Loading...
HomeMy WebLinkAboutBenchmark Environmental - Insurance Certificate (2019)Policy Number: Date Entered: 1 / 15 / 2 019 ACC? " CERTIFICATE OF LIABILITY INSURANCE D1/i /20 DDiY-YYY) J 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/C. No. (408) 298-5439 I FAX (408) 298-5455 l IADDRIESS: todd@courtneyfinancial. com San Jose, CA 95128 I INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Lloyd's of London 085202 I INSURED Benchmark Environmental Engineering Corp INSURER B: Mid Century Insurance Conpany 1 INSURER C : STATE COMPENSATION INSURANCE FUND ID 380038 INSURER D Starstone 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 L6;R POLICY"? POLICY EXP LTR TYPEOFINSURANCE INSD WVD POLICY NUMBER (MM/DDlYYYY) (MNII DD/YYYY) LIMITS A COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 2, 000, 000 CLAIMS -MADE ® OCCUR X ENC0002383-01 5/12/2018 5/12/2019 PREMISES (Eaoc occurrence) 100, 000 PREMISES (Ea occurn:nce) $ pollution included MEDF�(P(Anyoneperson) $ 10,000 professional incl I PERSONAL& ADV INJURY $ 2, 000, 000 GENT AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 3, 000, 000 POLICY R SEOT LOC I PRODUCTS - COMP/OP AGG $ 3, 000, 000 OTHER: $ AUTOMO BILE LIABILITY GUMtfIIVCU JINULL LIMI I $ 2, 000, 000 _ (Ea accident) B �/ ANY AUTO 60499-95-60 4/8/2018 4/8/2019 I BODILY INJURY (Per person) $ -A OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS ONLY AUTOS I ( ) XHIRED NON -OWNED YKUI'tK I Y UAIVAut AUTOS ONLY AUTOS ONLY (Per accident) $ D UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 3, 000, 000 ExcessLlAa CLAIMS -MADE 77739E180ALI 4/13/2018 5/12/2019 I AGGREGATE $ 3, 000,000 DED I I RETENTION S n/a $ WORKERS COMPENSATION \/ HtK AND EMPLOYERS'LIABILITY YIN _ICI STATUTE I I ERUIH- ANY PROPRIETOR/PARTNER/EXECUTIVE I E.L, EACH ACCIDENT $ 1, O D O, 0 0 0 C OFFICER/NfEMBEREXCLUDED? � N/A 9228785-18 4/8/2018 4/8/2019 (Mandatory in NH) I E.L. DISEASE- EA EMPLOYEE $ 1, 000, 000 f yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1, 000, 000 DESCRIPTION OF OPERATIONS I LOCATIONS I 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 City of Gilroy, its officers, officials and employees 7351 Rosanna St Gilroy, CA 95020 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 REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD Produced using Forms Boss Plus software. www.FormsOoss.com: Impressive Publishing, LLC 800-208-1977 effective date of this endorsement: policy number: ENC 0002383-01 0511212018 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 Qnsurance 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 z. 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 fora principal as a part of the same project. CG 2010 07 04 ©Insurance Services Office, Inc. Page