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HomeMy WebLinkAboutPetData - Insurance Certificate (2019)awteftm d16*1 State Farm Lloyds PO Box 853925 Richardson, TX 75085-3925 9 AT M-08- 3864-FC07 003177 0004 CITY OF GILROY ITS OFFICERS & EMPLOYEES 7351 ROSANNA ST GILROY CA 95020-6141 ROMMAUSTal"S" Office U F POLICY NUMBER 93-TV-3354-6 REINSTATEMENT DATE AUG 07 2019 DATE PROCESSED JUL 25 2019 AMOUNT PAID No Amount Due We are pleased to acknowledge receipt of the premium due on this policy. This policy will be continued in force subject to its printed terms and conditions upon the payment check clearing through your bank. ..insured: PETDATAINC PQ BOX 141929 IRVING TX 75014-1929 Agent: MIKE BAKER CLU Telephone: (214) 780-0900 01 Location: 8585 N STEMMONS FWY STE 11 OON DALLAS TX 75247-3822 3177 AIN 530-177.14 10-07-2013 (0*072e) 001 Statekmi JLState Farm Lloyds W PO Box 853925 Richardson, TX 75085-3925 AT M-08- 3864-FC07 003210 0004 CITY OF GILROY ITS OFFICERS & EMPLOYEES - 0*17351 ROSANNA ST GILROY CA 9,5020-6141 Office U F POLICY NUMBER 93-TV-3354-6 REINSTATEMENT DATE JUL 15 2019 DATE PROCESSED MAR 20 2019 AMOUNT PAID No Amount Due We are pleased to acknowledge receipt of the premium due on this policy. This policy will be continued in force subject to its printed terms and conditions upon the payment check clearing through your bank. Insured: PETDATAINC PO BOX 141929 IRVING TX 75014-1929 Agent: MIKE BAKER CLU Telephone: (214) 780-0900 01 Location: 8585 N STEMMONS FWY STE 11 OON DALLAS TX 75247-3822 3210 AI-V 530-177,14 10-07-2013 (olf3072e) 001 A COWD0 CERTIFICATE OF LIABILITY INSURANCE ( DATE(MM/DDIYYYY) 02/06/2019 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NA 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($). PRODUCER CONTACT Jen Wierzba NAME: aC'r?ilt7i Mike Baker jg oNfG, o, EMt: 214-803-7748 (A(c. No!? 214-780-0909 3400 Carlisle St Ste 470 EMAIL en.wierzba.m5 a statefarm.com Al Dallas, TX 75204 J{pQ ESS: J J INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: State Farm Lloyds 43419 INSURED INSURER B : State Farm Fire and Casualty Company 25143 Pet Data Inc I INSURER C : 1 PO Box 141929 I INSURER D : Irving, TX 75014 INSURERE: ' INSURERF: _.. 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 SUSR POLICY ffFF - POLICY EXP LTR TYPE OF INSURANCE 1NSD WVn POLICYNUMSER , IMM I Y- IMM@D/YYYYIf LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR A __ Y Y 93-TV-3354-6 ���GEN'L AGGREGATE LIMIT APPLIES PER: POLICY L _J _JECTPRO ❑ LOC PRO OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED At17OS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY �^ UMBRELLA LIAR OCCUR EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY B OFFICEWMEM ER EXCLUDED? ECU7IVE ( j NIA 93-CS-Z600-9 (Mandatory in NH) �J If yS do scribe under �_,,,, DESCRIPTION OF OPERATIONS below EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 3OO,000 MED EXP (Any one person) $ 5,000 11/13/2018 11/13/2019 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 PRODUCTS -COMPIOPAGO $ 4,000,000 COMBINE(75tNGLE LIMIT (En accident) BODILY INJURY (Per person) BODILY INJURY (Per acc(denq PROPERTY DAMAGE er c gLgntl EACH OCCURRENCE I AGGREGATE $ STATUTE I I ERH 07111/2018 07/11/2019 E.L.EACHACDIDENT $ 1,000,000 E.L. DISEASE -EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000-000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 191, Additional Remarks Schedule, maybe attached If more space Is required) Pet licensing The City of Gilroy, its officers and employees are listed as additional Insured on the above referenced GL policy. CERTIFICATE HOLDER City of Gilroy, Its officers and employees 7351 Rosanna St AUT gRIZED REPRE 7ENTATIV Q 1988.2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are egistered marks of ACORD Gilroy, CA 95020 ACORD 25 (2016103) 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. 1001486 132849.12 03-16-2016 RC Policy No. 93-TV-3354-6 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4786 ADDITIONAL INSURED — OWNERS, LESSEES, OR CONTRACTORS (Scheduled) This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 93-TV-3354-6 Named Insured: PET DATA INC PO BOX 141929 IRVING TX '75014-1929 Name And Address Of Additional Insured Person Or Organization: CITY OF' G:ILROY ITS OF'FICERS & EMPLOYEES 7351 ROSANNA ST GILROY CA 95020 6196 1. SECTION II — WHO IS AN INSURED of SECTION II — LIABILITY is amended to in- clude, as an additional insured, any person or organization shown in the Schedule, but only with respect to liability for "bodily in- jury", "property damage", or "personal and advertising injury" caused, in whole or in part, by: a. Ongoing Operations (1) Your acts or omissions; or (2) The acts or omissions of those acting on your behalf; in the performance of your ongoing opera- tions for that additional insured; or CMP-4786 CMP-4786 Page 1 of 1 b. Products -Completed Operations "Your work" performed for that additional insured and included in the "products - completed operations hazard". 2. Any insurance provided to the additional in- sured shall only apply with respect to a claim made or a "suit" brought for damages for which you are provided coverage. 3. Primary Insurance. The insurance afforded the additional insured shall be primary insur- ance. Any insurance carried by the additional insured shall be noncontributory with respect to coverage provided by you. There will be no refund of premium in the event this endorsement is cancelled. All other policy provisions apply. 1006104 137713.1 10-23-2013 ©, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission. RC Policy No. 93—TV-3354-6 CMP-4787 Page 1 of 1 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY CMP-4787 WAIVER OF TRANSFER OF RIGHTS OR RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SCHEDULE Policy Number: 93—TV-3354-6 Named Insured: PET DATA INC PO BOX 141929 'IRVING TX '75014-1929 Name And Address Of Person Or Organization: CITY OF GILROY ITS OFFICERS & EMPLOYEES 7351 ROSANNA ST GILROY CA 95020 6196 The following is added to Paragraph 10.b. of SECTION I AND SECTION 11 — COMMON POLICY CONDITIONS: We waive any right of recovery we may have against the person or organization shown in the Schedule because of payments we make for injury or damage arising out of: a. Your ongoing operations; or b. "Your work" done under contract with that person or organization and included in the "products - completed operations hazard". This waiver applies only to the person or organization shown in the Schedule. All other policy provisions apply. CMP-4787 1006225 137716.1 11-19-2013 (D, Copyright, State Farm Mutual Automobile Insurance Company, 2008 Includes copyrighted material of Insurance Services Office, Inc., with its permission.