY 3AXilditilldk�: b�bYe8��4k�b�# �i�Oi: Mdkoal�s; �o�oYa�+ 4aio�dlCdkd§ �fk��b.' d�y�F' fc$ �!$ b!,§ 2:§? �2��2$ �sP330�itFkB$> F.?? Sr. �' d�#?? 7kQ" kCK9, EekS'# ��-' f. �Cf�. C?".,' �'y.}�Y9C.",?'"�'I:BYcv.Y�Sf�Y. Under Who Is An Insured, the following provision is added. Who Is An Insured IsAdditional Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide: them with such insurance as is afforded by Or Organization this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured tinder this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. "Phis limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. Liability Insurance Additional Insured - Scheduled Person Or Organization CorMintOd Form 80 -02 -2367 {Rev. 5 -07) Endorsement Pegs r CHUBB' Liability Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance - Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. SwUhrUMM ..... �4f.. ... Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other term; and conditions remain unchanged. Authorized Reprasantative�� ' Liability Insurance Additional Insured - Scheduled Persan Or Organization Form 80 -02 -2367 (Rev. 5 -07) Endorsement • last page Page 2 • • HUBB' Conditions Legal Action Against Us (ccntrnuea) General Liability A person or organization may sue us to recover on an agreed setticmcn( ,:r tin ;i tinai judgment against an insured obtained after an actual: trial in a civil proceeding; or arbitration or other alternative dispute resolution proceeding; but we will not be liable for daruagcs that are not payable under the terms and conditions of this insurance or that are in excess of the applicable Limits Of Insurance. Other Insurance If other valid and collectible insurance is available it) the insured for loss we would otherwise cover under this insurance, our obligations arc limited as follows. Primary Insurance This insurance is primary except when the Excess Insurance provision described below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in the Method of Sharing provision described below. Excess insurance This insurance is excess over any ether insurance, whether primary, excess, contingent or on any other basis: A. that is Fire, Extended Coverage, Builders Risk, Installation Risk or similar insurance for your work; B. that is insurance that applies to property damage to premises rented to you or temporarily occupied by you with permission of the owner; C. if the loss arises out of aircraft, autrw or watercraft (to the extent not subject to the Aircraft, Autos Or Watercraft exclusion ); D. that is insurance: I. provided to you by any person or organization working under contract or agreement for you; or 2. under which you are included as an insured; or E. that is insurance under any Property section of this policy. When this insurance is excess, we will have no duty to defend the insured against any suit if any other insurer has a duty to defend such insured against such suit. If no other insurer defends, we will undertake to do so, but we will be entitled to the insured's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our shah: of the amount of toss, if any, that exceeds the sum of the total: • amount that all other insurance would pay for loss in the absence of this insurance; and • of all deductible and self-insured amounts under all other insurance. Liability Insurance Form 17,02.3080 fRev. 4.01i Contract Page 23 of 32 Conditions Other Insurance We will share the remaining loss, if any, with any other insurance that is not described in this (continued) Excess insurance provision and was not negotiated specifically to apply in excess of the (.units Of Insurance shown in the Declarations of this insurance. Method of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this method each insurer contributes equal amounts until it has paid its applicable limits of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Ender this method, each insurers share is based on the ratio of its applicable limits of insurance to the total applicable limits of insurance of all insurers. Premiurn Audit We will compute all premiums for this insurance in accordance with our rules and rates. In accordance with the Estimated Premiums section of the Premium Summary, premiums shown with an asterisk ( *) are estimated premiums and are subject to audit. In addition to or in lieu of such designation in the Premium Summary, premiums may be designated as estimated premiums elsewhere in this policy. In that case, these premiums will also be subject to audit, and the second paragraph of the Estimated Premiums section of the Premium Summary will apply. Separation Of Insureds Exccpt with. respect to the Limits Of Insurance, and any rights or duties spccificaily assigned in this insurance to the test named h uured, this insurance applies: as if each named insured were the only named insured; and separately to each inured against whom claim is made or suit is brought. Transfer Or Waiver Of We will waive the right of recovery we would otherwise, have had against another person or Rights Of Recovety organization, for loss to which this insurance applies, provided the insured has waived their rights Against Others of recovery against such person or organization in a contract or agrccrnent that is executed before such loss. To the extent that the hmred's rights to recover all or part of any payment made under this insurance have not been waived, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the hwxred will bring suit or transfer those rights to us and help us enforce them. This condition does not apply to medical expenses. ffkwxwf'* M*ZWZZ2:XL R7.eb'9@F.Qt?�7 1E LjabiRly ! .sura! ce Form , 7 - 0;1.3 RD f Rnv 4 -4'1 Con Ira cI — Page 24 of 32