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HomeMy WebLinkAboutCOI - Par Western Line Contractors, LLC - Expires 2023-05-01AiC®RD CERTIFICATE OF LIABILITY I 4...--" \~�. ..::aLJ..\ r.`a r�i MAY 2 3 2022 GILROY CITY CLERK'S OFFICE 5/1/2023 DATE(MMIDD/YYYY) 04/25/2022 S17RANg 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 po icy, 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 LOCKTON COMPANIES LOCKTON COMPANIES 3657 BRIARPARK DRIVE, SUITE 700 HOUSTON TX 77042 CONTACT NAME: PHONE FAX ExH: (A/C —Nob E-MAILo ADDRESS' INSURER(S) AFFORDING COVERAGE NAIC S INSURERA: Old Republic Insurance Company 24147 INSURED PAR WESTERN LINE CONTRACTORS, LLC - DIVISION # 1364692 A QUANTA SERVICES COMPANY 4770 N. BELLEVIEW AVE., SUITE 100 KANSAS CITY MO 64116 INSURER B : INSURER C : INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 12686314 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A A X COMMERCIAL GENERAL LIABILITY Y N MWZY 313093 22 MWZX 313095 22 05/01/2022 05/01/2022 05/01/2023 05/01/2023 EACH OCCURRENCE $ 5,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 1 ,000,000 MED EXP (Any one person) $ Excluded PERSONAL & ADV INJURY $ 1 ,000,000 GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE POLICY OTHER: LIMIT APPLIES PJE� PER: LOC PRODUCTS - COMP/OP AGG $ 5,000,000 $ A A AUTOMOBILE X X(Per X LIABILITY ANY AUTO OWNED AUTOS ONLY AUTOS ONLY ED X SCHEDULED AUTOS AU OS ONLY Y N MWTB 313092 22. MWZX 313091 22 05/01/2022 05/01/2022 05/01/2023(E0a 05/01/2023 accldeDt) INGLE LIMIT $ 5,000,000 BODILY INJURY (Per person) $ XXXXXXX BODILYINJURY Pid) $ XXXXXXX R p (Per accident) AMAGE $XXXXXXX $ XXXXXXX UMBRELLA LIAB EXCESS LIAB O OCCUR CLAIMS -MADE NOT APPLICABLE EACH OCCURRENCE $ XXXXXXX AGGREGATE $ XXXXXXX DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY OFFICER/MEMBER /EXCLU DED? ECUTIVE (Mandatory In NH) If yes, describe under . - DESCRIPTION OF OPERATIONS below Y / N N NIA N MWC 313094 22 05/01/2022 05/01/2023 X STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1 ,000,000 E.L. DISEASE - POLICY LIMIT $ 1 ,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Additional Insured in favor of The City of Gilroy (on a I policies except Workers' Compensation/EL) where and to the extent required by written contract. CERTIFICATE HOLDER CANCELLATION 12686314 The City of Gilroy 7351 Roseanna St Gilroy CA 95020 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 ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD