Loading...
HomeMy WebLinkAboutPyro Spectaculars - Insurance Certificate (2019)CERTHOLDER COPY NF P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04-11-2019 CITY OF GILROY NF 7351 ROSANNA ST GILROY CA 95020-6141 GROUP: POLICY NUMBER: 0804575-2018 CERTIFICATE ID: 798 CERTIFICATE EXPIRES: 10-14-2019 10-14-2018/10-14-2019 This is to certify that we have issued a valid Workers` Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 10-14-2008 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. EMPLOYER PYRO SPECTACULARS NORTH INC. NF 5301 LANG AVE MCCLELLAN CA 95652 M0408 (REV.7-2014) PRINTED : 04-12-2019 CERTIFICATE OF LIABILITY INSURANCE 1 DATE(MM /DD/YYYY) 3129!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 pokcy(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 CONTACT NAME: Britton Gallagher PHONE FAX No r One Cleveland Center, Floor 30 - i -- - 1375 East 9th Street A ORIESS: Cleveland OH 44114 INSURERS) AFFORDING COVERAGE NAIC # _ INSURED Pyro Spectaculars North, Inc. 5301 Lang Ave McClellan Park CA 95652 INSURER A INSURER B INSURER C: INSURER D: COVERAGES CERTIFICATE Nt1MRFR- 1AO1fR37aQ DC1110ind1 ki"u000. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PEmOD 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 A13DLISUOR POLICY EFF POLICY EXP TYPE OF INSURANCE L7 IN SR WVO POLICY NUMBER iMM1DDrfYYYI JMM/DD LIMITS A GENERAL LIABILITY S18GL00282 -181 1/13/2018 1/13/2019 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE K] OCCUR PREMISES Ea N urnmce $500,000 MED EXP (Any one person) $ PERSONAL 8 ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPlOP AGG $2,000,000 POLICY X PRO- LOC $ AUTOMOBILE LIABILITY Ea acddan BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED ,AUTOS AUTOS BODILY INJURY Per accident ( ) $ HIRED AUTOS AUN SWNED PROPERTY DAMAGE a acddenl $ B UMBRELLA LIAB X OCCUR EXC6017995 1/13/2018 1/13/2019 EACH OCCURRENCE $4,000,000 X AGGREGATE $4,000,000 EXCESS LIAB _ j CLAIMS -MADE $ DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA WC STATU- OTH- E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Certificate Holder is named as an Additional Insured In regards to General Liability. Additional Insured extension of coverage is provided by above referenced General Liability policy where required by written agreement. Date of Display: July 4, 2018 Location of Display: Gilroy High School; Gilroy, CA Additional Insured: City of Gilroy, Gilroy Unified School District, Gilroy Unified School District Building Corporation, Gilroy Fire Department and their officers, agents and employees when acting in their official capacity as such. City of Gilroy 7351 Rosanna Street Gilroy CA 95020 VP%r4L CLLP11 IUN 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 U 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD POLICY NUMBERSI8GL00282 -171 COMMERCIAL GENERAL LIABILITY ECG 20 592 05 09 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Orqanization(s) I ANY PERSON OR LEGAL ENTITY IN WHICH YOU HAVE A WRITTEN CONTRACT, AGREEMENT, OR PERMIT WHICH REQUIRES THAT YOU NAME THE CONTRACTING PARTY AS AN ADDITIONAL INSURED. City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 City of Gilroy, Gilroy Unified School District, Gilroy Unified School District Building Corporation, Gilroy Fire Department and their officers, agents and employees when acting in their official capacity as such. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — 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" but only to the extent caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you. B. The insurance afforded to an additional insured shall only include the insurance required by the terms of the written agreement and shall not be broader than the coverage provided within the terms of the Coverage Part. C. The Limits of Insurance afforded to an additional insured shall be the lesser of the following: 1. The Limits of Insurance required by the written agreement between the parties; or 2. The Limits of Insurance provided by this Cov- erage Part. D. With respect to the insurance afforded to an addi- tional insured, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising in- jury" arising out of any act or omission of an addi- tional insured or any of its employees. ECG 20 592 05 09 Copyright, Everest Reinsurance Company 2009 Page 1 of 1 ❑ Includes copyrighted material of Insurance Services Office, Inc., used with its permission. �RL]® CERTIFICATE O F LIABILITY INSURANCE F DATE (MM /DD/YYYY) 3r291z018 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(s1. PRODUCER Britton Gallagher One Cleveland Center, Floor 30 1375 East 9th Street Cleveland OH 44114 INSURED Pyro Spectaculars North, Inc. 5301 Lang Ave. McClellan Park CA 95652 INS INSURER D : INSURER E: COVERAGES CERTIFICATE NUMBER: 974- 14n3Fi7 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 T TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFF MMIDD /YyYY) POLICY EXP (MMID2= LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY A M AGE O PREMISES Ea n a $ MED EXP (Any one person $ CLAIMS -MADE F7 OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GEN'LACIOREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ POLICY PRO- LOC $ A AUTOMOBILE LIABILITY SI8CA00031 -181 1/13/2018 1/13/2019 _�OM accident $1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident ( ) $ HIRED AUTOS _X NON -OWNED AUTOS X PROPERTY DAMAGE Peracddont $ B UMBRELLA LIAB X OCCUR EXC6017995 1/13/2018 1/13/2019 EACH OCCURRENCE $4,000,000 X AGGREGATE $4,00.000 EXCESS LIAR CLAIMS -MADE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ NIA WC STATU- 6TH- TORY LIMITS LER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Certificate Holder is Named as an additional insured. Date of Display: July 4, 2018 Location of Display: Gilroy High School; Gilroy, CA Additional Insured: City of Gilroy, Gilroy Unified School District, Gilroy Unified School District Building Corporation, Gilroy Fire Department and their officers, agents and employees when acting in their official capacity as such. __._.. .I-- I,HIVI.,tLLHI IU1Y 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 1�/ � © 1988 -2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD