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HomeMy WebLinkAboutCOI - Chrisp Company - Expires 2022-12-01SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 11/29/2021 Arthur J.Gallagher &Co. 2121 N.California Blvd.,Suite 350 Walnut Creek CA 94596 Certificate Department 925-299-1112 925-953-6270 CertRequests@ajg.com License#:0726293 Starr Indemnity &Liability Company 38318 CLIENT CODE:CHRICOM-02 Chrisp Company 43650 Osgood Road Fremont,CA 94539 987296897 A X 2,000,000 X 100,000 5,000 X DED/OCC 2,000,000 4,000,000 X Y Y 1000025834211 12/1/2021 12/1/2022 4,000,000 A 2,000,000 X X X Y Y 1000198720211 12/1/2021 12/1/2022 A X 5,000,000 X 1000587463211 12/1/2021 12/1/2022 5,000,000 X 10,000 A XY100000444212/1/2021 12/1/2022 1,000,000 1,000,000 1,000,000 [SEE ATTACHED SUPPL.PAGE] Chrisp Job #:15G.20.553 |Project#:20-RFP-PW-451 RE:On -Call striping and markings maintenance service,Gilroy CA.ADDITIONAL INSURED(S):City of Gilroy and its directors,officers,volunteers and employees ADDITIONAL INSURED(S):The Producer will endeavor to mail 30 days written notice to the Certificate Holder named on the certificate if any policy listed on the certificate is cancelled prior to the expiration date.Failure to do so shall impose no obligation or liability of any kind upon the Producer or otherwise alter the policy terms. City of Gilroy 7351 Rosanna Street Gilroy,CA 95020-6197 DocuSign Envelope ID: 815BE03C-2BA5-46D1-B04B-5348C5F3F088 Dallas, TX 1-866-519-2522 OG 185 (04/12)Page 1 of 1 Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. ADDITIONAL INSURED- OWNERS, LESSEES OR CONTRACTORS – COMPLETED OPERATIONS Effective Date: 12/01/2021Policy Number: 1000025834211 Named Insured: Chrisp Company This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE NAME OF ADDITIONAL INSURED PERSON OR ORGANIZATION: AS REQUIRED PER WRITTEN CONTRACT LOCATION AND DESCRIPTION OF COMPLETED OPERATIONS: AS REQUIRED PER WRITTEN CONTRACT ADDITIONAL PREMIUM: (If No entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) SECTION II - WHO IS AN INSURED is amended to include as an insured; The pe rson or orga niza tion shown in the Sche dule, but only with resp ect to lia bil ity ar ising out of "your wo rk" at the locat ion de sig nated and des cribed in the sc hed ule of this endorsement perfor med for that addit ional insured and included in the "products- completed operations hazard". All other terms and conditions remain unchan ged. DocuSign Envelope ID: 815BE03C-2BA5-46D1-B04B-5348C5F3F088 Dallas, TX 1-866-519-2522 OG 180 (04/12)Page 1 of 1 Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. ADDITIONAL INSURED- OWNERS, LESSEES, OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION Effective Date: 12/01/2021Policy Number: 1000025834211 Named Insured: Chrisp Company All other terms and conditions remain unchanged. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE NAME OF PERSON OR ORGANIZATION: AS REQUIRED PER WRITTEN CONTRACT (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) A.SECTION II -WHO IS AN INSURED is amended to include as an insured; The person or organization shown in the schedule, but only with respect to liability arising out of your ongoing operations performed for that additional insured. B.With respect to the insurance afforded to these additional insureds, SECTION I - COVERAGES, COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2.-Exclusions, is amended to include the following additional exclusion; This insurance does not apply to "bodily injury" or "property damage" occurring after: (1)all work, including materials, parts or equipment furnished in connection with such work, on the project (other than service,maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed;or, (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. DocuSign Envelope ID: 815BE03C-2BA5-46D1-B04B-5348C5F3F088 Dallas, TX 1-866-519-2522 OG 107 (04/11) Page 1 of 1 Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. Primary and Non-Contributory Condition Effective Date: This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part A. SECTION IV – CONDITIONS, condition 4. Other Insurance is amended as follows: 1.The following is added to paragraph 4.a. of the Other Insurance condition: This insurance is primary insurance as respects our coverage to the additional insured, where the written contract or written agreement requires that this insurance be primary and non-contributory. In that event, we will not seek contribution from any other insurance policy available to the additional insured on which the additional insured is a Named Insured. ALL OTHER TERMS AND CONDITIONS REMAIN UNCHANGED. Signed for STARR INDEMNITY & LIABILITY COMPANY Steve Blakey, President Nehemiah E. Ginsburg, General Counsel Policy Number : Named Insured: 12/01/2021 1000025834211 Chrisp Company DocuSign Envelope ID: 815BE03C-2BA5-46D1-B04B-5348C5F3F088 CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 POLICY NUMBER: COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV – Conditions: 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 in the "products-completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. 1000025834211 DocuSign Envelope ID: 815BE03C-2BA5-46D1-B04B-5348C5F3F088 SICA 1016 (04/14)Page 1 of 1 Copyright © Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. Dallas, TX 1-866-519-2522 Effective Date: 12/01/2021 at 12:01 A.M.Policy Number: 1000198720211 Named Insured: Chrisp Company This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the declarations page. Please read the endorsement and respective policy(ies) carefully. Business Auto Coverage Form THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. It is hereby agreed that ,A. Coverage,1. Who Is An Insured, is amended to include the following: d. (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said written contract or written agreement. All other terms and conditions of this Policy remain unchanged. Signed for STARR INDEMNITY & LIABILITY COMPANY Steve Blakey, President and Chief Executive Officer Nehemiah E. Ginsburg, General Counsel DocuSign Envelope ID: 815BE03C-2BA5-46D1-B04B-5348C5F3F088 Dallas, TX 1-866-519-2522 SICA 1017 (02/12)Page 1 of 1 Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INSURANCE PRIMARY AS T O CERTAIN ADDITIONAL INSUREDS Effective Date: 12/01/2021 at 12:01 AM Policy Number: 1000198720211 Named Insured: Chrisp Company This policy is amended as follows: BUSINESS AUTO COVERAGE FORM is amended by the addition of the following sentence: The insurance afforded under this policy to an additional insured will apply as primary insurance for such additional insured where so required under an agreement executed prior to the date of accident. We will not ask any insurer that has issued other insurance to such additional insured to contribute to the settlement of loss arising out of such accident. All other terms and conditions remain unchanged. Signed for STARR INDEMNITY & LIABILITY COMPANY Steve Blakey, President and Chief Executive Officer Nehemiah E. Ginsburg, General Counsel DocuSign Envelope ID: 815BE03C-2BA5-46D1-B04B-5348C5F3F088 POLICY NUMBER: COMMERCIAL AUTO CA 04 44 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA 04 44 10 13 © Insurance Services Office, Inc., 2011 Page 1 of 1 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: Endorsement Effective Date: SCHEDULE Name(s) Of Person(s) Or Organization(s): 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. 12/01/2021 1000198720211 Chrisp Company DocuSign Envelope ID: 815BE03C-2BA5-46D1-B04B-5348C5F3F088 12/01/2021 Starr Indemnity & Liability Company 1000004442 Chrisp Company DocuSign Envelope ID: 815BE03C-2BA5-46D1-B04B-5348C5F3F088 DocuSign Envelope ID: 815BE03C-2BA5-46D1-B04B-5348C5F3F088