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HomeMy WebLinkAboutOMI - Insurance Certificate (2019)ALC/l[3/ 1' �er...`III�L/ CERTIFICATE OF LIABILITY INSURANCE DATE 9 /20/18 06/19/2018 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 LIC #0437153 1- 212 - 948 -1306 Marsh Risk & Insurance Services CONTACT NAME: PHONE FAX 1- 212 CIRTS_Support @jacobs.com - A/C No): - 948 -1306 -___ -- -- E -MAIL 633 W. Fifth Street ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC C 07/01/19 INSURER A: ACE AMER INS CO 22667 Los Angeles, CA 90071 INSURED INSURER B OPERATIONS MANAGEMENT INTERNATIONAL, INC. -- INSURER C : $ 500,000 INSURER D:__ _PREMISES MED EXP (Any one person) 9191 South Jamaica Street INSURER E CONTRACTUAL LIABILITY INSURER F: Englewood, CO 80112 -5946 COVERAGES CERTIFICATE NUMBER: 53102530 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 POLICY EFF MMIDDNYYY POLICY EXP MMIDON LIMITS A X COMMERCIAL GENERAL LIABILITY HDO G71096750 07/01/18 07/01/19 EACH OCCURRENCE $ 7,000,000 CLAIMS-MADE OCCUR DAMAGES(RENTED (Ea occurtence) $ 500,000 X _PREMISES MED EXP (Any one person) _ $ 5,000 CONTRACTUAL LIABILITY PERSONAL 8 ADV INJURY $ 7,000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 10,000,000 GENT POLICY JECT PRO F1 LOC PRODUCTS - COMP /OP AGG $ 10,000,000 $ OTHER: • AUTOMOBILE LIABILITY ISA H25158684 07/01/18 07/01/19 COMBINED SINGLE LIMIT Ea accident $ 2,000,000 BODILY INJURY (Per person) _ $ X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) - $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS UAS CLAIMS -MADE DED RETENTION $ $ • • • WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETORIPARTNERIEXECUTIVE � OFFIdatory In NH) XCLUDED7 (MandalorylnNH) NIA WLR C6479033A (ADS) WCU 064789533 (LA, OH, T SCF 064789570 (WI) 07101/18 T /01/18 07/01/18 07/01/19 07/01/19 07/01/19 X FFEER STATUTE EORH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) LOCATION: Englewood, CO. CONTRACT ADMINISTRATOR: Brett Rester. RE: GAVILAN COLLEGE PUMP STATION. THE CERTIFICATE HOLDER IS INCLUDED AS AN ADDITIONAL INSURED ON THE GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES AS REQUIRED BY WRITTEN CONTRACT OR AGREEMENT. GENERAL LIABILITY AND AUTOMOBILE LIABILITY POLICIES INCLUDE A WAIVER OF SUBROGATION. *$2,250,000 SIR for states of: LA, OR, TX. *THE TERMS, CONDITIONS, AND LIMITS PROVIDED UNDER THIS CERTIFICATE OF INSURANCE WILL NOT EXCEED OR BROADEN IN ANY WAY THE TERMS, CONDITIONS, AND LIMITS AGREED TO UNDER THE APPLICABLE CONTRACT.* CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016103) Cert_Renewal 53102530 ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD rV O C' a It M J z W SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE CITY OF GILROY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 ROSANNA STREET AUTHORIZED REPRESENTATIVE GILROY, CA 95020 ,^7�{e��'.1✓/�. USA ACORD 25 (2016103) Cert_Renewal 53102530 ©1988 -2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD rV O C' a It M J z W