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HomeMy WebLinkAboutByron Epp - Insurance Certificate (2020)BRYON-1 OP ID: CFIE ACORL7 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) ---�� 10/02/2019 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 909-509-8103 (CONTACT NAME: Homewell Insurance Serv, Inc 901 Via Piemonte Ste 205 (A/C, No, Ext): 909-509-8103 (A/C, No):909-257-3027 Ontario, CA 91764 E-MAIL Aaron Brewart ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC H INSURER A: Admiral Ins Co 24856 INSURED INSURERB:AmGUARD Insurance Company 42390 Byron Epp Inc. 26062 Merit Circle Suite 107 INSURER C : Nat[ Union Fire Ins Co of PA 19445 Laguna Hills, CA 92653 INSURER D : y Securit National Insurance Co 19879 INSURER E:EMC Insurance Companies 21415 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 DERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH DOLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDL SUER POLICY EFF POLICY EXP LT}2 TYPE OF INSURANCE INSR WVD POLICY NUMBER IMM/DD/YYYYI IMM/DD/YYYYI LIMITS e X COMMERCIAL GENERAL LIABILITY 1 UOO UUU CLAIMS -MADE [X] OCCUR X CA00003615201 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY �X PRO- ❑ LOC JECT OTHER: B AW OMOBILE LIABILITY ANY AUTO BYAU092103 OWNED SCHEDULED AUTOS ONLY X AUTOS X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY B UMBRELLA LIAB X OCCUR _ X EXCESS LIAR CLAIMS -MADE EBU03541417600 DED I X I RETENTION $ 0 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE SWC1213410 OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) If yes, describe under [ESC�IPTION OF OPERATIONS below E Contractors 6X1160620 Equipment EACH OCCURRENCE $ 10/01/2019 10/01/2020 PREMISESO(Ea occurrence) $ MED EXP (Anv one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ Emp Ben. $ COMBINED SINGLE LIMIT (Ea accidentl $ 10/01/2019 10/01/2020I BODILY INJURY (Per person) $ I BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ 10/01/2019 12/05/2019 10/01/2019 10/01/2020 $ EACH OCCURRENCE $ AGGREGATE $ $ X STATUTE EERH E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT S 10/01/2019 10/01/2020 Equipment DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *Cancellation provision reverts to 10 days for non-payment of premium. Certificate holder to be included as additional insured with respects to the General Liability perform attached. CERTIFICATE HOLDER CITYGIL City of Gilroy Attn: Rick Brandini 7351 Rosanna Street Gilroy, CA 95020-6197 CANCELLATION 50,000 5,000 1,000,000 2,000,000 2,000,000 1,000,000 1,000,000 5,000,000 5,000,000 1,000,000 1,000,000 1,000,000 100,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE I ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BRYON-1 OP ID: CFIE AC�(JKL! CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) �--�� 10/02/2019 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 909-509-8103 (CONTACT NAME: Homewell Insurance Serv, Inc PHONE 901 Via Piemonte Ste 205 (A/C, No, Ext): 909-509-8103 (A/C, No):909-257-3027 Ontario, CA 91764 E-MAIL ADDRESS: Aaron Brewart INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Admlral Ins CO 24856 INSURED INSURER B: AmGUARD Insurance Company 42390 Won Epp Inc Circle Suite 107 INSURER C : Natl Union Fire Ins Co of PA 19445 Laguna Hills, CA 92653 INSURER D:Security National Insurance Co 19879 INSURER E:EMC Insurance Companies 21415 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 IADDL SUBR POLICY EFF POLICY EXP LT1R TYPE OF INSURANCE IINW WVD POLICY NUMBER IMM/DD/YYYYI IMM/DD/YYYYI LIMITS H X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ICLAIMS -MADE [K OCCUR X GEN'L AGGREGATE LIMIT APPLIES PER: POLICY F_X] PRO- ❑ LOC JECT OTHER: B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY X AUTOS X UXTSOLYATOS ONLY NON-OWNED ONLY B UMBRELLA LIAB X OCCUR X EXCESS LIAB CLAIMS -MADE DED I X I RETENTION $ 01 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? Y N / A (Mandatoryin NH) If yes, describe under DESCRIPTION OF OPERATIONS below E Contractors Equipment CA00003615201 RENED 10/01/2019 10/01/2020 ( PREMISESO(Ea occurrrencel $ 50,000 MED EXP (Anv one oerson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 Emp Ben. $ 1,000,000 BYAU092103 COMBINED SINGLE LIMIT (Ea accident) 10/01/2019 10/01/2020I BODILY INJURY (Per oerson) $ 1,000,000 $ I BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ EBU03541417600 EACH OCCURRENCE 10/01/2019 12/05/20191AGGREGATE $ 5,000,000 $ 5,000,000 SWC1213410 X PER I OERH 10/01/2019 10/01/2020I E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 6X1160620 10/01/2019 10/01/2020 Equipment 100,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) *30 days cancellation provision reverts to 10 days in the event of non- gp ment of premium. Ci of Gilroy, its officers, officials and employees are named as an ad itional insured with respects to the General Liability per form attached. CERTIFICATE HOLDER CITYGIL City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy, CA 95020-6197 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. AUTHORIZED REPRESENTATIVE I ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD BRYON-1 OP ID: CFIE '4CaR� CERTIFICATE OF LIABILITY INSURANCE I DATE (M10/0/202/20 9 19 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 909-509-8103 (CONTACT NAME: Homewell Insurance Serv, Inc PHONE 909-509-8103 FAX 909-257-3027 901 Via Piemonte Ste 205 (A/C, No, Ext): (A/C, No): Ontario, CA 91764 E-MAIL Aaron Brewart ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Admiral Ins Co 24856 INYySURED INSURERB:AmGUARD Insurance Company 42390 26062 Merriit (Circle Suite 107 INSURER C : Natl Union Fire Ins Co of PA 19445 Laguna Hills, CA 92653 INSURER D:Security National Insurance Co 19879 INSURER E:EMC Insurance Companies 21415 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 LT`R TYPE OF INSURANCE uy,SD WVD POLICY NUMBER POLICY EFF POLICY EXP IMMIDD/YYYYI IMMIDD/VYYV) LIMITS H X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR CA00003615201 10/01/2019 10/01/2020I DAMAGE TO RENTED 50 000 X PREMISES 'Ea occurrence) $ MED EXP (Anv one Person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICYFX] LOC 2,000'000 JECT PRODUCTS-COMP/OPAGG $ OTHER: Emp Ben. $ 1,000,000 B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) 1,000,000 $ ANY AUTO BYAU092103 10/01/2019 10101120201 BODILY INJURY (Per Person) $ OWNED SCHEDULED X AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED X NON -OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY (Per accident) $ B UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 X EXCESS LIAB CLAIMS -MADE EBU03541417600 10/01/2019 12/05/2019 AGGREGATE 5,000,000 DED I X I RETENTION $ 0 $ $ C WORKERS COMPENSATION X I STATUTE I I ORH AND EMPLOYERS' LIABILITY VSWC1213410 ANY PROPRIETOR/PARTNER/EXECUTIVE 10/01/2019 10/01/2020 E.L. EACH ACCIDENT 1,000,000 $ OFFICER/MEMBER EXCLUDED? � N / A (Mandatory in NH) 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ 1,000,000 E Contractors 6X1160620 10/01/2019 10/01/2020 Equipment 100,000 Equipment DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) "Cancellation provision reverts to 10 days for non-payment of premium. Re:City of Gilroy, PD City of Gilroy, its officers, officials and employees are included as additional insured with respects to the General Liability per form attached. CERTIFICATE HOLDER CITYOGL City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy, CA 95020 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. AUTHORIZED REPRESENTATIVE I ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number: CA00003615201 CG 20 37 04 13 Effective Date: 10/01/2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Any person or organization that is an owner or manager of real property or personal property for whom you work or have worked, or a contractor on whose behalf you work or have worked, but only if coverage as an additional insured extending to "bodily injury" or "property damage" included in the "products -completed operations hazard" is required by a written contract or written agreement that is an "insured contract" and provided that the "bodily injury" or "property damage" first occurs subsequent to the execution of the contract or agreement. Location And Description Of Completed Operations All locations except locations where "your work" is or was related to a job or project involving single-family dwellings, multi -family dwellings (other than rental apartments in an apartment building: (a) originally constricted and at all times used for such purpose, or (b) converted from a commercial building), condominiums, townhomes, townhouses, time- share units, fractional -ownership units, cooperatives and/or any other structure or space used or intended to be used as a residence. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 04 13 0 Insurance Services Office, Inc., 2011 Page 1 of 1 13 Policy Number: CA00003615201 CG 20 10 04 13 Effective Date: 10/01 /2019 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Any person or organization that is an owner or manager of real property or personal property on which you are per- forming ongoing operations, or a contractor on whose be- half you are performing ongoing operations, but only if cov- erage as an additional insured is required by a written contract or written agreement that is an "insured contract', and provided the "bodily injury" or "property damage" first occurs, or the "personal and advertising injury" offense is first committed, subsequent to the execution of the contract or agreement. Location(s) Of Covered Operations All locations at which the Named Insured is performing ongoing operations. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect 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(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: L All -work; including -materials -parts -or equipment Rimished-in connection with -such -work, on the-projert-(uther tha r service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 20 10 0413 © Insuurance Services Office, Inc., 2012 Page 1 of 2 13 2. 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 subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 04 13 © Insurance Services Office, Inc., 2012 Page 2 of 2 13