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HomeMy WebLinkAboutFiorio Farms - Insurance Certificate (2020)FIORFAR-01 LISA ,a►cORn� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 4/18/2019 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 License # OK07568 I CONTACT NAME: Pacific Diversified Insurance Services PH/ONl o, EXt): (408) 842-2131 FAX, Ne);(408) 842-0867 I 15005 Concord Circle, Suite 110 E-MAIL 1 Morgan Hill, CA 95037 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:AIIIed Insurance 10127 INSURED INSURER B : Wesco Insurance Company 25011 Florio Farms Inc. Dan Florio INSURER C 6330 Thomas Rd INSURER D ; Gilroy, CA 95020 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 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. LTR TYPE OF INSURANCE ANSD WVD POLICY NUMBER (MM/DDIYYFYY) (MM/DDNYYYI LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE ® OCCUR X FPKFMP7880914858 411/2019 4/1/2020 I PREMI ETORENTED 100,000 PREMISES occurrence) $ GEN'L AGGREGATE LIMIT APPLIES PER; POLICY ❑ YE LOC OTHER: A AU-OMOBILE LIABILITY X ANYAUTO FPKFMP7880914858 OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUOTOS ONLY A X UMBRELLA LIAB X OCCUR EXCESS LIAB CLAIMS -MADE FPKFMP7880914858 DIED I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N WWC3414682 ANY PROPRIETOR/PARTNER/EXECUTIVE F�FICER/MEMBER EXCLUDED? N / A (Mandatory In IN f yes, describe under DESCRIPTION OF OPERATIONS below A Rented Equipment FPKFMP7880914858 4/1/2019 4/1/2020 411/2019 4/1/2020 4/1/2019 411/2020 4/1/2019 4/112020 MED EXP (Anv one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OPAGG $ COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ (Pe�accitlentl AMAGE $ $ EACH OCCURRENCE $ AGGREGATE $ X PER EERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ EL, DISEASE - POLICY LIMIT $ Ded $500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: Monterey & Luchessa Rd, Gilroy, CA. (Gilroy Sports Complex) Certificate holder is named as Additional Insured with respects to the above referenced land. 10 days notice for non-payment of premium. 5,000 1,000,000 2,000,000 1,000,000 1,000,000 4,000,0001 4,000,0001 1,000,000 1,000,000 1,000,000 500,000 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y Y ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD FPK FMPN 78 8 0914858 INSURED'$ COPY Form FORM 8110 ADDITIONAL INFORMATION SUPPLEMENTAL DECLARATIONS DESCRIPTION FL70610 ADDITIONAL INSURED -DESIGNATED OPERATION, LOCATION OR EQUIP MARIO C I& INEZ B FIORIO,TRVSTEES OF THE FIORIO FAMILY TRUST 6300 THOMAS RD,GILROY,CA9$020,LOC 001 YVONNE "LENCIA,501 PINECREEK CT,ROSEVILLE,CA 95747, LOC 001 CITY OF GILROY,7531 ROSANNA ST,GILROY,CA 95020.RE LOC 009 JAMES RANCH,DXLL & SUE JAMES,7550 KENTWOOD CT,GILROY,CA 95020 RE LOC 003 RICHARD MASONI,7340 CREWS RD 4ILROY,CA 95020 RE LOC 013 MITCHELL J MILLA,2175 OAK KNOLL AVE,SAN MARTIN,CA 91108 RE LOC 014 SEE FORM 280 FOR MORE ADDITIONAL INSUREDS 1 FP70526 EXTENDED FARM OFFICE EQUIPMENT 001/002 FP70582 LIMITED FUNGI OR BACTERIA COVERAGE ENDORSEMENT - PROPERTY LIMIT: 010,000 FP70550 RENTED/LEASED FARM MACHINERY & EQUIPMENT- PRIMARY COVERAGE AGGREGATE LIMIT: 0000000 PERIOD OF COV-NUM OF DAYS: 090 PACIFIC AG RENTAL$, 1 HARRIS PL EGA, SALINASI CA 93901 PETERSON TRACTOR COMPANY, 13155 SYCAMORE AVE, SAN MARTIN, CA DUMAC LEASING, PO BOX 760, SANTA ROSA, CA, 95402 PENSKE TRUCK LEASING COMPANY, PENSKE TRUCK LEASING CO.,LP FL70634 ADDITIONAL INSURED -VENDOR OF YOUR PRODUCT 01 ADDITIONAL INSUREDS WH BOLTHOUSE FARMS, INC. ISAOA CARROTS 6110 )01-01) UD Page 14964 47 EFFECTIVE DATE: 12:01 AM Standard Time, FARM (at your principal place of business) FL 70610 (01-01) THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURE® - DESIGNATE® OPERATION, LOCATION OR EQUIPMENT COVERAGE ENDORSEMENT This endorsement modifies insurance provided under the following: FARM LIABILITY COVERAGE FORM This endorsement applies only to the person(s) or organization(s) identified on Form 8110 (Additional Endorsement Information) of this policy. Under Section C. WHO IS AN INSURED, in paragraph 2., each of the following is also an insured: The persons or organizations shown on Form 8110, but only with respect to liability arising out of the designated operation or location or your use of equipment shown on Form 8110, subject to the following additional exclusion: This insurance, including any duty we have to defend "suits", does not apply to "bodily injury", "property damage" or "personal and advertising injury" that arises out of, in whole or in part, or is a result of, in whole or in part, the active or primary negligence of any person or organization designated as an additional insured on Form 8110. All terms and conditions of this policy apply unless modified by this endorsement. FL 706 10 (01-01) FIORFAR-01 LISA CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 4/18/2019 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 License # OK07568 CONTACT NAME: Pacific Diversified Insurance Services PHONE , Ext): (408 842-2131 FAX 408 842-0867 15005 Concord Circle, Suite 110 ) (A/C, No):( ) Morgan Hill, CA 95037 ADDRIESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Allied Insurance 10127 INSURED INSURER B : Wesco Insurance Company 25011 Florio Farms Inc. Dan Fiorio INSURER C 6330 Thomas Rd INSURER D : J Gilroy, CA 95020 INSURER E : J INSURER F : J COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 1 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER /YPOLICY EFF POLICY EXP LIMITS LTR INSD WVD (MM/DDYYY) (MM/DDIYYYY) A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE F_X] OCCUR X FPKFMP7880914858 4/1/2019 4/1/2020 DAMAGE TO RENTED 100,000 PREMISES (Ea occurrence) $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC OTHER: A AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY AUUTOS ONLDY A X UMBRELLA LIAB OCCUR EXCESS LIAB �d CLAIMS -MADE DED I I RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below A Rented Equipment FPKFMP7880914858 FPKFMP7880914858 WWC3414682 FPKFMP7880914858 411 /2019 411 /2020 4/1/2019 4/1/2020 MED EXP (Anv one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ EACH OCCURRENCE $ AGGREGATE $ X I STATUTE I EERH 4/1/2019 4/1/2020 I E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ 4/1/2019 4/1/2020 Ded $500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: Monterey & Luchessa Rd, Gilroy, CA. (Gilroy Sports Complex) Certificate holder is named as Additional Insured with respects to the above referenced land. 10 days notice for non-payment of premium. CERTIFICATE HOLDER CANCELLATION 5,000 1,000,000 2,000,000 1,000,000 1,000,000 4,000,000 4,000,000 1,000,000 1,000,000 1,000,000 500,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN y y ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD FPK FMPN 78 8 0914858 INSUREDS COPY FORM 8110 ADDITIONAL INFORMATION SUPPLEMENTAL DECLARATIONS Form DESCRIPTION FL70610 ADDITIONAL INSURED-DESIONATED.OPERATION, LOCATION OR EQUIP HARI0 C & INEZ B FIORIO,.TRUSTEES OF THE FIORIQ FAMILY TRUST 6300 THOMAS RDPOILROY,CA95020,LOC 001 YVONNE "LENCIAMI PINECkEEK CT,ROSEVILLE,CA 957471 LOC 001 CITY OF GILROY,753,1 ROSANNA ST,GILROYsCA 95020 RE LOC 009 JAMES RANCH,2ILL & SUE JAMESi7550 KENTWOOD CT,GILROY,CA 95020 RE LOG 003 RICHARD MASONx,7340 CREWS RDjGILROY$CA 95020 RE LOC 013 MITCHELL J MILLA,2175 OAK KNOLL AVE,SAN MAR,TIN,CA 91108 RE LOC 014 SEE FORA 28B, FOR MORE ADDITIONAL INSUREDS PP70526 EXTENDED FARM OFFICE EQUIPMENT 001`002 FP70582 LIMITED FUNGI OR BACTERIA COVERAGE ENDORSEMENT PROPERTY. LIMIT: $10400 FP70550 RENTED/LEASED FARM MACHINERY & EQUIPMENT- PRIMARY COVERAGE AGGREGATE LIMIT's *500.400 PERIOD OF COV-NUM OF DAYS: 090 PACIFIC AG RENTALS, 1 HARRIS PL *A, SALINAS.. CA 93.901 PETERSON TRACTOR COMPANY, 13155 SYCAMORE AVE, SAN MARTIN, CA DUMAC LEASING, PO BOX 760, SANTA ROSA, CA, 95402 PENSKE TRUCK LEASING COMPANY, PENSKE TRUCK LEASING CO.,LP FL70634 ADDITIONAL INSURED -VENDOR OF YOUR PRODUCT 01 ADDITIONAL INSUREDS WN BOLTHOUSE FARMS, INC. ISAOA CARROTS silo (01.01) 00 Page 14964 47 EFFECTIVE DATE: 12:01 AM Standard Time, FARM (at your principal place of business) FL 70610 (01-01) THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED OPERATION, LOCATION OR EQUIPMENT COVERAGE ENDORSEMENT This endorsement modifies insurance provided under the following: FARM LIABILITY COVERAGE FORM This endorsement applies only to the person(s) or organization(s) identified on Form 8110 (Additional Endorsement Information) of this policy. Under Section C. WHO IS AN INSURED, in paragraph 2., each of the following is also an insured: The persons or organizations shown on Form 8110, but only with respect to liability arising out of the designated operation or location or your use of equipment shown on Form 8110, subject to the following additional exclusion: This insurance, including any duty we have to defend "suits", does not apply to "bodily injury", "property damage" or "personal and advertising injury" that arises out of, in whole or in part, or is a result of, in whole or in part, the active or primary negligence of any person or organization designated as an additional insured on Form 8110. All terms and conditions of this policy apply unless modified by this endorsement. FL 706 10 (01-01)