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HomeMy WebLinkAboutCOI - Rana Creek Habitat Restoration - Expires 2022-07-29-,® CERTIFICATE OF LIABILITY INSURANCE I DATE (MMIDD/VVYY) 6/1/2022 ~ 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(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 lleu of such endorsement(s). PRODUCER ~2fi~~CT Andreini & Company Andreini & Company-San Mateo rfigN..\',.. ,:u♦,. 650-573-1111 ! ft~ No\: 650-378-4361 220 West 20th Avenue San Mateo CA 94403 xtlri~ss: czena@andreini.com INSURER/S) AFFORDING COVERAGE NAIC# ·--·-INSURER A, Evanston Insurance Co 35378 INSURED RANAC-2 INSURER B: United Financial Casualty Co. 11770 Rana Creek Habftat Restoration INSURER C: Lloyd's of London 27875 Berwick Drive Ste. A Carmel CA 93923 INSURERD: State Com~ensation Ins Fund 35076 INSURER E: INSURERF: COVERAGES CERTIFICATE NUMBER:271166634 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. IIIISR ........................... _______ ----·-·--·· .. -ADDL Sl.H:11'1 ............... ----·-------·-·-··--· .. POLICY EFF ... ·p· LICV EXP··-· ----.-•---·--------···-··-----·-----·--·---··--.. _, ______ LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMIDOIVYVYI (M~/00/VYVYI LIMITS A X COMMERCIAL GENERAL LIABILITY y MKLV5ENV103146 712912021 7/2912022 EACH OCCURRENCE $1,000,000 .... I CLAIMS-MADE 0 OCCUR t:l~iyi_AGt TO RENTED . .J-5~_000 ------· ,-f'f!EMISES {Ea oocurrencaL_ ........_ MED EXP (Any one person) $5,000 ,_ PERSON,'1,L & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $2,000,000 _j POLICY 0 m?r r---1 L_j LOC PRODUCTS· COMP/OP AGG $2,000,000 I OTHER: $ El AUTOMOBILE LIABILITY 01261735-5 5/412022 11/4/2022 fi:OMBl(IIED SINGLE LIMIT $1,000,000 -·-( ,.a acmdent) ANY AUTO BODILY INJURY (Per person) $ ,_ OWNED X SCHEDULED BODILY INJURY (Per ac,;idant) $ ,_ AUTOS ONLY ~ AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ ,_ AUTOS ONLY ,__ AUTOS ONLY .. Q'.er accjd9ntl ............. -.......... ----·----·•-•.--· __ ., ----·--··--·-·-·-- $ A X UMBRELLA LIAB ~ OCCUR MKLV5EFX100804 7/29/2021 7129/2022 EACH OCCURRENCE $5,000.000 ,_ EXCESS LIAB CLAIMS-MADE AGGREGAT_E_. ____ $~_..Q!J.0,000 OED I I RETENTION$ PROD/COMP OPS $5,000,000 D WORKERS COMPENSATION 930751222 6/'112022 6/1/2023 ER I I om. AND EMPLOYERS' LIABILITY X I STATUTE ER VIN ANYPROPRIETORIPARTNERIEXECUTIVE □ NIA E.L. EACH ACCIDENT $1,000,000 OFFICERIMEMBEREXCLUDED'I {Mandatory In NH) E.L. DISEASE· EA EMPLOYEE $1,000,000 II las, describe under E.L. DISEASE· POLICY LIMIT $1,000,000 DESCRIPTION OF OPEFlATIONS below C Professional Liability ANE160767521 7/29/2021 7/29/2022 EACH CLAIM LIMIT 1,000,000 AGGREGATE 1,000,000 I DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Addltlonal Remarks Sohedule, may be attached If more space Is required) Contractors Pollution Liability: Evanston Insurance Co. Policy Number MKLV5ENV103146 Eff. Date: 7/2912021 to 7/29/2022 Limits: Shared General Aggregate Limit $2,000,000 Ea. Pollution Condition Limit $1,000,000 Ea. Transportation Pollution Condition Limit $1,000,000 Ea. Non-Owned Disposal Site Pollution Condition Limit $1,000,000 Self Insured Retention: $10,000 Each Pollution Condition See Attached ... 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 Gilroy, its officers, officials and employees 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 ~~yi,,-~~--9~~--... [_..,,. .,,. I © 1988•2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 2of5 7433 -~® ACORD ~- AGENCY Andreini & Company-San Mateo POLICY NUMBER CARRIER ADDITIONAL REMARKS AGENCY CUSTOMER ID: _R_A_N_AC_-_2 _____________ _ LOC#: ______ _ ADDITIONAL REMARKS SCHEDULE Page 1 of NAMED INSURED Rana Creek Habitat Restoration 27875 Berwick Drive Ste. A Carmel CA 93923 I N,11.ICCODE EFFECTIVE DATE:: THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE Policy Basis: Occurrence Service Agreement: Fire Department Personnel Testing City of Gilroy, its officers, officials and employees are included as an additional insured, per the attached Endorsement. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 3of5 7433 POUCY NUMBER: MKLV5ENV103146 COMMERCIAL GENERAL LIABILITY CG :w 100104 THIS EN,DORSEMENT CHANGES THE POLICY. PlE.ASE READ IT CARE FULL V. ADDITIONAL INSURED -OWNERS,, LESSEES OR C,QNTRACTORS -SCHEDULIED PERSON OR O·RGANIZA TION This endorsement modifies insurance provided u11d~~r the followlng; COMMERCIAL GENERAL LrABU. .. ff'"( COVERAGE PART SCHEDULE Name Of AddlUonal Insured Pt,uson(s) Or Orga.niiation{St): Locatfio111s) 10f Covered OP1.m:1ticms . lk•}ui«:rl by wrillr.Ji c:ontract : Jnfor.rnatton required to comelete this Schedule, if not sho\vn above, wilJ be shown in the Oech1raUons. A. SecU(Hl II -Who Is An ll'ISI.Ued rs amended f,o. include as an additional insured Iha persi::m(s) or orgianizalion(s) shown in the Schedule, but only with respect to liability for "bodily I nJ1.11y'', "prOPlllrty damage" or "persona! and advertising injury" cau$ed, In whote orlo part, by: 1. Ymu acts or omissions; or 2. The acls or cimissions of those actin:i;, on your behalf; in the performance of your ongoing operations fo•r 'the additional insured(s) al the location(::;) delllig~ mated above, a. With respect lo the Insurance afforded 10 these additional insureds, the following additional exch.r~ :s.ions apply: This insurance does riot apply to "bodify injury" or ''property damage," occurring after: 1. All work, including materials, parts or equip- ment furnished In connectl.on with such work. on Ute project (other than service, maintenance or reps:lrs) to be performed by or on b,ehsf:i of' the additional in.sured{:$) at the location of the covered operations has be-an 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 subcon1ractor erigaged in perfonning operations. for a princi- pal as a part of the same project CG 2010 07 04 © 'ISO Properties, Inc., 2004 Page 't of 1 ! : tl 5of5 7433 Andreini & Company-San Mateo 220 W. 20th Avenue San Mateo, CA 94403 7433 2 MB 0.482 7433 111 111 11 I •I 111111 11111 11 I I 11 11 I• 1 I I• 11111 11 1 I l'I I 111!11111 11 11 11 11 CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOY 7351 ROSANNA ST GILROY, CA 95020-6141 1 of5 7433