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HomeMy WebLinkAboutCOI - F.S. Trucking Company Inc - Expires 2023-06-13ii ii HANSEN INS PRDGREIIIVE® 800 EAST LAKE AVE WATSONVILLE, CA 95076 COMMERCIAL CITY OF GILROY 7351 ROSANNA ST GILROY, CA 95020 Additional insured endorsement Name of Person or Organization CITY OF GILROY 7351 ROSANNA ST GILROY, CA 95020 Policy number: 02525351-7 Underwritten by: United Financial Cas Co Insured: F.S. TRUCKING COMPANY INC May 27, 2022 Policy Period: Jun 13, 2022 -Jun 13, 2023 Mailing Address United Financial Cas Co PO Box 94739 Cleveland, OH 44101 1-800-876-8270 For customer service, 24 hours a day, 7 days a week The person or organization named above is an insured with respect to such liability coverage as is afforded by the policy, but this insurance applies to said insured only as a person liable for the conduct of another insured and then only to the extent of that liability. We also agree with you that insurance provided by this endorsement will be primary for any power unit specifically described on the Declarations Page. limit of Liability Bodily Injury Property Damage Combined liability Not applicable Not applicable $1,000,000 each accident All other terms, limits and provisions of this policy remain unchanged. This endorsement applies to Policy Number: 02525351-7 Issued to (Name of Insured): F.S. TRUCKING COMPANY INC FRANK SMITH TRUCKING Effective date of endorsement: 06/13/2022 Form 1198 (01/04) Policy expiration date: 06/13/2023 I AGENCY CUSTOMER ID: 570000073826 LOC#: ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED Aon Risk services central, Inc. American Medical Response, Inc. POLICY NUMBER see certificate Number: 570093173556 CARRIER INAICCODE- see certificate Number: 570093173556 EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of l.iability Insurance INSURER(S) AFFORDING COVERAGE NAIC# INSURER INSURER INSURER INSURER Page_ of_ ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR POLICY POLICY ADDL SUBR POLICY NUMBER El•'FECTIVE EXPIRATION LIMITS J:l'R TYPE OF INSURANCE INSD WVD DATE DATE (MM/DD/YYYY) (MM/DDIYYYY) WORKERS COMPENSATION C N/A SCFC68920322 03/31/2022 03/31/2023 WI Paid LOSS Retro ..,.....__ -- - . ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ~ --!!!!!!l!!!!!!!! -- A- v_ ~= o= "'-8-. ==== (\J ==== g ==== -gJ - i;,:_ g---!!! X ~ ~-0~ 13 ~ <(= n. === n.=