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HomeMy WebLinkAboutSabah International - Insurance Certificate (2020)ACC) CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �W " I 7/1/2019 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). Specialty USA I CONTACT PRODUCER JLT S p NAME: Elizabeth Stackowitz 350 Madison Avenue, 7th Floor I PHONE I FAX New York, NY 10017 E-MAILo. Extl: (A/C, No): ADDRESS: elizabeth.stackowitz(Miltus.com I INSURER(S) AFFORDING COVERAGE NAIC # www.jltus.com I INSURERA: Everest Indemnity Insurance Company 10851 INSURED INSURER B : Hartford Fire Insurance Company 19682 Sabah International INSURERC: Hartford Casualty Insurance Company 29424 and Per I L T8 00 5925 Stoneridge Drive INSURER D : AXA Insurance Company 33022 Pleasanton CA 94588 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 49762659 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) A v/ COMMERCIAL GENERAL LIABILITY 51GLO14498-191 7/1/2019 7/1/2020 EACH OCCURRENCE $1,000,000 CLAIMS -MADE ✓ OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100,000 _ I MED EXP (Any one person) $ 5,000 I PERSONAL & ADV INJURY $ 1,000,000 _ GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ 2,000,000 ✓ POLICY PRO- ❑ LOC JECT I PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY 10 UEA DD3733 7/1/2019 7/1/2020 COMBINED SINGLE LIMIT $ � (Ea accident) 1,000,000 _ ✓ ANY AUTO I BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTYDAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY Comp/Coll $1,000 A �/ UMBRELLA LIAB OCCUR 51 CCO05276-191 7/1/2019 7/1/2020 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DED I I RETENTION $ $ C WORKERS COMPENSATION 10 WEA AB6S9Z 7/1/2019 7/1/2020 ✓ I I I AND EMPLOYERS' LIABILITY Y� SPER TATUTE EORH ANYPROPRIETOR/PARTNER/EXECUTIVE I E.L, EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED7 NIA (Mandatory (Mandatory in NH) I E.L. DISEASE - EA EMPLOYEE $ 1.000.000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 ,000,000 D Pollution & Professional Liability PECO054554 7/1/2019 7/1/2020 Per Claim/Agg Limit: $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Job #8952, Furnish Material, and Troubleshoot and Repair existing Access Security System, Gilroy, CA. City of Gilroy, Police Department, its officers, agents, volunteers and employees is named additional insured per forms CG2010 0704 and CG2037 0704 attached. CERTIFICATE HOLDER CANCELLATION Clt of Gilroy SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Y THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 73 1 Rosanna Street ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy CA 95020 AUTHORIZED REPRESENTATIVE 'A" Andre Eichenholtz ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 49762659 1 18/19 AU WC POLL PL I Elizabeth Stackowitz 1 7/1/2019 5:40:36 PM (EDT) I Page 1 of 1 This certificate cancels and supersedes ALL previously issued certificates. ACC CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �4 ' I 7/1/2019 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). CONTACT PRODUCER JILT Specialty USA NAME: Elizabeth Stackowitz 350 Madison Avenue, 7th Floor PHONE I FAX New York, NY 10017 E-M No. Extl: (A/C, No): AAIL DDRESS: elizabeth.stackowitz@iltus.com INSURER(S) AFFORDING COVERAGE NAIC # www.jltus.com INSURERA: Everest Indemnity Insurance Company 10851 INSURED INSURER B : Hartford Fire Insurance Company 19682 Sabah International and Per IL T8 00 INSURERC: Hartford Casualty Insurance Company 29424 5925 Stoneridga Drive INSURER D : AXA Insurance Company 33022 Pleasanton CR 94588 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 49762660 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. IR TYPE OF INSURANCE ANSD POLICY NUMBER SWVD LT POLICY EFF POLICY EXP (MM/DD/YYYY) (MM/DD/YYYY) LIMITS A �/ COMMERCIAL GENERAL LIABILITY 51GLO14498-191 7/1/2019 7/1/2020 EACH OCCURRENCE $1,000,000 DAMAGES CLAIMS -MADE FJ OCCUR (RENTED I PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 _ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F PRO JECT LOC I PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY 10 UEA DD3733 7/1/2019 7/1/2020 COMBINED SINGLE LIMIT $ (Ea accident) 1,000,000 ✓ ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED I BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS HIRED NON -OWNED ✓ ✓ Peer ac $ AUTOS ONLY AUTOS ONLY idTnDAMAGE Comp/Coll $1,000 A �/ UMBRELLA LIAB , OCCUR 51 CCO05276-191 7/1/2019 7/1/2020 EACH OCCURRENCE $ 5,000,000 EXCESS LIAR Ind CLAIMS -MADE AGGREGATE $ 5,000,000 DED I I RETENTION $ $ C WORKERS COMPENSATION 10 WEA A136S9Z 7/1/2019 7/1/2020 I I I ORH AND EMPLOYERS' LIABILITY Y / N SPER TATUTE ✓ ANYPROPRIETOR/PARTNER/EXECUTIVE NIA E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1.000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 D Pollution & Professional Liability PECO054554 7/1/2019 7/1/2020 Per Claim/Agg Limit: $5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) All Services/maintenance work at the Gilroy Police Department, 7301 Hanna Street, Gilroy, CA 95020. City of Gilroy, its officers, officials and employees are additional insured per forms attached. CERTIFICATE HOLDER CANCELLATION City Of Gilroy,its officers SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN officials and employees ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna Street Gilroy CA 95020 AUTHORIZED REPRESENTATIVE A All Andre Eichenholtz ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 49762660 1 18/19 AU WC POLL PL I Elizabeth Stackowitz 1 7/1/2019 5:40:36 PM (EDT) I Page 1 of 1 This certificate cancels and supersedes ALL previously issued certificates.