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HomeMy WebLinkAboutPerma Green Hydroseeding - Insurance Certificate (2020)AC� ® I CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 1/14/2020 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: Pacific Diversified Insurance Services PHONE FAX 15005 Concord Circle, Suite 110 I (A/C. No. Ext): 408-842-2131 (A/C. No):408-842-0867 Morgan Hill CA 95037 ADDRIESS: I INSURER(S) AFFORDING COVERAGE NAIC # License#: OK07568 INSURER A: Associated Industries Insurance Company, Inc. 23140 INSURED PERMGRE-01 INSURER B: American Fire and Casualty Company 24066 Parma Green Hydroseeding, Inc dba; Mitchell Chuck 7096 Holsclaw Road INSURERC: Cypress Insurance Company 10855 Gilroy CA 95020 I INSURERD: Ohio Security Insurance Company 24082 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:1118881904 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 LTR TYPE OF INSURANCE ADDLSUBR I NSD WVD POLICY NUMBER POLICY EFF POLICY EXP LIMITS I M MID D/YYYY I (M M/D D/YYYY) A X COMMERCIAL GENERAL LIABILITY Y AES1024720 07 10/23/2019 10/23/2020 EACH OCCURRENCE $ 1,000,000 DAMAGES CLAIMS -MADE � OCCUR (RENTED PREMISES (Ea occurrence) $ 100,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000.000 � POLICY JECT LOC PRODUCTS - COMP/OPAGG $2,000,000 OTHER: $ J B AUTOMOBILE LIABILITY BAA56367171 10/23/2019 10/23/2020 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) X ANY AUTO _ BODILY INJURY (Per person) $ OWNED AUTOS SCHEDULED AUTOS ONLY BODILY INJURY (Per accident) $ X HIRED X NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR HCLAIMS-MADE EACH OCCURRENCE $ EXCESS LIAR AGGREGATE $ DED I I RETENTION $ $ I C WORKERS COMPENSATION PEWC124617 2/1/2020 2/1/2021 X I PER OTH- AND EMPLOYERS' LIABILITY Y/N STATUTE ER 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 D Property BKS56367171 10/23/2019 10/23/2020 Limit See below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE. Irrigation Antenna Replacement at Santa Teresa and Mantelli City of Gilroy, its officers, officials and employees are included as additional insured if required by written contract as respects the general liability policy (forms attached). 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. its officers, officials and employees 7351 Rosanna St Gilroy CA 95020 AUTHORIZED REPRESENTATIVE USA V.&r"(1V ✓ I ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD