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HomeMy WebLinkAboutBiomedical Waste Disposal - Insurance Certificate (2019)A14— o CERTIFICATE ®F LIABILITY INSURANCE DATE19 /DD /YYY8 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 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 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 NAME: VICK KAZARYAN SUPPORT INSURANCE AGENCY PHONE t . 818 - 5 52 - 516 6 FAX No : 818 -552-5160 400 S GLENDALE AVE E-MAIL VICK@ SUPPORT INSURANCE. COM INSURERS AFFORDING COVERAGE NAIC # STE I GLENDALE CA 91205 -4635 INSURERA:UNITED SPECIALTY INSURANCE CO 12537 INSURED INSURER B : ARCH INSURANCE GROUP 11150 BIOMEDICAL WASTE DISPOSAL, INC. INSURER C: STATE FUND 35076 INSURER D: PREMISES (E...'; urrence 11152 FLEETWOOD STREET #10 INSURER E: MED EXP (Any one person) SUN VALLEY CA 91352 INSURER F: Environmental Pollution 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 INSD SUER POLICY NUMBER MM DD/YEYYY MMIDDYIYYYI' LIMITS COMMERCIAL GENERAL LIABILITY USA4 2 0 7 4 0 4 04/09/18 04/09/19 EACH OCCURRENCE DAMAGE TO RENTED $ 1,000,000 CLAIMS -MADE © OCCUR PREMISES (E...'; urrence $ 100,000 MED EXP (Any one person) $ 5, 000 Environmental Pollution PERSONAL & ADV INJURY $ 1,000,000 A X X GENT AGGREGATE LIMIT APPLIES PER: - ❑ r—] POLICY PRO LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP /OP AGG $ 2,000,000 Pollution Coverage $ 2,000,000 OTHER: OTHER: AUTOMOBILE LIABILITY FBCAT0321603 01/28/18 01/28/19 Eaaaccident) DSINGLELIMiT $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO B ALL OWNED SCHEDULED AUTOS AUTOS $ BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Per accident $ $ ERRORS & OMISSIO OCCUR EACH OCCURRENCE $ AGGREGATE $ PROFESSIONAL CLAIMS -MADE DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR /PARTNER /EXECUTIVE OFFICER /MEMBER EXCLUDED? ❑ NIA 9059294 06/01/18 06/01/19 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A POLLUTION /SPILLAGE COV X FBCAT0321603 01/28/18 01/28/19 Combined Single Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SERVICE AGREEMENT: MEDICAL WASTE DISPOSAL SERVICES City of Gilroy, its officers, officials and employees are named as additional insured, per the attached endorsement. CERTIFICATE HOLDER CANCELLATION CITY OF GILROY, ITS OFFICERS, OFFICIALS AND SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE EMPLOYEES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 ROSANNA STREET AUTHORIZED REPRESENTATIVE GILROY, CA, 95020 ©1988 -2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ENV 2020 0815 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: ENVIRONMENTAL SERVICES LIABILITY COVERAGE FORM Biomedical Waste Disposal, Inc. - Policy # USA4207404 Effective: 04/09/2018 — 04/09/2019 SCHEDULE Designated Person or Organization: Designated Project or Premises: ; ity of Gilroy, its officers, officials and employees Service Agreement: Medical Waste Disposal Services 7351 Rosanna Street Gilroy, CA 95020 Various locations as per written contract with the Named Insured of Gilroy, its officers, officials and employees named as an additional insured, per the hed endorsement. In consideration of the premium paid, it is hereby agreed that: 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 above, but only with respect to "bodily injury", "property damage ", or "environmental damage" 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 Designated Project(s) or Premises shown in the Schedule above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2 If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. The following shall not apply to and shall afford no coverage to additional insureds shown in the Schedule above: 1. Coverage E -Consultants' Professional Liability; or 2 Coverage F — Scheduled Property Pollution Liability; or 3. Coverage G - Non -Owned Disposal Site Pollution Liability. C. With respect to the insurance afforded any such additional insured(s), the following exclusions apply: This insurance does not apply to "bodily injury", "property damage" or "environmental damage" occurring after: 1. All of "your work ", including materials, parts or equipment furnished in connection with "your work ", on the Designated Project(s) or Premises (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the Designated Project(s) or Premises has been completed. 2 That portion of "your work" out of which the "bodily injury", "property damage" or "environmental damage" arises has been put to its intended use by any other person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same Designated Project(s) or Premises. All other terms and conditions of this policy remain unchanged. ENV 2020 0815 Includes copyrighted materials of Insurance Services Office Inc, with its permissions Page 1 of 1 0 ISO Properties, Inc., 1996