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HomeMy WebLinkAboutTwo Brothers Cathodic - Insurance Certificate (2020)Froa1:,Malga Murchison FaxID:Agency Fax Date:1/24/2019 1:39:13 PM Page: 1 of 6 --�"� TWOBROT•02 MMURCHISON �CQRQN CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 414.� 01124/2019 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 RgfijACT Malla Murchison Cumbre Insurance Services, LLC 4065 Mother Lode Drive Suite A Shingle Springs, CA 95682 INSURED Two Brothers Cathodic Services, Inc, 5361 Hilltop Road Garden Valley, CA 95633 N E. PHONE AIC NNo, Ext): (530) 558-3957 FAX No): " �s .murchisonm a�cumbreins.com.............................................. .............. I........................ .............................INS. i I$),AFF0121�ING„COV RAG .............. ,,...,.,,.,..,........,.,,.... ...... ,,.,,NA.I�....,,,..... IN5URrR. A; -Co Ionylnsurance„Company 39993 ,INsuRR ,,;,National Union Fire Insurance Company of Pittsburgh, Pa.19445 INSURERC..............................................................................................................................................................................� ,INSURER D ; 11 INSU[2ER E,:................................................................................................................................... ,....,....� 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 CONTRA :T OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT 1-0 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 'OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS. _.�....._............................................................................................................................................... ......,.......................................................... .............. ......... INSR ADDL SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE POLICY NUMBER LIMITS ..............................................,,..............................................ttiSR, kJ^.Ilt�........................,.......,........,..........,...,...............................dM.Mild[71Y..Y..Y.XI.�(MMl0.0CL.Y.,X.YL,.............................................................., A X COMMERCIAL GENERAL LIABILITY 1,000,000 ,,,,,, ;"ACW OCCURRENCE $ J CLAIMS -MADE L " J OCCUR X 101GL000533605 GEN%AGGREC,ATE LIMIT APPLIES PER: POLICY I PRO- JECT I........1 LOG ............ OTWER;, AUTOMOBILE LIABILITY ANY AUTO �...... OWNED SCHEDULED ,.AIURRT��OS ONLY AUTOS$ p A✓JT�S ONLY WNW ONt�Y —.......................................................... ,.........,........ ............ ............................. .......... B X UMBRELLA LAB I X OCCUR EXCESS LIAB CLAIMS -MADE EBU018286311 _.............. DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETORIPARTNERIEXECUTIVE O FICERIMCMBE EXCLUDED? 1 NIA (Mandatory In NH) If yes, describe under ESCf21PT10N,0 OPERATIONS below 02103/2019 02/0312020 02/0312019 02/0312020 DAMAGE TO RENTED 100,0001 M,ED PXP (Any,one,person),,,,,,, $ S,OOOI PERSONAL,B AUV INJURY $ 1 cg,NRRaL.P..G.099> 7 �............... 2,000,000 ,RNoqucrs,;,coMp(oP,acc,,,,� 2,000,0001 ......................................................................................................1 COMBINED SINGLE LIMIT (Ea.ac.�ident)......................................$ BODILY INJURY (Per parson , $ BODILY INJURY JPer accident)„ $ �&Lacc.PE I�TY DAMAGE ., er,9....................................................................................... EACW OCCURRENCE $ 3,000,000 AGGREGATE........................3,000,000 Product IOps Agg 3,000,0001 OTH- ..., ..�.9T.ATE.,,L._..,...E.R.................................................................� .L., EACE (ACCIDN 1...................6 �.G., pISE,ASE • �A, EMpLQYEE..� ...................................................� „�;l;,pIS�ASE„„pOI;ICY,LIMIT „� DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required City of Gilroy, Its officers, officials and employees are named as an additional insured RE: Work performed by the nsured when under contract. 10 days notice of cancellation for nonpayment of premium. 30 days for all others. CEj ,TI ICA71E„HOLDER City of Gilroy, its officers officials and employees 7351 Rosanna Street 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 ACORD 25 (2016103) O 1988.2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD FroW:Malia Murchison FaxID:Agency Fax Date:1/24/2019 1:39:13 PM Page: 2 of 6 101 GL 0006336.05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. • r . � � r l � • r � r This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL. LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) (Additional Insured): Location(s) of Covered Operations: All persons or organizations as required by a written Locations as required by a written contract or contract or agreement with the named insured, agreement with the named insured, 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 for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured 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. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured. Contractual Liability "bodily injury" or "property damage" for which the additional insured(s) are obligated to .pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations at Work "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. Negligence of Additional Insured "bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional insured(s). U156A-0313 Includes copyrighted material of ISO Properties, Inc., Page 1 of 2 with its permission. From:,Malia Murchison FaxID:Agency Fax Date:1/24/2019 1:39:13 PM Page: 3 of 6 101 GIL 0006336-05 C. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 4. Other Insurance is amended and the following added: The insurance afforded by this Coverage Part for the additional insured required by a written contract or agreement with the named insured is primary insurance and we will not seek contribution from any other insurance available to that additional insured. D. SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS, 8. Transfer Of Rights Of Recovery Against Others To Us is amended and the following added: We waive any rights of recovery we may have against any person or organization because of payments we make for injury or damage resulting from your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard" if: a. you agreed to such waiver; b, the waiver is included as part of a written contract or lease; and c, such written contractor lease was executed prior to any loss to which this insurance applies. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U156A-0313 Includes copyrighted material of ISO Properties, Inc., Page 2 of 2 with its permission. FroM,.,Malia Murchison FaxID:Agency Fax Date:1/24/2019 1:39:13 PM Page: 4 of 6 101 GIL 0006336.05 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. iOR 0 This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name of Person or Organization: CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOYEES 7351 ROSANNA STREET GILROY, CA 95020 The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any rights of recovery we may have against any person or organization shown in the Schedule above because of payments we make for injury or damage resulting from your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard" if: a, you agreed to such waiver; b. the waiver is included as part of a written contract or lease; and c. such written contractor lease was executed prior to any loss to which this insurance applies. This waiver applies only to the person or organization shown in the Schedule above. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED, U047A-0310 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission. Fr=om:Malia Murchison FaxID:Agency Fax Date:1/24/2019 1:39:13 PM Page: 5 of 6 101 GL 0006336.06 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED OWNERS, LESSEES OR CONTRACMRS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s) (Additional Insured): Location(s) of Covered Operations: CITY OF GILROY, ITS OFFICER, OFFICIALS PER WRITTEN CONTRACT WITH THE AND EMPLOYEES NAMED INSURED 7351 ROSANNASTREET Gilroy, CA 95020 The insurance afforded by this Coverage Part for the additional insured shown in the Schedule is primary insurance and we will not seek contribution from any other insurance available to that additional insured. 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 for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured 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. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: Additional Insured Contractual Liability "Bodily injury" or "property damage" for which the additional insured(s) are obligated to pay damages by reason of the assumption of liability in a contract or agreement. Finished Operations at Work "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. Negligence of Additional Insured U156-0310 Includes copyrighted material of ISO Properties, Inc., Page 1 of 2 with its permission. F,rbm:Mal�a Murchison FaxID:Agency Fax Date:1/24/2019 1:39:13 PM Page: 6 of 6 101 GL 0006336.05 "Bodily injury" or "property damage" arising directly or indirectly out of the negligence of the additional insured(s). ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. U156-0310 Includes copyrighted material of ISO Properties, Inc., Page 2 of 2 with its permission. Fwo Brothers Cathodic Services, Ine. City of Gilroy I-Ii Sheila Office: (530) 333-0764 Fax: (530) 333-4389 5361 Hilltop Rd Oarden Valley, Ca 95633 March 26,2019 I am the sole proprietor and owner of Two Brothers Cathodic Services, Inc. I do not employ any people as it is just myself. Thank you Date Ham,,uin (j,!w1state, 'fou're In good hands. CERTIFICATE OF INSURANCE Cl CW A02 10 11 This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder. Named Insured: CITY OF GILROY TWO BROTHERS CATHODIC SERVICE ITS OFFICERS, OFFICIALS AND 5361 HILLTOP RD EMPLOYEES AS ADDITIONAL INSURED GARDEN VALLEY CA 95633-9501 7351 ROSANNA ST GILROY, CA USA 950206141 Automobile Liability Insurer Name: Allstate Insurance Company Policy Number: 04 8751653 1 Any Auto 2 - Owned Autos Only 3 - Owned Priv. Pass, Autos Only 4 Owned Autos Other Than Priv. 5 - Owned Autos Subject to 6 - Owned Autos Subject to a Compulsory UM Law Pass, Autos Only No Fault Ix 7 -- Specifically Described Autos 8 - Hired Autos Only 9 - Nonowned Autos Only Policy Effective Date: 11-16 - 2 018 I Policy Expiration Date: 11-16 - 2 019 Limits of I $2, 000, 000 (Combined Single Limit (each accident) ce Insuran: I BI Per Person BI Per Accident I PD Per Accident Description of Operations/Locations/Vehicles/Endorsements/Special Provisions Interested Party Type: Additional Insured - Municipality THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer: BACIOCCO BROS INS Authorized Representative: Date:09-02-18 Includes copyrighted material of Insurance Services Office, Inc., with its permission BU114R•3 CI CW A02 10 11 Allstate Insurance Company Additional Insured Copy Page 1 of 1 (WAlls ate. !au're in good hands. POLICY NUMBER: 048751653 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM - - - - - - - - - - - - - - - - -With - respect- to- coverage- -provided- by -this. endorsement; - the- provisions- of- -the -Coverage- Form- apply- -unless modified by this endorsement. '4� BU114R-3 This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form, This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: TWO BROTHERS CATHODIC SERVICE Endorsement Effective Date: 11-16 - 2 018 SCHEDULE Name Of Person(s) Or Organization(s): CITY OF GILROY ITS OFFICERS,OFFICIALS AND EMPLOYEES AS ADDITIONAL INSURED 7351 ROSANNA ST GILROY, CA USA 950206141 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form, CA20481013 © Insurance Services Office, Inc., 2011 Additional Insured Copy Page 1 of 1