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HomeMy WebLinkAboutDuke's Root Control - Insurance Certificate (2020)DATE (MM/DD/YYYY) A� " CERTIFICATE OF LIABILITY INSURANCE 6/25/2019 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: Krauter & Company, LLC I PHONE FAX 1350 Avenue of the Americas (A/C. No. Ext): (A/C, No): E-MAIL 18th Floor ADDRESS: tcastillo@krautergroup.com New York NY 10019 I INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Everest Indemnity Insurance Company 10851 INSURED FUMIHOL-01 INSURER B : Starr Indemnity & Liability Company 38318 Duke's Root Control, Inc. 1020 Hiawatha Blvd. West I INSURER C : Syracuse, NY 13204 I INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1288385916 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/DDIYYYY) (MM/DDIYYYY) A X COMMERCIAL GENERAL LIABILITY EF1 MLOO146-191 6/30/2019 6/30/2020 EACH OCCURRENCE $ 1 000 000 CLAIMS -MADE OCCUR PREM SESO(Ea occurrence) $ 300,000 MED EXP (Any one person) $ 25,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY ❑PRO- ❑ LOC JECT PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: Pollution Legal $ 1,000,000 B AUTOMOBILE LIABILITY 1000635722191 6/30/2019 6/30/2020 COMBINED SINGLE LIMIT $ 1,000,000 (EaCO accident) X ANY AUTO 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 UMBRELLALIA13 OCCUR EX:EFlC000101-191 6/30/2019 6/30/2020 EACH OCCURRENCE $10,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 10,000,000 DED I I RETENTION $ $ B WORKERS COMPENSATION 100000376100 6/30/2019 6/30/2020 X I PER OTH- STATUTE ER AND EMPLOYERS' LIABILITY Y ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? N/A ❑ (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 A Pollution Legal EF1 MLOO146-191 6/30/2019 6/30/2020 Products Pollution 1,000,000 Contractors Pollution 1,000,000 Site Pollution 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Certificate Holder is listed as Additional Insured on the General Liability, Pollution Liability, Automobile Liability and Excess Liability policies, as required by written contract, subject to policy terms, conditions and exclusions. Waiver of Subrogation is granted, as required by written contract, subject to policy terms, conditions and exclusions. Policies are primary and non-contributory. 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 7351 Rosanna Street Gilroy CA 95020 AUTHORIZED REPRESENTATIVE (047-1 @ 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 1000635722191 COMMERCIAL AUTO CA04441013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Douglas Products and Packaging Company, LLC Endorsement Effective Date: 6/30/2019 SCHEDULE Name(s) Of Person(s) Or Organization(s): As Required by Written Contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The Transfer Of Rights Of Recovery Against Others To Us condition does not apply to the person(s) or organization(s) shown in the Schedule, but only to the extent that subrogation is waived prior to the "accident" or the "loss" under a contract with that person or organization. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 CONTRACTOR'S POLLUTION LIABILITY ECG 20 532 0412 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED- DESIGNATED PERSON OR ORGANIZATION - ONGOING AND COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: CKeL>1L7_Ti)tii1M,IaWWII A IN0404/_1:1111VK9101TAzIa,Le?0:-` SCHEDULE Name of Person or Organization: City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy, CA 95020 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured under the Contractor's Pollution Liability Coverage Part is amended to include as an insured the person(s) or organization(s) shown in the Schedule, only with respect to liability for "bodily injury" or "property damage" but only to the extent caused, in whole or in part, by: (1) Your acts or omissions; or (2) The acts or omissions of those acting cn your behalf; in the performance of your operations for the additional insured. B. The insurance afforded to these additional insureds shall only include the insurance required by the terms of the written agreement and only to the extent that coverage is provided within the terms of this Coverage Part. C. The Limits of Insurance afforded to these additional insureds shall be the lesser of the following: 1. The Limits of Insurance required by the written agreement between the parties; or 2. The Limits of Insurance provided by this Coverage Part. D. For the purposes of this endorsement, paragraph 4. Other Insurance under SECTION IV - CONDITIONS of the Contractor's Pollution Liability Coverage Part is replaced by the following: 4. Other Insurance The insurance afforded to these additional insureds is excess over any other insurance naming an insured whether such insurance is primary, excess, contingent or contributing. This insurance may not be used to satisfy any deductible or self -insured retention amounts an insured may owe as a result of this loss, damage or injury. ECG 20 532 0412 Copyright, Everest Reinsurance Company, 2012 Page 1 of 1 ❑ Includes copyrighted material of ISO Properties, Inc., with its permission. ECG 24 588 12 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY ONGOING AND/OR COMPLETED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART CONTRACTOR'S POLLUTION LIABILITY COVERAGE PART MOTOR VEHICLES POLLUTION LIABILITY COVERAGE PART PROVISION - YOUR OPERATIONS Paragraph 4., Other Insurance of Conditions (Section IV) is amended by the addition of the following: If other liability insurance similar to this insurance listing as a Named Insured a person or organization that is a. An owner of real or personal property on which you are performing operations; or b. A contractor on whose behalf you are performing operations, and this policy names those persons or organizations as additional insureds for those operations, then this insur- ance is primary to that other insurance, and that other insurance shall not contribute to amounts payable under this insurance, for liability arising out of your ongoing and/or completed operations performed for that person or organization under a written contract which requires that this insurance be primary. However, this does not apply if the written contract was not executed prior to the date that your operations for that person or organization com- menced. ECG 24 588 12 15 Copyright Everest Reinsurance Company, 2015 Page 1 of 1 ❑ Includes copyrighted material of Insurance Services Office, Inc., with its permission. ECG 24 506 06 15 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILTY COVERAGE PART CONTRACTORS POLLUTION LIABILITY COVERAGE PART MOTOR VEHICLE POLLUTION LIABILITY COVERGE PART SCHEDULE Name of Person or Organization: Blanket where required by written contract. Any person or organization that is: 1. An owner of real or personal property on which you are performing operations, but only at the specific writ- ten request by that person or organization to you, and only if that request is made prior to the date your operations for that person or organization commenced; or 2. A contractor on whose behalf you are performing operations, but only at the specific written request by that person or organization to you, and only if that request is made prior to the date your operations for that person or organization commenced. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition (Section IV - CONDITIONS) is amended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included n the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. ECG 24 506 06 15 Copyright, Everest Reinsurance Company, 2015 Page 1 of 1 ❑ Includes copyrighted material of Insurance Services Office, Inc., with its permission WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 00 03 13 (Ed.4-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) This agreement shall not operate directly or indirectly to benefit anyone not named in the Schedule. Schedule As Required by Written Contract This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Policy No. 100000376100 Insured 6/25/2019 Insurance Company Countersigned by Star Indemnity & Liability Company WC 00 03 13 (Ed.4-84) © 1983 National Council on Compensation Insurance.