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Home My WebLink AboutMike O'Brien Specialized Hauling - Insurance Certificate (2020)A DO CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DDIYYYY) 11 /19/2019 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 I CONTACT Carrisa Nowinski NAME: Cal -Valley Insurance Services, Inc. PHONE (559) 225-1300 FAX (559 225-8966 (AICANo. Extl: (A/C, No): ) 5070 N. Sixth St. #155 ADDRESS: Carrisan@calvalleyinsurance.com License #0733383 INSURER(S) AFFORDING COVERAGE NAIC # Fresno CA 93710 I INSURERA: Capitol Specialty Insurance Corp INSURED I INSURER B : Canal Insurance Company Mike O'Brien Specialized Hauling, Inc I INSURER C : Scottsdale Insurance Co. 41297 1459 18th Street #162 I INSURER D : State Compensation Ins Fund 35076 INSURER E : Hartford Fire Insurance Company 19682 San Francisco CA 94107 I INSURER F : COVERAGES CERTIFICATE NUMBER: TRK/GL/CARGO/WC 19-20 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 AUUL DUCK LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF POLICY EXP (MMIDD/YYYY) (MM/DDIYYYY) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �/ CLAIMS -MADE OCCUR DAMAGE TO RENTED I PREMISES (Ea occurrence) $ 100,000 X $1,000 deductible per claim MED EXP (Any one person) 5,000 $ A Y CS0281237803 07/01/2019 07/01/2020 I 1,000,000 PERSONAL & ADV INJURY $ GGEEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO-j—u 2,000,000 POLICY JECT LOC PRODUCTS - COMP/OPAGG $ OTHER: I $ AUTOMOBILE LIABILITY I COMBINEDSINGLE L.IMIT $ 1,000,000 (Ea accident) ANY AUTO I BODILY INJURY (Per person) $ g OWNED X SCHEDULED Y 1-393250001-3 AUTOS ONLY AUTOS 07/01/2019 07/01/2020 BODILY INJURY (Per accident) $ X HIRED \/ NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY X� AUTOS ONLY (Per accident) Uninsured motorist BI- $ 60,000 X UMBRELLA LIAB OCCUR EAC�"'HH"' OCCU"61'RRENCE $ 3,000,000 C EXCESS LIAB CLAIMS -MADE XLS0110679 07/01/2019 07/01/2020 AGGREGATE $ DIED I I RETENTION $ I $ WORKERS COMPENSATION X/ PER OTH- X AND EMPLOYERS' LIABILITY Y / N I STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE D Y NIA 9242023-19 I000,000 12/01I2019 12/01/2020 E.L.EI_ EACH $ OFFICER/MEMBER EXCLUDE (Mandatory In NH) I E.L. DISEASE - EA EMPLOYEE $ 1,000.000 under If DESCRIPTION OF O DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1.000.000 Per Conveya/$1,200,000 Deduct/10,000 Motor Truck Cargo E 51 MS FP2381 06/27/2019 06/27/2020 Trailer Interc/$50,000 Deduct/10,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate issued as evidence of coverage maintained by named insured. Certificate holder has been named additional insured. Endorsement to follow from the company. *10 day notice of cancellation for non payment of premium. 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. 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 �e.*"% A. I @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD