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Home My WebLink AboutCOI - Combined Transport, Inc. - Expires 2023-06-01ACORD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~· 06/01/2022 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 riahts to the certificate holder in lieu of such endorsement(s). PRODUCER NAM~~"' McGrlff Insurance Services, Inc. r..vgNtfo Extl: 503-943-6621 I r.e~ No): 503-943-6622 1800 SW First Avenue, Suite 400 Portland, OR 97201 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC# INSURER A :The Travelers Indemnity Company of Connecticut 25682 INSURED INSURER B: Combined Transport, Inc. Blackwell Consolidation, LLC INSURERC: 5656 Crater Lake Highway INSURER D: P.O. Box 3667 Central Point, OR 97502 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:92CBQZY5 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 TYPE OF INSURANCE ADDL SUBR ,:m-Jgrv~YYi ,~8rJ%YvW~·1 LIMITS LTR '""n WVD POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY Y-630-071 0R943-TCT-22 06/01/2022 06/01/2023 EACH OCCURRENCE $ 1,000,000 ~ D CLAIMS-MADE [8J OCCUR DAMAGE j~I RENTED PREMISES Ea occurrence\ $ 300,000 ,-- MED EXP (Any one person) $ 5,000 I- PERSONAL & ADV INJURY $ 1,000,000 ~ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ~ □PRO· □LOG PRODUCTS -COMP/OP AGG $ 2,000,000 POLICY JECT OTHER: $ AUTOMOBILE LIABILITY pg~~~~~~t~IN<.:iLE LIMIT $ I- ANY AUTO BODILY INJURY (Per person) $ I-OWNED ,--SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ I-HIRED -NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY /Per accident\ $ I--$ UMBRELLA LIAB H OCCUR EACH OCCURRENCE $ I- EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION I J'T~~"TE I 1orn AND EMPLOYERS' LIABILITY ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE □ NIA E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) E.L DISEASE • EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE· POLICY LIMIT $ $ $ $ $ $ DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Certificate Holder is named as an Additional Insured as respects the ongoing operations of the Named Insured with respects to General Liability coverage where required by written and signed contract subject to policy terms, conditions, limits and exclusions. CERTIFICATE HOLDER 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. City of Glllroy AUTHORIZED REPRESENTATIVE ~ ~ 7351 Rosanna St ~ Gillroy, CA 95020 Page 1 of 1 © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CURREQU-01 ARAI ACORD• CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) ~ 5/20/2022 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 22~?,cT Drisana Wallace Proco Insurance Services wg,NJo, Ext): (408) 709-1167 I FAX 91 O E Hamilton Ave (AIC, No): #410 i~D~~<>s: drisana.wallace@proco.global Campbell, CA 95008 INSURER(SI AFFORDING COVERAGE NAIC# INSURER A: Associated Industries Insurance Company, Inc. 23140 INSURED INSURER B: Everest lndemnitv Insurance Comoanv 10851 Currie Equipment, LLC INSURER c: State Compensation Insurance Fund of California 35076 J.S. Cole Inc. INSURER D: National Fire Insurance Co of Hartford 20478 320 Deer Island Lane Novato, CA 94945 INSURERE: 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. 'f~: TYPE OF INSURANCE ~.~£)~ ~~~ POLICY NUMBER POLICY EFF PO,~l9,Y EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 f--D CLAIMS-MADE [!] OCCUR DAMAGE TO RENTED 100,000 X AES1034812 08 5/17/2022 5/17/2023 PREMISES (Ea occurrence\ $ f-- 0 MED EXP (Anv one oersonl $ f-- 1,000,000 PERSONAL & ADV INJURY $ f- 2,000,000 ~'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY □ ~&'& ~ LOC PRODUCTS -COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY ifc~~~b~~~tflNGLE LIMIT $ 1,000,000 ANY AUTO CF2CA00235-211 9/6/2021 9/6/2022 BODILY INJURY (Per oersonl $ f--OWNED X SCHEDULED f--AUTOS ONLY f--AUTOS BODILY INJURY /Per accident\ $ f--~L't1fs ONLY ~ ~&ro~'1f~'r.~ F~f~Jc~d\,':'.;t?AMAGE $ $ A UMBRELLA LIAB ~OCCUR EACH OCCURRENCE $ 5,000,000 f-- EXA1053137-04 5/17/2022 5/17/2023 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ OED I X I RETENTION $ 0 $ 5,000,000 C WORKERS COMPENSATION X I ~-\JruTE I I OTH-AND EMPLOYERS' LIABILITY ER Y/N 9132704-2022 5/17/2022 5/17/2023 1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE □ E.L. EACH ACCIDENT $ Pr.l'IA<ai~~~~~~ EXCLUDED? N/A 1,000,000 E.L. DISEASE -EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1,000,000 D Property 6018120031 5/17/2022 5/17/2023 Per Item 750,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) City of Gilroy, its officers, officials, and employees are named as an additional insured on General Liability policy per the attached endorsement. CERTIFICATE HOLDER City of Gilroy 7351 Rosanna St. Gilroy, CA 95020 ACORD 25 {2016/03) 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. © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: AES1034812 08 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 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): Location(s) Of Covered Operations All persons or organizations as required by written contract with the Named Insured 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equip- ment 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 location 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 in- tended use by any person or organization other than another contractor or subcontractor en- gaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 □