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HomeMy WebLinkAboutBenchmark Environmental - Insurance Certificate (2019)Policy Number: Date Entered: 1/15/2019 A�� "® CERTIFICATE OF LIABILITY INSURANCE D1/15/2019ATE (MIVI1 YI 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 COURTNEY FINANCIAL INSURANCE SERVICES NAME: 1405 S Bascom Ave I A/cNNo.EuD: (408)298-5439 I(A/c.No); (408)298-5455 ADDRESS: todd@courtneyfinancial.com San Jose, CA 95128 INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Lloyd's of London 085202 INSURED Benchmark Environmental Engineering Corp INSURER B : Mid Century Insurance Company INSURER C : STATE CCIAPENSATION INSURANCE FD[•ID ID 380038 Starstone INSURER D ; 3732-A Charter Park Dr I INSURERE: San Jose, CA 95136 INSURER F 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. INSR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMB ER IMM/ DD/YYYY) (MMI DDIYYYY) LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2, 000, 000 CLAIMS -MADE ® OCCUR X ENC0002383-01 5/12/2018 5/12/2019 UHNWIS (Ea PREMISES (Ea occurrence) $ 100, 000 Xv pollution included MED FRCP (Any one person) $ 10, 000 A professional incl I PERSONAL& ADV INJURY $ 2, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 3, 000, 000 POLICY JET LOC I PRODUCTS - COMP/OP AGG $ 3, 000, 000 OTHER: $ AUTOMO BILE LIABILITY UUMbINtU 51NGLt LIMI I (Ea accident) $ 2, 000, 000 B �/ ANYAUTO 60499-95-60 4/8/2018 4/8/2019 I BODILY INJURY (Per person) $ ,4 OWNED SCHEDULED I BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS XHIRED NON -OWNED AUTOS ONLY AUTOS ONLY I'KUFLK I Y UAMAUL (Per accident) $ D UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 3, 000, 000 EXCESS LIAB CLAIMS -MADE 77739E180ALI 4/13/2018 5/12/2019 I AGGREGATE $ 3, 000, 000 DED I I RETENTION $ n/a $ WORKERS COMPENSATION \/ I I AND EMPLOYERS' LIABILITY Y/N JAI STATUTE ERH ANY PROPRIETOR/PARTNER/EXECUTIVE C N / A 9228785-18 4/8/2018 4/8/2019 E.L. EACH ACCIDENT $ 1, 000, 000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 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 / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached If more space is required) survey of the police dept for asbestos and lead paint City of Gilroy, its officers, officials and employees are listed as additional insured on the general liability CERTIFICATE HOLDER CANCELLATION City of Gilroy, its officers, officials eeS and employees SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1� y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna St ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FormsBoss.com; Impressive Publishing, LLC 800-208-1977 effective date of this endorsement: policy number: EN 0002383-01 05112/2018 Endorsement Number: 04 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION In consideration of an additional premium of $o, this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART All other terms and conditions of this Policy remain unchanged. SCHEDULE Name of Additional Insured Person(s) Or Organization(s): CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES - Location(s) of Covered Operations ANNEX BUILDING, CITY OF GILROY 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" 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 location(s) designated above. CG 20 10 07 04 ©Insurance Services Office, Inc. Page 1 B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 ©Insurance Services Office, Inc. Page