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HomeMy WebLinkAboutCOI - Alpha Analytical Laboratories, Inc. - Expires 2023-04-06ACORO' ALPHANA-01 CERTIFICATE OF LIABILITY INSURANCE MGOMES DATE (MMIDDIYYYY) 3/18/2022 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 Team Insurance & Financial Services, Inc. PO Box 1472 Ukiah, CA 95482 INSURED Alpha Analytical Laboratories, Inc. 208 Mason St. Ukiah, CA 95482 COVERAGES CONTACT Menthie Gomes NAME: PHONE (A/C, No, Ext): (707) 462-5901 E-MAIL menthie@teamins.net ADDRESS: INSURER(S) AFFORDING COVERAGE INSURER A:Guideone Insurance INSURER B : Nationwide Mutual Insurance Company 42579 I INSURER C : Employers Comp Ins Co 11512 I INSURER D : IINSURER E : IINSURER F : CERTIFICATE NUMBER: REVISION NUMBER: (FA/ (C, No): (707) 462-3763 NAIC # 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 CONTRA ;T OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLIC ES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 'OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY DAID CLAIMS. INSR LTR TYPE OF INSURANCE A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X ADDL SUBR INSD WVD POLICY NUMBER OCCUR X X ENV562004850-01 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO- LOC JECT OTHER: B AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A UMBRELLA LIAB X OCCUR X EXCESS LIAB CLAIMS -MADE DED X RETENTION $ 0 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe underer DESCRIPTION Of �RATIONS below A Professional Lia A Pollution Liability YIN POLICY EFF POLICY EXP IMM/DDIYYYYI (MM/DD/YYYY) 4/6/2022 4/6/2023 ACPBA7830172096 11 /1 /2021 11 /1 /2022 ENV562004851-01 4/6/2022 4/6/2023 LIMITS EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ EACH OCCURRENCE $ AGGREGATE $ X PER STATUTE OTH- ER x EIG261089203 5/1/2021 5/1/2022 E.L. EACH ACCIDENT $ NIA E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ ENV562004850-01 4/6/2022 4/6/2023 Ea. Occ./Aggregate ENV562004850-01 4/6/2022 4/6/2023 Ea. Occ./Aggregate DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: City of Gilroy Pretreatment Wastewater Processing City of Gilroy, its officers, representatives, agents and employees are named as an Additional Insured on the general liability. Waiver of Subrogation and Primary Wording applies. CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 3,000,000 100,000 5,000 3,000,000 3,000,000 3,000,000 1,000,000 2,000,000 2,000,000 1,000,000 1,000,000 1,000,000 3,000,000 3,000,000 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 lcnJk (Enu.� ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 'Id T abed •loafoad awes eq; to ped e se ledlouud e aol suolleaado 6ulwaoped u! pe6e6ue aopea;uoogns ao aopea;uoo aagloue uegl Jaw uollezlue6ao ao uosaad Aue Aq asn papua; -ul sll o;;nd uaaq seq sasue abewep ao Amful agl go!gM to lno „)IaoM anoA„ to uo!pod ;eql ao :palaldwoo uaaq seq suol;eaado palenoa aq; to uolleool aq; le (s)paansu! leuol;lppe aql to liegaq uo ao Aq pewaoped eq o; (snedaa ao aoueualulew 'eolnaas ueq; .1aq;o) loafoad aql uo ')IaoM Lions gl1M uogoauuoo ul pagslwnf wow -dmbe ao sued 'slelaa;ew 6ulpnpul `1{aoM II`d b '1700Z "DuI `satlaadoad OSI OO b0 LO O1 0Z 9J •Z :aalle 6ulaan000 „a6ewep Apadoad„ ao „Amp! Allpoq„ of Aldde lou saop eoueansul slgl :Aldde suols -nloxa leuoliippe 6u1Mollol aql `spaansul leuollippe asap of pepaolle aoueansul aq; o; ;oadsaa g4iM •8 •anoge pa;eu6lsap (s)uol;eool NI le (s)paansul leuolllppe ag; aol suoi;BJado 6ulobuo anoA to aouewaoped aql u! �llegaq anoA uo 6ul;oe asoq; l0 suolsslwo ao sloe agl 'Z ao :suolsslwo ao sloe anon • I, :Aq '4Jed ul JO alo1M ul `pasneo „Aanful 6ulsipanpe pue leuosaad„ ao „a6ewep Alaadoad„ `Junful Allpoq„ aol A;IIlgei of padsaa q;!M Apo ;nq 'alnpagog aql u! uMogs (s)uo!iez!uebio ao (s)uosied aql paansul leuogippe ue se epnpul o; papuawe sl paansuf uy sf o1M - f( uof}oes •suol;eaepoa aq; ul uMogs eq II!M 'anoge uMogs;ou 4! `alnpagog slgl a;aldwoo of )SAJInbaa 1Jol)fs(wo)UI •„)poM anoA„ 6ulwaoj ed sl paansu! peweu aql aaagM uolleool Aue ol;oadsaa ul suol}eaad0 paienoO 10 (s)uofleaol .y •Aogod anoA uo paansu! leuolllppe ue se pappe aq uo!lez!ue6ao ao uosied Lions;eql `peouawwoo uogezlue6ao ao uosaed leg; aol suol;eaado inoA amp aql of aoud pa;oalla luaweaa6e ao loealuoo a ul 6ull!M ul paaa6e aneq uol;ez!ue6a0 ao uosied Lions pue no/ ua1M suol;eaado 6ulwaoped aae noA wogM ao? uo!lezlue6ao ao uosied Aud :(s)u0e2luebJO �O (s)uosaad paansuf feuof}lppy10 amt.,' 31la3H3S lUVd 39b2i3AOO l.11118d111` b13N3O 1VIO2I3WWOO :6ulnnopol aq; aapun papinoad eoueansul salllpow luawasaopue s!ql NOIIVZINV U0 ?IO NOS2I3d a31la3HOS - S2I013V11NOa 2IO S33SS31 `S213NMO - a32IfSNI ivNowaav 'A11f1d32Ii311 OV32I 3SV31d •JI3I1Od 3H1 S3ONVH31N3IN S2IOCIN3 SIHI ti0 LO OL OZ 9J A.LilI VI11V)I3N301VIJ2l3WWOJ 1O-OS81700Z9SAN3 :a381AlfIN IkjllOd POLICY NUMBER: ENV562004850-01 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 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 SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement, effected prior to the date your operations for that person or organization commenced, that such person or organization be added as an additional insured on your policy. Location And Description Of Completed Operations In respect to any location where the named insured is performing "your work". Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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". CG20370704 © ISO Properties, Inc., 2004 Page 1 of 1 uolsslwaad sll y;inn 1.10 b abed •oul 'aoy;O saowas aoueansul;o leua;etN palybpAdoD sapnioul L6-OL VAti-86Z0 OS •pa6ueyoun uleweJ suolllpuoo pue swag; Jaw IPd •uollez!ue6Jo Jo uosaad ley; um loeJ;Uoo e Japun pawaoj ed „)IJoM JnoA„;o;no 6uls!Je a6ewep Jo AJnfu! 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Apo pue no/ of uogezlue6Jo Jo uosaad ley; Aq isanbai Ua1IIJM oy!oeds ay; le Apo inq `suoueaado 6ulwaojad aje nod yolyM uo Apedad leuosJed Jo leaa;o JOUMO UV • I. :sl ley! uollezlue6Jo Jo uosied Auy :uogezlue5aO ao uosJad;o 6W 31f1a3HOS 121Vd 39V1BAOD A11118`dI1 1d213N301VI0213WWOO :6u1Mopo; ayl Japun pepinoJd eoueJnsul sal;lpow ;uawasJopua sly! NO11VOO2J911S AO iI3AIVM a3 IN3WV 'Alild32IVO lI ad3?I 3SV 1d 'A011Od 3H1 S3ONVH31N314113S21OaN3 SIHI THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY/NON-CONTRIBUTORY COVERAGE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRIMARY/NON-CONTRIBUTORY — If required by written contract or agreement, effected prior to the date your operations for that person or organization commenced and named below, such insurance as is afforded by this policy to any additional insureds under this policy shall be primary insurance, and any insurance or self-insurance maintained by such additional insured(s) shall not contribute to the insurance afforded to the named insured. All other terms and conditions remain unchanged. SCHEDULE 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 written request by that person or organization to you, and only if: a. That request is made prior to the date your operations for that person or organization commenced; and b. A Certificate of Insurance evidencing that request has been issued by your authorized insurance agent or broker; 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: a. That request is made prior to the date your operations for that person or organization commenced; and b. A Certificate of Insurance evidencing that request has been issued by your authorized insurance agent or broker. 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