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HomeMy WebLinkAboutPerma Green Hydroseeding - Insurance Certificate (2019)PERMGRE-01 VERONICA ,,,, �''�� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 5/15/2019 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). License # OK07568 I CONTACT PRODUCER NAME: Pacific Diversified Insurance Services PHONE 408 842-2131 FAX, No):(408) 842-0867 15005 Concord Circle, Suite 110 E--MAIL IL Ext): ( ) Morgan Hill, CA 95037 i E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Perma Green Hydroseeding, Inc dba; Mitchell Chuck 7096 Holsclaw Road Gilroy, CA 95020 INSURER A: Associated Industries Insurance Company, Inc. 23140 INSURER B :American Fire and Casualty Company 24066 INSURER C.Cypress Insurance Company 10855 INSURER D : INSURER 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 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/YYYYI (MM/DD/YYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 I CLAIMS -MADE [X] OCCUR X Primary & Non-Contri GEN'L AGGREGATE LIMIT APPLIES PER POLICY ®JEPROCT ❑ LOC I OTHER: B AUTOMOBILE LIABILITY X ANY AUTO _ OWNED SCHEDULED _ AUTOS ONLY 'NON AUTOS HIRED -OWNED _ AUTOS ONLY AUTOS ONLY X AES102472006 UMBRELLA LIAB OCCUR EXCESS LIAR CLAIMS -MADE DED I I RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? Y N 1 A (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below BAA56367171 PEWC019710 10/23/2018 10/23/2019 I PREMISES DAMAGES (RENTED (Ea occurrence) $ MED EXP (Anv one person) $ 1 PERSONAL & ADV INJURY $ 10/23/2018 10/23/2019 2/1/2019 2/1/2020 GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT (Ea accidentl $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ j EACH OCCURRENCE $ (AGGREGATE $ X I SPER TATUTE I I OERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ 100,000 Excluded 1,000,000 2,000,000 2,000,000 1,000,000 1,000,000 1,000,000 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE. Irrigation Antenna Replacement at Santa Teresa and Mantelli City of Gilroy, its officers, officials and employees are included as additional insured if required by written contract as respects the general liability policy (forms attached). CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy, ACCORDANCE WITH THE POLICY PROVISIONS. its officers, officials and employees 7351 Rosanna St Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE I (� ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD COMMEFRICIAL GENERAL LIABILITY CG 20 33 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section 11 — Who Is An Insured is amended to include as an additional insured any person or or- ganization 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 addi- tional insured on your policy. Such person or or- ganization is an additional insured only with re- spect 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. A person!s or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are com- pleted. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the render- ing of, or the failure to render, any professional architectural, engineering or surveying servic- es, including: a. The preparing, approving, or failing to pre- pare or approve, maps, shop drawings, opi- nions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than ser- vice, maintenance or repairs) to be per- formed by or on behalf of the additional in- sured(s) at the location of the covered operations has been completed; or b. 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 other than another contractor or subcontrac- tor engaged in performing operations for a principal as a part of the same project. CG 20 33 07 04 0 ISO Properties, Inc., 2004 Page I of 1 E3