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HomeMy WebLinkAboutInnovative Claims Solutions - Insurance Certificate (2020)� ® I DATE (MM/DDIYYYY) A C" CERTIFICATE OF LIABILITY INSURANCE 3/28/2019 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 CONTACT NAME: Connie Lundquist Andreini & Company -Stockton I PHONE FAX 3203 W. March Lane, Suite 130 rA No. E.0- 877-469-0507 I (A/C. No): 650-378-4361 11- Stockton CA 95219 I ADDRESS: clundquist@andreini.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Federal Insurance Company 20281 INSURED INNOV-5 INSURER B Innovative Claim Solutions Inc Attn: Gary Archibald I INSURER C 11344 Coloma Rd., Suite 745 I INSURER D : Gold River CA 95670 I INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:246734792 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 POLICYNUMBER (MM/DD/YYYY) (MM/DD/YYYY) A X COMMERCIAL GENERAL LIABILITY 35754610 4/1/2019 4/1/2020 EACH OCCURRENCE $ 1 000 000 DAMAGE TO CLAIMS -MADE F OCCUR PREMISESS (Ea occurrence) $1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY JE� LOC PRODUCTS - COMP/OP AGG $ Incl Agg OTHER: $ A AUTOMOBILE LIABILITY 73513506 4/1/2019 4/1/2020 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 ANYAUTO BODILY INJURY (Per person) $ OWNED SCHEDULED BODILY INJURY AUTOS ONLY AUTOS (Per accident) $ X HIRED X NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) A X UMBRELLA LIAB X OCCUR 79797000 4/1/2019 4/1/2020 EACH OCCURRENCE $ 5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5,000,000 DED I X I RETENTION $ n $ WORKERS COMPENSATION I ORH AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE YIN SPER TATUTE I E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ A Professional Liability 81722762 4/1/2019 4/1/2020 Professional Limit $3,000,000 A Fidelity Limit 81815467 4/1/2019 4/1/2020 Fidelity Limit $2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Gilroy, its officers, respentatives, agents and employees are included as additional insured as respects to the General Liability as their interest may appear per the attached Blanket Additional Endorsement Form #80-02-2367(05/07) where required by written contract. This insurance is primary and non-contibutory per the attached form #17-02-3080 (04/01). CERTIFICATE HOLDER 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. City of Gilroy HR Director/Risk Manager 7351 Rosanna Street AU HORIZED REPRESENTATIVE Gilroy CA 95020 I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD • • • C H U B B• Liability Insurance Endorsement Policy Period APRIL 1, 2019 TO APRIL 1, 2020 Effective Date APRIL 1, 2019 Policy Number 3575-46-10 WCE Insured INNOVATIVE CLAIM SOLUTIONS INC. Name of Company FEDERAL INSURANCE COMPANY Date Issued JANUARY 11, 2019 fi::::3:c:C:i::.r:;:a^3�,+nn�+�,+v..,.ye•.wnnv�•.+•.,..;;Y:'LAG:L':i3^+'x.Ytr:'t`:v'::aftk;�::::i::J;R2�r:t-:kk?�:i.Rk:'tS<:",';;:'t'�3::,;;.>A"R2v'++A'ChAWA.S�:;:.+4<S;kk:!,:u:R:;r..:; :• �:'•r'-�:•;:<•>:•:w t+. ,:a•;+. .. +`f.:;:S.t,'C';ic'-Rain,...+...........3:.bwYnxi22:^::v�..,v"tG:k�::tic-:Rtb.4:Fh:::.^•.:}:`�:;:`.:'oYp':2•: This Endorsement applies to the following forms: GENERAL LIABILITY sir,::kkr:;�::::<:>:k:.<::z:::�, vtzamus:;.;racre'�.�r,:::ec2:s;:.;�.;.:s:t:xssxa�<:k;::.:sx<:w..x�:a�:�:aacr•��.!»�::::sa�:z;�:cexr.,�z�;r�.�uart:e: �.:t:,�s:.':��:r•+.vr.��.r,�r.:...•-�<::a �• krs:..:v:::<:�:;:s::mar::+:,N•:crcaco.�a'�::�,s»: Under Who Is An Insured, the following provision is added. Who Is An Insured Additional Insured - Persons or organizations shown in the Schedule are insureds; but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. :'S^:£4:,42\;:".;t•�.�r.,n::t:•'.;�:.+:'3J194SRCNk>.tkkk}kr+•aba:.Ke:s`ifs•}�:•}.+�k:S::R:':•'.i:::J':•:•:�:.:`.•':•'.�.',:i9.'t>ktk.��.?S:':;;++..�>.r..::;;*z"',3tk+-U:•'.?:'•.'ff.G:-`.£'k'k k2>!;-:�ti:::-i�'c`.��9..i.•,'x+.Kdtd�'�.t�i :�.dk�n"JSfkF:GYGt5t5�k�x`�:Y•: Liability Insurance Additional Insured - Scheduled Person Or Organization Form 80-02-2367 (Rev. 5-07) Endorsement continued Page 1 Liability Endorsement (continued) 0 Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Authorized Representative Qc— QN ' a 0 Liability Insurance Additional Insured - Scheduled Person Or Organization last page Form 80-02-2367 (Rev. 5-07) Endorsement Page 2 CHUBS" Conditions Legal Action Against Us (continued) • General Liability A person or organization may sue us to recover on an agreed settlement or on a final judgment against an insured obtained after an actual: trial in a civil proceeding; or arbitration or other alternative dispute resolution proceeding; but we will not be liable for damages that are not payable under the terms and conditions of this insurance or that are in excess of the applicable Limits Of Insurance. ::::::>:>::>:::: ......... ............ Other Insurance If other valid and collectible insurance is available to the insured for loss we would otherwise cover under this insurance, our obligations are limited as follows. Primary Insurance This insurance is primary except when the Excess Insurance provision described below applies. If this insurance is primary, our obligations are not affected unless any of the other insurance is also primary. Then, we will share with all that other insurance by the method described in the Method of Sharing provision described below. Excess Insurance "this insurance is excess over any other insurance, whether primary, excess, contingent or on any other basis: A. that is Fire, Extended Coverage, Builder's Risk, Installation Risk or similar insurance for your work; B. that is insurance that applies to property damage to premises rented to you or temporarily occupied by you with permission of the owner; C. if the loss arises out of aircraft, autos or watercraft (to the extent not subject to the Aircraft, Autos Or Watercraft exclusion); D, that is insurance: 1. provided to you by any person or organization working under contract or agreement for you; or 2. under which you are included as an insured; or E. that is insurance under any Property section of this policy. When this insurance is excess, we will have no duty to defend the insured against any suit if any other insurer has a duty to defend such insured against such suit. If no other insurer defends, we will undertake to do so, but we will be entitled to the inmred's rights against all those other insurers. When this insurance is excess over other insurance, we will pay only our share of the amount of loss, if any, that exceeds the sum of the total: • amount that all other insurance would pay for loss in the absence of this insurance; and of all deductible and self -insured amounts under all other insurance. Liability Insurance Form 17-02-3080 (Rev. 4-01) Contract Page 23 of 32 Conditions Other Insurance We will share the remaining loss, if any, with any other insurance that is not described in this (continued) Excess Insurance provision and was not negotiated specifically to apply in excess of the Limits Of Insurance shown in the Declarations of this insurance. Method of Sharing If all of the other insurance permits contribution by equal shares, we will follow this method also. Under this method each insurer contributes equal amounts until it has paid its applicable limits of insurance or none of the loss remains, whichever comes first. If any of the other insurance does not permit contribution by equal shares, we will contribute by limits. Under this method, each insurer's share is based on the ratio of its applicable limits of insurance to the total applicable limits of insurance of all insurers. Premium Audit We will compute all premiums for this insurance in accordance with our rules and rates. In accordance with the Estimated Premiums section of the Premium Summary, premiums shown with an asterisk (*) are estimated premiums and are subject to audit. In addition to or in lieu of such designation in the Premium Summary, premiums may be designated as estimated premiums elsewhere in this policy. In that case, these premiums will also be subject to audit, and the second paragraph of the Estimated Premiums section of the Premium Summary will apply. Separation Of Insureds Except with respect to the Limits Of Insurance, and any rights or duties specifically assigned in this insurance to the first named insured, this insurance applies: 0 as if each named insured were the only named insured; and separately to each insured against whom claim is made or suit is brought. ......::..:..:::.:..::.:::.::.. _ Transfer Or Waiver Of We will waive the right of recovery we would otherwise have had against another person or Rights Of Recovery organization, for loss to which this insurance applies, provided the insured has waived their rights Against Others of recovery against such person or organization in a contract or agreement that is executed before such loss. To the extent that the insured's rights to recover all or part of any payment made under this insurance have not been waived, those rights are transferred to us. The insured must do nothing after loss to impair them. At our request, the insured will bring suit or transfer those rights to us and help us enforce them. This condition does not apply to medical expenses. • Liability Insurance Form 17-02-3080 (Rev. 4-01) Contract Page 24 of 32