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HomeMy WebLinkAboutEvans & DeShazo - Insurance Certificate (2019)EYAN S-1 ()O ID· Kl= ACORD" CERTI F ICAT E OF LI A BILITY INS URAN C E I DATE (MM/00/YYYY ) ~ 03/07/2018 THIS CERTIFICATE IS ISSUED AS A MATIER 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 ISSU ING 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 riahts to the certificate holder in lieu of such endorsement(s). PRODUCER 707 -87 4-2666 ~~~I~cT Kirsten E dwards Gene Gaffney Ins Services, Inc rtgNJo. Ext): 707 -87 4 -2666 j r..e~. Noi:707 -8 7 4-1233 P.O . Box 428 Occidental, CA 95465 ~*1nAJ~ss: kirsten@gattneyins.com Kirsten Edwards INSUR ER/SI AFFORDING COVERAGE NAIC# INS URER A: Hartford Casualty Ins. Co. 294 24 INSURED Evans & DeShazo , Inc. INSURER B : RLI I nsurance Group 13056 Attn: Sally Evans 6876 Sebastopol Ave. INSURERC : Sebastopol, CA 95472 INSURER O: INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER · REVIS IO N NUMBER· TH IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD IND ICATED . NOTWITHSTANDING ANY REQUIREMENT , TERM OR CO NDI TIO N OF ANY CONTRACT OR OTHER DOC UMENT WITH RESPECT TO WH ICH THIS CERTIF ICATE MAY BE ISSUE D OR MAY PERTAIN , THE INSURANCE AFFORDED BY THE PO LI CIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS , EXCLUS IONS ANO COND ITI ONS OF SUCH POLICIES . LIM ITS SHOWN MAY HAV E BEEN REDUCED BY PAID CLAIMS . iN,: ADOL ~.~~! TYPE OF INSURANCE ,.,en POLIC Y NUMBER POLICY EFF POLICY EXP LIM ITS A X COMMERCIAL GENERAL LIAB ILITY EACH OCC URRE NCE $ 2,000,000 I CLAIMS -MADE [R] OCCUR y 57SBMBH7623 04/20/2018 04/20/2019 DAMAG E T9i:~';_NT~~~~ft, $ 1,000 ,000 -MEO EXP /Aflv one oersonl s 10,000 I-PER SONA L & ADV INJ URY s 2,000,000 4,000,000 GEN 'L AGGREGATE LIMIT AP PLIES PER GENERAL AGGREGATE s ~ POLICY D ~r8r D Loe PROD UCTS · COMP/OP AGG $ 4,000,000 OTHER : s A AUTOMOBILE LIABILITY ~i:~~~~~~~1rlNGL E LIMIT s 2,000,000 1-- ANY AUTO 57SBMBH7623 04/20/2018 04/20/2019 BOOI L Y INJURY /Per oersonl s -OWNED ~ SCHE DUL ED AUTOS ONLY ,__ AU TOS BOOI L Y INJURY (Per acci denll s ,__ iP~9~2c~d~t?AMAGE X Hlf.M X NON ,gWNEO $ AU SONLY ,__ AUTO ON LY s UMBRELLA LIAB H OCCUR EACH OCCURRENCE s -EXCESS LIAB CLAIMS-MADE AGGREGAT E s OED I I RET ENTION $ "' WORKERS COMPENSATION I ~~~TII TI= I I fJH· ANO EMPLOYERS' LIABILITY Y I N ANY PR OPR IETOR/PARTNER/EXEC UTIVE D E L. EAC H ACC IDEN T s OFF ICER/MEMBER EXCLU DED? N/A (Mandatory in NH) E.L. DISEASE· EA EMPLOY EE $ ~~S~~f~~ 'o1~PERATIONS below E L. DISEASE -POLICY LIMIT s B Professional Liabi RTP0006077 08/06/2017 08/06/2019 Agg regate 2,000,000 Occurence 2,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Addition•I Romorks Sehodulo, may bo •tt~eh od if moro spaco ls roqulrod) A rcheaeoloay & Historic Preservati on Consultants The C i ty of 1l roy, its Officers, Official s , and Enployees are named as Additional Insureds per attached pol icy form IH12001185. CERTIFICATE HOLDER City of Gilroy, its officers, officals and employees 7351 Rosanna Street Gilroy, CA 95020 ACORD 25 (2016/03) CANCELLATION 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 REPRESE NTATIVE K i rsten Edwards The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 57 SBM BH7623 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -STATE/POLITICAL SUBDIVISION CITY OF GILROY ITS OFFICERS, OFFICIALS, AND EMPLOYEES 7351 ROSANNA ST GILROY, CA 95020 Form IH 12 00 11 85 T SEQ. NO. 003 Printed in U.S.A. Page 001 Process Date: 02/01/18 Expiration Date: 04/20/19 BUSINESS LIA BILITY COVERAGE FORM F. OPT IO NAL ADDI TIO NAL INS UR ED COVERAGES If listed or shown as applicable in the Declarations , one or more of the following Optional Additional Insured Coverages also ap ply. When any of these Optional Additional Insured Coverages apply, Paragraph 6. (Addition al Insureds When Required by Written Contract , Written Agreement or Permit) of Secti o n C., Who Is An Insured , does not apply to the person or organization shown in the Declarations. These coverages are subject to the terms and conditions applicable to Business Liability Coverage in this policy , exce pt as provided below: 1 . Add itiona l Insured -Des i g n ated Person Or Organiza tio n WHO IS AN INSURED under Section C. is amended to include as an additional insured the person(s) or o rgan ization(s ) shown in the Declarations , but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: a. In the pe1iormance of your ongoing operation s; or b. In connection with your premises owned by or re nted to you. 2. Additional In s ured -Managers Or Lessors Of Pr emises a. WHO IS AN INSURED under Section C. is am ended to in clude as an additional insured the person(s) or organization(s) shown ln the Decla rat ions as an Additional Insured - Designated Person Or Organization; but only with respect to liability arising out of the ownership, maintenance or ;,ise of thclt part of the premises leased to you an d shown in the Declarations . b . With respect to the insurance afforded to these additional insu reds, the following additional exclusions apply: This insu rance does not apply to: (1 ) Any "occurrence" which takes place after you cease to be a tenant in that premises; or (2) Structura l alterations , new Page 18 of 24 construction or demolition operations performed by or on behalf of such person or organization. 3 . Additional Ins ured -Grantor Of Fran chis e WHO IS AN INSURED under Section C. is ame nded to include as an additional insured the person(s) or organization(s) shown in the Declarations as an Addition al Insured • Grantor Of Franchise , but only w ith respect to their liability as grantor of franchise to you. 4. Additi o n al Insured -Lessor Of Leased Equipment a. WHO IS AN INSURED under Section C. is amen ded to include as an additional insu red lhe person(s) or organization(s) shown in the Declarations as an Additional Insured -Lessor of Leased Equipment, but only wi th res pect to liability for "bodily injury". "property damage" or "personal and advertising injury" caused , in whole or in part, by your maintenance , operation or use of equipment leased to you by such person(s) or organization(s). b. With respect to the insurance afforded to these additional insureds, this insuran ce does not apply to any "occu rre nce" which takes pla ce after you cease to lease that equipment. 5. Add itio nal Insured · Owners Or Other I nterests From Whom Land Has Been Leased a. WHO IS AN INSURED under Sect ion C . is amended to include as an add iti onal i nsured the person(s) or organization(s) shown in the Declarations as an Additional Insured -Owners Or Other Interests From Whom Land Has Been Leased, but only with respect to li abil ity arising out of the owne rship. maintenance or use of that part of the land leased to you and shown in the Declarations. b. With res pect to the insurance afforded to tl1ese additional insureds, the following additional exclusions apply: This insurance does not apply to: ('I) Any "occurrence" that ta kes place after you cease to lease that land; or (2) Structu ral alterations, new construction or demolition operations performed by or on behalf of sucll person or organization. 6. Additi o nal I nsured -State Or Political Subdivis ion -Permits a. WHO IS AN INSURED under Section C. is amended to in clude as an additional insured the state or political subdivision shown in the Declarations as an Additional Form SS 00 08 04 05 Insured -State Or Political Subdivision - Permits , but only with respect to operations performed by you or on your behalf for which th e state or political subdivision has issued a permit. b. With respect to the insurance afforded to these additional insureds, the following add itional excl usions apply: This in s urance does not apply to: (1) "Bodily injury", "property damage" or "persona l a nd advertising injury" aris in g ou t of operations performed for the state or municipality; or (2) "Bodily injury" or "property damage" included in the "product-completed operations" hazard. 7. Additional I nsured -Vendors a. WHO IS AN INSURED under Section C. is amended to inclu de as an additional i nsured the person(s) or organization(s) (referred to below as vendor) shown in the Declarations as an Additional Insured - Vendor, bu t only with respect to "bodil y in jury" or "property damage " arising out of "your products" which are distributed or sold in the regu lar course of the vendor's busi ness and only if this Coverage Part provide s coverage for "bodily injury" or "property damage" included within the "products-completed operations hazard". b. The insurance afforded to the vendor is subject to the followi ng additional excl usions : (1) This insurance does not apply to: (a) "Bodily injury" or "property da mage" for which the vendor is obligated to pay damages by reason of the assumption of liability in a contract or agreement. This exclusion does not apply to li ab ility for damages that the vendor would have in the absence of the con tract or agreement; (b) Any express warranty unauthorized by you; (c) Any physical or chemical change in the product made inteniionally by the vendor; (ct) Repackag ing. unless unpacked solely for the purpos e of inspection, demonstration, testing, or the substitutio n of parts under instructions from the manufacturer, and then repackaged in the original container; Fo rm SS 00 08 04 05 BUSIN ESS LIABI LITY COVERAGE l=ORM (e) Any failure to make such inspections, adjustments , tests or servicing as the vendor has agreed to make er nonnally undertakes to make in the usual course of business, in connection w~h the distribution or sale of the products; (f) Demonstration, installation , servicing or repair operations, except such operations performed at the vendor's premises in con nection with the sale of the product; (g) Products which, after distribution or sale by you, have been labeled or relabeled or used as a container , part or ingredient of any other thing or substance by or for the vendor; or (h) "Bodily injury" or "property damage" arisi ng out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its beha lf . However, this exclusion does not apply to: (i) The exceptions contained in Subparagraphs (d) or (f); or (i i) Such inspections, adjustments, tests or servicing as the vendor has agreed to make or normally undertakes to make in the usual course of business , in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. 8. Additional Insured -Controllin g Interest WHO IS AN INSURED under Section C. is amended to include as an additional insured the person (s) or organization (s) shown in the Declarations as an Additional Insured - Controlling Interest, but only with respect to their liability arising out of: a. Their financial control of you; or b. Premises they own, maintain or control while you lease or occupy these premises. Page 19 of 24 BUSIN E SS LIABILITY C O V E RAGE FORM This insurance does not app ly to structural alterations, new construction and demol ition operations performed by or for that person or organization . 9. Ad d itional In sured -Ow n ers, Lesse es Or Contra cto rs Scheduled P erson Or Organ izat io n a. WHO IS AN INSURED under Sect ion C . is amended to incl ude as an additiona l i nsured the person(s) or organization(s) shown in the Declarations as an Add itional Insured -Owner, Lessees Or Contractors, but only wi t h respect to liabil ity for "bodily injury", "property damage" or "pe rsonal a nd adverti sing injury" caused , in whole or in part, by your acts or omissions or the acts or omissions of those acting on yo ur behalf: (1) In the performance of your ongoing operations for the additional insu red(s); or (2 ) In connection with "your work" performed for that additional insured and included with in the "pro ducts- completed operations hazard", but only if thi s Coverage Part provides cov e rage for "bodily injury" or "property damage" included within the "products-completed operations haza rd". b. With res pect to the i nsurance afforded to these addition al insu reds, this insu rance does not ap ply to "bodily injury", "property damage" o r "personal an advertising inj ury" arisi ng out of th e rendering of, or the failure to rende r, any professional architectu ral, engi neering or surveying service s , incl uding: (1) The preparing, approving, or failure to prepare or approve, maps, shop drawin gs, opinions, reports , surveys, fi el d o rders , change orders, designs or drawings and specifications; or (2) Supe rvis o ry , i nspection, architectural or engineering activities . 10. Addit ional In s ured -C o -Owner Of In sured P r emises W HO IS AN IN SURED under Section C. is amended to include as an additional insured the person(s) or O rganization(s) shown in the Decla rations as an Add itional Insured -Co- Owner Of Insured Prem ises , but only with respect to th eir li ability as co-owner of the premises shown in the Declarations. Page 20 of 24 Th e limits of insurance that apply to additional in sured s are described in Section D. -Limits Of Insurance. How this insurance applies when other insurance is availab le to an additional insured is descri bed in the Othe r Insurance Condition in Section E. - Liability And Medica l Expenses General Conditions . G. LI AB ILITY AND MEDICAL EXPENSES DEFI NITI ONS 1. "Advertisement" me ans the widespread public dissemination of information or images that has the purpose of inducing the sale of goods, products or services through: a. (1) Radio ; (2) Television ; (3) Billboard ; (4) Magazine; (5) Newspaper; b . The Internet, but only that part of a web site that is about goods, products or services for the purposes of inducing the sale of goods. products or services; or c. Any other pub licati on that is given widespread public distribution. However, "advertisement" does not include: a . The design , printed material , information or images contain ed in , on or upon the packaging or labeling of any goods or products; or b. An interactive conversation between or among persons through a computer network. 2. "Advertis ing idea " means any idea for an "advertisement". 3. "Asbestos haza rd" means an exposure or threat of exposure to the actual or alleged properties of asbestos and includes the mere presence of asbestos in any form. 4. "Auto" means a land motor vehicle, trailer or semi-trai ler designed fo r travel on public roads, including any attached mach inery or equipment. But "auto" does not include "mob ile equipment". 5. "Bod il y i njury" means physical: a. Injury; b. Sicl<ness; or c. Disease sustained by a person and, if arising out of the above , mental anguish or death at any time. 6 . "C overage territory" means: Form SS 00 08 04 05 NA ISSUE DATE: 08-14-2018 9139842-2018 29 08-14-2019 08-14-2018/08-14-2019 CITY OF GILROY NA PO BOX 66 GILROY CA 95021-0066 30 30 EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2017-08-28 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF GILROY ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 08-14-2016 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #2570 ENTITLED WAIVER OF SUBROGATION EFFECTIVE 2018-08-14 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. THIRD PARTY NAME: CITY OF GILROY EVANS & DE SHAZO, INC. NA 6876 SEBASTOPOL AVE SEBASTOPOL CA 95472 PRINTED : 10-31-2018 POLICYHOLDER COPY [P18,HO]