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HomeMy WebLinkAboutGoodwin Consulting Group - Insurance Certificate (2020)DATE (M M/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/25/19 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 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 CONTANAME CT Ernie Dillard DILLARD INSURANCE AGENCY PHONE A/C No,E#) (916) 939-8553 (A/C,No) (916) 933-5532 5145 Golden Foothill Pkwy #100 ADDRIESSernie@dillardins.com El Dorado Hills, CA 95762 INSURER(S) AFFORDING COVERAGE Ob45426 IINSURED Goodwin Consulting Group Inc 333 University Avenue, Suite 160 Sacramento, CA 95825 (916) 561-0890 INSURER A Mid Century INSURER B Truck Insurance Exchange INSURER C Capitol Specialty Insurance Co INSURER D Mid -Century Work Comp INSURER E INSURER F NAIC# 21687 21709 10328 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 SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MM/DD/YY" (MM/DD/YY" I LIMITS IA X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE CI OCCUR GEN'L AGGREGATE LIMIT APPLIES PER POLICY CI JJECT F LOG OTHER AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED A AUTOS AUTOS NON -OWNED X HIRED AUTOS X AUTOS X UMBRELLA LIAB X OCCUR B EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N EACH OCCURRENCE $ 2 , 000 , 000 UAMAGE I O HEN I EU PREMISES (Ea occurrence) $ 250 .000 IVIED EXP (Any one person) $ 5 , 000 605454772 5/1/2018 5/1/2019 PERSONAL& ADV INJURY $ 2 , 000 , 000 Y Y 5/1/2019 5/1/2020 I GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP/OP AGG $ 4,000,000 $ COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ 5/1/2018 5/1/2019 BODILY INJURY (Per accident) $ Y Y 605454772 5/1/2019 5/1/2020 PROPERTY DAMAGE $ (Per accident) EACH OCCURRENCE $ 1,000,000 605454636 5/1/2018 5/1/2019 AGGREGATE $ 1,000,000 5/1/2019 5/1/2020 X I STATUTE I I ERH ANY PROPRIETOR/PARTNER/EXECUTIVE � A094 63819 5/1/2018 5/1/2019 I E.L EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED' N N/A Y (Mandatory in NH) _, 5/1/2019 5/1/2020 I E L DISEASE - EA EMPLOYEE $ 1,000,000 If yes, descrihe under 1 000 000 DESCRIPTION OF OPERATIONS below E.L DISEASE - POLICY LIMIT $ 1,000,000 C E&O / Prof. Liab. SGC03576 5/1/2018 5/1/2019 cm retro 5/1/01$1,000,00 C 5/1/2019 5/1/2020 0 pr Occ,$1,000, aggreg A EPLI 605454772 5/1/2019 5/1/2020 EPLI: $1 million DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Service Agreement: Annual CFD Special Tax Administration Services. City of Gilroy, its officers, officials, and employees are named as additional insured per the attached endorsement. CERTIFICATE HOLDER CANCELLATION City of Gilroy, its officers, officials, SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE and employees THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 7351 Rosanna St ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE ©1988-2013 ACORD CORPORATION. All rights reserved. ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 605454772 BUSINESSOWNERS BP 04 48 01 97 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - DESIGNATED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: BUSINESSOWNERS POLICY SCHEDULE* Name Of Person Or Organization: City of Gilroy, its officers, officials and employees 73S1 Rosanna Street Gilroy, CA 9S020 Service Agreement: Annual CFD Special Tax Administration Services. * Information required to complete this Schedule, if not shown on this endorsement, will be shown in the Decla- rations. The following is added to Paragraph C. Who Is An Insured in the Businossownors Liability Coverage Form: 4. Any person or organization shown in the Schedule is alsn an insured, Nut only with respect to linhility arising out of your ongoing operations or premises owned by or rented to you. BP 04 48 01 97 Copyright, Insurance Services Office, Inc., 1997 Page 1 of 1 ❑ 0 DATE (MM/DD/YYYY >��:C>R" CERTIFICATE OF LIABILITY INSURANCE 04/02/19 �._._... 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 INSORER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT; If the certificate holder is an ADDITIONAL. INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to j the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the I certificate holder in lieu of such ondorsemont(s). PRODUCER NAME: Ernie Dillard _ DILLARD INSURANCE AGENCY "PHONE � � - - FAx"-_ - ---.----I INC, No. Exn: ( 16) 339mm8553 __ �iv_c_No)_(9l6) 9:33 - 5 5 3 2 i 51,45 Golden Foothill Rk.wy #100 E oi�ss:ernie@di.11.ardins .cam --------- 1 El Dorado Hills, CA 95762-_--------------------------I Ob45426 INSURED Goodwin Consulting Group Inc 333 University Avenue, Suite 160 Sacramento, CA 95825 (916) 561-�0890 IN6UR.R(6) ..FORDING CM1 RAGE NAICN INSURERA:Mid Century-- ----- -- -- 21687--- INSURER B: Truck Insurance Hixchange -- 21709 1 NSURF:R c. Capitol. Specialty Insurance Ca 10328 INSURER D.Mid- Century - Word ------ INSURER E INSURER F COVERAGES CEFRTIFICAT'•E NUMBER: _ REVISION NUIVIBEI`i: •T'HIS IS TO CERTIFY THAT THE POI-ICIES Oh INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE, INSURED NAMED A13OVE.= 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 SUB I_CT TO AI_I. THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ---- ---- ---"- - no15L-(suRR"---- - --- -_POLECC EFF FQLICY FXf -" -- --- ---"--'- --- T -- F.fR ( TYPE OF INSURANCE {wsu IwvD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY LIMITS COMMkRC1.L O[iNFR.L LIAUILI'rY IA j �,--T�- _i _ EACH OCCURRENCE $ 2,000 000 c-- -� --- ' -- -- PREMISES_( ao uc`©oena---t-$ 250,000 50 CLAIMS -MADE LX I OCCUf2 r L...------- �._.. --- -" " -�--- -",: (Any P ) F' A X 6054547 12 5/1/2019 i5/1/2020 � PERSONAL_ aADV INJURY $ 2,000,001 _I i GF:N'I.. AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE' rE $ 4 , 000 , 000 i -- JE �T OTHER: �I I_ I POI -ICY OC PRODUCTS - CUMI'/UP AGE' $ 0 0l) /\(JrOMOBILF LIABILI1Yb1VTl3TE7t15 I^FlNYAUI'0 - I SCI af�f20E9/1.f2U2OIBODILYIINJURY(Perperson) 000,000 BODILY INJURY I or acc!dont $ ALL. OWIJFD AUTOS NON -OWNED 6054547'12 120Pf RlY f.)AMAGG " -) - AUTOS AUTOS ! F I ; $ ' HIRED AUTOS I (Per acc!dont)___ $ _ AUTOS $ 1 UMBRELLA LIAB IX I _ OCCUR I EACH OCCURRENCE $ 1,000,0001 I 1 605454636 5/l/2019 5/1./2020!-- --- ---- ----------- -- 13 EXCESS LIAB CLAIMS-MADI'I AGGREGATE -$ 1. , 0-00 , 000 I I- --F -- i _WORKERS COMPENSATION r T� n SIIAIUrl $ LAND EMPLOYERS' LIABILITY ��� j_- , AJ _. ,. 1 ._ FR _ � DED RETEN'I-ION$ YEN' 0- t' •31.9 rfl.f 2QI,)iJ/1,�. ' --------I---------------- .. 5111 oFFICFHmc�e alp/Exc uoFozeruilvF: I;N/n r xa 9 kt� ar 020 k1. EACHACCIDFN'r j i--- -.. �- - -- - (Mandatory in NH) -- E.I_ DISEASE - EA E-ME I_GYEsE,. $ 1,000,000 If yes, describe under i.. - - - - - -- --- DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT j $ 1,000,000 C E&O / prof. Li.ab. SGC03576 "a/l/20191/1/20201�yn retro .ra/1./01$1,000,00 C 0 pr Occ,$1.,000, aggrog j A E1?LI _ 605454772 5/1/2019 5/1/2020 EP141 : $1 million DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101. Additional Remarks Schodulo, may be attached if more space Is required) Service Agreement: Annual.. CE'D Special Tax Administration Serv.i.ces, City of Gilroy, its officers, officials, and employees are named as additional. insured per the attached endorscinaent:. CERTIFICATE HOLDER City of Gilroy, its officers, officials, and employees 7351 Rosanna St Gilroy, CA 95020 CANCELLATION SHOULD ANY OF: '1-111- ABOVE' DESCRIBED POOI.ICIrcS BE CANCELLED BEFORE THE EXPIRATION DA-11 THEREOF, NOTICE WILL. 13E DELIVERED IN ACCORDANCE WITH FHE.. 1301-ICY PROVISIONS, AUTHORIZED REPRFSENTATI _ � ACORD 25 (2013/Ox4) © 1988-2013 ACORD CORPORATION. All rights resorved The ACORD name and logo are registered marks of ACORD AC,0Ra DATE (MM/DDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 04/02/19 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. I IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, Subject to I 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 endorsernent(s). PRODUCER, DILLARD INSURANCE AGENCY 5145 Golden Foothill Pkwy #100 El Dorado Hills, CA 95762 Ob45426 INSURED Goodwin Consulting Group Inc 333 University Avenue, Suite 160 Sacramento, CA 95825 (916) 561-08 90 CONTACT NAME: Ernie Dillard PHNE FAX (A/CO,No.Ext): (916) 939-8553 (A/C No):(916) 933-5532 E-MAIL ADDRESs:ernie@dillardins. cam INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: Mid Century 21687 E Truck Insurance Exchange INSURER B: 21709 INSURER C. Capitol Specialty Insurance Co 10328­1 INSURER D Mid -Century Work Comp INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: R E­V I S I GN N U IVI 'B E R: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO ITIE INSURED NAMED ABOVE FOR THE POLICY PERIOD RESPECT I I WHICH j fj S INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH f ESI ECT -0 WH C- T I CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL. THE TERMS, EXCLUSIONS AND CONDIT-IONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR IADDL SUIBIR POLICY EFF POLICY EX_P__ ITR I TYPE OF INSURANCE INSID WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS X COMMERCIAL GENERAL LIABILrry CLAIMS -MADE [X-i OCCUR A GEN'L AGGREGATE LIMIT APPLIES PER JCY I" POI- L_1 JECT L_I LOC OTHER: AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED A AUTOS AUTOS X NON -OWNED X HIRED AUTOS AUTOS Y Y 605454772 X X UMBRELLA LIAB X OCCUR B EXCESS LIAB CLAIMS -MADE DED RETENTION $ ;WORKERS COMPENSATION JAND EMPLOYERS' LIABILITY Y! N IA'qY flf2OPR!ETC)R/{'ARTNER/L�Y.ECUI'IVF- OFFICER/MEMBER EXCLUDED? N I A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E&O / Prof. Liab. Y 605454772 605454636 Y A.09463819 SGC03576 —D-AVAGE TO REN,rF_D____ PREMISES _LEa 0CC1Jrre_nce) 2.5,0, 0_0 0 5/1/2019 5/1/2020 I IVIED EXP (Any one rson) pe$ F i PERSONAL & ADV INJURY $ _Q0 0 2t000,000 GENERAL AGGREGATE s 4,000,000i PRODUCTS - COMP/OP AGG $ 4, 0 0 0 0 0 0 6 b 067P `01!5-8'FF�6 7- TOW1 F-7 $ (E accident)_._...._ 1,000t000! 1 5/1/20195/1/20210 BODILY INJURY (Per person) $ ! BODILY INJURY (Par accident)! $ RTY DARA6 $ - ----- .. ...... Per accident EACH OCCURRENCE $ 1,000F000 15/1/2019 .5/1/2020' AGGREGATE $ 1 0_0,0_.L 0_0_0 $ STATUT E'R kX_iPF__ _tEj_: I- EACH ACCIDENT 000,0()0 DISEASE - EA EMPLOYEE $ 1 0 0 0 0 0 0 F� L DISEASE - POLICY LIMIT I $ 1 r 0 0 0 r 0 0 Q 5/1/2019 5/1/2020 cm retro 5/1/01$1,000,00 � 1 C0 pr Occ,$1,000, aggreg I A � EPLI 605454772 5/1/2019 5/l/2020 EPLI: $1 million DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Service Agreement: Annual CFD Special Tax Administration Services. City of Gilroy, its officers, officials, and employees are named as additional insured i .,per the attached endorsement. CERTIFICATE HOLDER City of Gilroy, its officers, officials, and employees 7351 Rosanna St Gilroy, C.A. 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 W REPRESENTATIP�— ACORD 25(20'13/04) nj9 1988-2011 3 ACORD CCRPORATION. All rights re-,erved_ The ACORD name and logo are registered marks of ACORD