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HomeMy WebLinkAboutKoff & Associates - Insurance Certificate (2019)t 0 DATE /DDIYYYY) mow,+"'" CERTIFICATE OF LIABILITY INSURANCE I 03/22 /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 LIC #OE77964 1-925-671-5110 (CONTACT NAME: Eileen Hollander Integro Insurance Brokers PHONE FAX (A(O.No. Extl: 925-852-0445 (A/C.No): 925-852-0495 E-MAIL rou Eileen.Hollander@ante ro 23'00 Contra Costa Blvd ADDRESS: g g p.com Suite 375 I INSURER(S) AFFORDING COVERAGE NAIC# Pleasant Hill, CA 94523 IINSURERA: CITIZENS INS CO OF AMER 31534 INSURED INSURERB:ALLMERICA FIN BENEFIT INS CO 41840 Koff & Associates, Inc. IINSURER C: HOUSTON CAS CO 42374 2835 7th Street IINSURERD: INSURER E : Berkeley, CA 94710 IINSURERF: COVERAGES CERTIFICATE NUMBER: 55701315 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 E TYPE OF INSURANCE wADDL SUBR POLICY EFF POLICY EXP LIMITS INS❑ vD POLICY NUMBER (MMIDD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY X OBF-D709934-00 10/01/18 10/01/19 1 EACH OCCURRENCE $ 2,000,000 CLAIMS -MADE FxI OCCUR GGEENI AGGREGATE LIMIT APPLIES PER: " POLICY E � LOC II OTHER: B AUTOMOBILE LIABILITY AWF-D709922-00 X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB I X I OCCUR OBF-D709934-00 EXCESS LIAB j i CLAIMS -MADE DED I 'X I RETENTION $ NIL B WORKERS COMPENSATION X W2F-D709926-00 AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? ❑ NIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below C Professional Liability H719-112999 CLAIMS -MADE DAMAGE TO RENTED 1,000,000 PREMISES (Ea occurrencel $ MED EXP (Any one person) $ 10,000 PERSONAL $ADVINJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 (PRODUCTS - COMP/OPAGG $ 4,000,000 10/01/18 10/01/19 COMBINED SINGLE LIMIT $ 1,000,000 (Ea accldent) BODILY INJURY (Per person) $ BODILY INJURY (Per accldent) $ PROPERTY DAMAGE $ (Per accident) $ 10/01/18 10/01/19 (EACH OCCURRENCE $ 1,000,000 (AGGREGATE $ 1,000,000 $ 10/01'/18 10/01/19 X STATUTE I PER ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L,DISEASE- POLICY LIMIT $ 1,000,000 03/01/19 03/01/20 Each Claim 1MM/2MM In the Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) RE: Professional Services Contract Additional Insured(s): The Certificateholder is included as Additional Insured but only as respects to operations of the Named Insured for the above event -General Liability coverage only; Waiver of Subrogation as per the enclosed forms 30 Days Notice of Cancellation, except for Non -Payment which shall be 10 days Applicable Form(s): 391-1006 0816, 401-1235 1214, WC000313 0484; Claims Made Date: 04/16/14 CERTIFICATE HOLDER CANCELLATION City of Gilroy, its officers, representatives, agents and employees 7351 Rosanna St Gilroy, CA 95020 1 USA 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 yrI ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD EHollander 55701315 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESSOWNERS LIABILITY SPECIAL BROADENING ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESSOWNERS COVERAGE FORM SUMMARY OF COVERAGES 1. Additional Insured by Contract, Agreement or Permit 2. Additional Insured - Broad Form Vendors 3. Alienated Premises 4. Broad Form Property Damage - Borrowed Equipment, Customers Goods and Use of Elevators 5. Incidental Malpractice (Employed Nurses, EMT's and Paramedics; 6. Personal and Advertising Injury - Broad Form 7. Product Recall Expense Product Recall Expense Each Occurrence Limit Product Recall Expense Aggregate Limit Product Recall Deductible 8. Unintentional Failure to Disclose Hazards 9. Unintentional Failure to Notify Limits Page Included 1 Included 2 Included 3 Included 3 Included 3 Included 4 Included 4 $26,000 5 Occurrence $50,000 5 Aggregate $500 5 Included 6 Included 6 This endorsement amends coverages provided under the Businessowners Coverage Form through new coverages and broader coverage grants. This coverage is subject to the provisions applicable to the Businessowners Coverage Form, except as provided below. The following changes are made to SECTION II - LIABILITY: 1. Additional Insured by Contract, Agreement or Permit The following is added to SECTION II - LIABILITY, C. Who Is An Insured: Additional Insured by Contract, Agreement or Permit a. Any person or organization with whom you agreed in a written contract, written agreement or permit to add such person or organization as an additional insured on your policy 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 your acts or omissions, or the acts or omissions of those acting on your behalf, but only with respect to: (1) "Your work" for the additional Insured(s) designated In the contract, agreement or permit; (2) Premises you own, rent, lease or occupy; or (3) Your maintenance, operation or use of equipment leased to you. b. The insurance afforded to such additional insured described above: (1) Only applies to the extent permitted by law; and (2) Will not be broader than the insurance which you are required by the contract, agreement or permit to provide for such additional insured. (3) Applies on a primary basis if that is required by the written contract, written agreement or permit. (4) Will not be broader than coverage provided to any other insured. (5) Does not apply if the "bodily injury", "property damage" or "personal and advertising injury"is otherwise excluded from coverage under this Coverage Part, Including any endorsements thereto. 391.1006 0816 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 1 of 6 c. This provision does not apply: (1) Unless the written contract or written agreement was executed or permit was Issued prior to the "bodily injury", "property damage", or "personal injury and advertising Injury". (2) To any person or organization Included as an insured by another endorsement Issued by us and made part of this Coverage Part. (3) To any lessor of equipment: (a) After the equipment lease expires; or (b) If the "bodily injury", "property 2. damage", "personal and advertising Injury" arises out of sole negligence of the lessor. (4) To any: (a) Owners or other interests from whom land has been leased if the "occurrence" takes place or the offense is committed after the lease for the land expires; or (b) Managers or lessors of premises if: (i) The "occurrence" takes place or the offense is committed after you cease to be a tenant in that premises; or (ii) The "bodil�r injury", "property damage", personal injury' or "advertising injury" arises out of structural alterations, new construction or demolition operations performed by or on behalf of the manager or lessor. (5) To "bodily Injury", "propert damage" or "personal and advertising injury" arising out of the rendering of or the failure to render any professional services. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring ofothersby that insured, if the "occurrence" which caused the "bodily injury" or "property damage" or the offense which caused the "personal and advertising injury" involved the rendering of or failure to render any professional services by or for you. d. With respect to the insurance afforded to these additional insureds, the following is added to SECTION II - LIABILITY, D. Liability and Medical Expense Limits of Insurance: Hanuraover Group- OBFD709934 5701660 The most we will pay on behalf of the additional insured for a covered claim is the lesser of the amount of insurance: 1. Required by the contract, agreement or permit described in Paragraph a.; or 2. Available under the applicable Limits of Insurance shown In the Declarations. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations e. All other Insuring agreements, exclusions, and conditions of the policy apply. Additional Insured - Broad Form Vendors The following is added to SECTION II - LIABILITY, C. Who Is An Insured: Additional Insured - Broad Form Vendors a.. Any person or organization that is a vendor with whom you agreed In a written contract or written agreement to include as an additional insured under this Coverage Part Is an insured, but only with respect to liability for "bodily injury" or "property damage" arising out of "your products" which are distributed or sold in the regular course of the vendor's business. b. The insurance afforded to such vendor described above: (1) Only applies to the extent permitted by law; (2) Will not be broader than the insurance which you are required by the contract or agreement to provide for such vendor; (3) Will not be broader than coverage provided to any other Insured; and (4) Does not apply if the "bodily injury", advertitising Injury Is otherwiseoexcluded from coverage under this Coverage Part, Including any endorsements thereto c. With respect to insurance afforded to such vendors, the following additional exclusions apply: The Insurance afforded to the vendor does not apply to: (1) "Bodily injury" or "property damage" for which the vendor is obligated to pay damages by reasons of the assumption of liability in a contract or agreement. This exclusion does not apply to liability for damages that the insured would have In the absence of the contract or agreement; (2) Any express warranty unauthorized by you; 3914006 08 16 Includes copyrighted materials of Insurance Services Offices, Inc., with Its permission. Page 2 of 6 (3) Any physical or chemical change in the Product made intentionally by the vendor; (4) Repackaging, unless unpacked solely for the purpose of inspection, demonstration, testing, or the substitution of parts under instruction from the manufacturer, and then repackaged in the original container; (5) Any failure to make such Inspection, 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 sale of the product; (6) Demonstration, installation, servicing or repair operations, except such operations performed at the vendor's premises In connection with the sale of the product; (7) 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; (8) "Bodily Injury" or "property damage" arising 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 behalf. However, this exclusion does not apply to: (a) The exceptions contained within the exclusion in subparagraphs (4) or (6) above; or (b) 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. (9) "Bodily injury" or "property damage" arising out of an "occurrence" that took place before you have signed the contract or agreement with the vendor. (10)To any person or organization Included as an insured by another endorsement Issued by us and made part of this Coverage Part. (11)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. d. With respect to the insurance afforded to these vendors, the following is added to SECTION II - LIABILITY, D. Liability and Medical Expense Limits of insurance: The most we will pay on behalf of the vendor for a covered claim is the lesser of the amount of Insurance: 1. Required by the contract or agreement described in Paragraph a.; or 2. Available under the applicable Limits of Insurance shown in the Declarations; This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. 3. Alienated Premises SECTION II - LIABILITY, B. Exclusions, 1. Applicable To Business 'Liability Coverage k. Damage to Property, paragraph (2) is replaced by the following: (2) Premises you sell, give away or abandon, If the "property damage" arises out of any part of those premises and occurred from hazards that were known by you, or should have reasonably been known by you, at the time the property was transferred or abandoned. 4. Broad Form Property Damage - Borrowed Equipment, Customers Goods, Use of Elevators a. The following is added to SECTION II - LIABILITY, B. Exclusions, 1. Applicable To Business Liability Coverage, k. Damage to Property: Paragraph (4) does not apply to "property damage" to borrowed equipment while at a jobsite and not being used to perform operations. Paragraph (3), (4) and (6) do not apply to "property damage" to "customers goods" while on your premises nor to the use of elevators. b. For the purposes of this endorsement, the following definition is added to SECTION 11 - LIABILITY, F. Liability and Medical Expenses Definitions: 1. "Customers goods" means property of your customer on your premises for the purpose of being: a. Worked on; or b. Used in your manufacturing process. c. The Insurance afforded under this provision is excess over any other valid and collectible property insurance (including deductible) available to the insured whether primary, excess, contingent or on any other basis. 5. Incidental Malpractice - Employed Nurses, EMTs and Paramedics . SECTION 2.a.(1)(d) ldoes, not apply to annurse, 3914006 0816 Includes copyrighted materials of Insurance Services Offices, Inc., with its permission. Page 3 of 6 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. NOTICE OF CANCELLATION TO DESIGNATED ENTITY(S) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART HANOVER COMMERCIAL FOLLOW FORM EXCESS AND UMBRELLA POLICY COMMERCIAL PROPERTY COVERAGE PART BUSINESS AUTO COVERAGE FORM BUSINESSOWNERS COVERAGE FORM SCHEDULE Name of Designated Entity Mailing Address or Email Address Number Days Notice On file with Companv as per 30 Days written contract (Information required to complete this Schedule, if not shown above, will be shown in the Declarations.) If we cancel this policy for any reason other than nonpayment of premium, we will give written notice of such cancellation to the Designated Entity(s) shown in the Schedule. Such notice may be delivered or sent by any means of our choosing. The notice to the Designated Entity(s) will state the effective date of cancellation. Unless otherwise noted in the Schedule above, such notice will be provided to the Designated Entity(s) no more than the .number of days in advance of the effective date of cancellation that we are required to provide to the Named Insured for such cancellation. Such notice of cancellation is solely for the purpose of informing the Designated Entity(s) of the effective date of cancellation and does not grant, alter, or extend any rights or obligations under this policy. ALL OTHER TERMS AND CONDITIONS OF THIS POLICY REMAIN UNCHANGED Page 1 of 1 401-1235 12 14 Includes copyrighted material of Insurance Services Office, Inc., with its permission. WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named In the Schedule. Schedule APPLIES AS BLANKET WAIVER FOR THOSE HAVING A WRITTEN CONTRACT WITH THE POLICY- HOLDER REQUIRING WOS FOR WC POLICYHOLDER EMPLOYEES This endorsement changes the policy to which It is attached and is effective on the date issued unless otherwise stated. (The information below Is required only when this endorsement is Issued subsequent to preparation of the policy.) Endorsement Effective Policy No. Endorsement No. Insured Koff & Associates Inc W2F-D709926-00 Premium Insurance Company Countersigned by Alimerica Financial Benefit Insurance WC 00 03 13 (Ed. 4-84) Copyright 1983 National Council on Compensation Insurance.