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HomeMy WebLinkAboutCOI - Applied EarthWorks, Inc. - Expires 2022-10-01CERTIFICATE HOLDER © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) AUTHORIZED REPRESENTATIVE CANCELLATION DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE LOCJECTPRO-POLICY GEN'L AGGREGATE LIMIT APPLIES PER: OCCURCLAIMS-MADE COMMERCIAL GENERAL LIABILITY GENERAL LIABILITY PREMISES (Ea occurrence)$DAMAGE TO RENTED EACH OCCURRENCE $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $RETENTIONDED CLAIMS-MADE OCCUR $ AGGREGATE $ EACH OCCURRENCE $ UMBRELLA LIAB EXCESS LIAB DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS WC STATU-TORY LIMITS OTH-ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT $ $ $ ANY PROPRIETOR/PARTNER/EXECUTIVE If yes, describe under DESCRIPTION OF OPERATIONS below (Mandatory in NH) OFFICER/MEMBER EXCLUDED? WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED HIRED AUTOS NON-OWNEDAUTOSAUTOS AUTOS COMBINED SINGLE LIMIT BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE $ $ $ $ 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 ADDL WVD SUBR N / A $ $ (Ea accident) (Per accident) 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 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). The ACORD name and logo are registered marks of ACORD COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: INSURED PHONE(A/C, No, Ext): PRODUCER ADDRESS:E-MAIL FAX(A/C, No): CONTACTNAME: NAIC # INSURER A : INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : INSURER(S) AFFORDING COVERAGE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. United Agencies,Inc 2300 W.Magnolia Blvd. Burbank CA 91506 Candy Montoya 818-643-2304 818-643-2313 cmontoya@unitedagencies.com Continental Casualty Company 20443 APPLEAR-01 Underwriters at Lloyd's London 15792AppliedEarthworks,Inc. 1391 W.Shaw Ave #C Fresno CA 93711 The Continental Insurance Company 35289 Carolina Casualty Insurance Company 10510 254909678 A X 1,000,000 100,000 X 1,000,000 2,000,000 2,000,000 6049918187 10/1/2021 10/1/2022 X Y Y 15,000 A 1,000,000 X X X 6049918173 10/1/2021YY 10/1/2022 C X X 2,000,000 X 2,000,000 $0 6049918190 10/1/2021 10/1/2022 Prod/CompOps Agg 2,000,000 D Y Y BNUWC0155167 10/1/2021 10/1/2022 1,000,000 1,000,000 1,000,000 B Professional Liability 6/3/2022 X 0000-00236428E 10/1/2021 10/1/2022 Per Claim Limit Aggregate Limit Deductible 2,000,000 2,000,000 5,000 Subject to all policy terms,conditions and exclusions.30 days NOC except 10 for non-payment of premium. RE:#20-RFQ-CDD-330:On Call Planning Services,Environmental Reviews and Historical Evaluation As respect GL and Auto:The City of Gilroy is included as Additional Insureds if required by written contract per attached endorsements;including Primary Non-Contributory wording.As respect G:,Auto,and WC:Waivers of Subrogation are included per attached endorsements. City of Gilroy 7351 Rosanna Street Gilroy CA 95020-6197 DocuSign Envelope ID: EA80C521-0DF8-4608-BED1-9B41977636A8 DocuSign Envelope ID: EA80C521-0DF8-4608-BED1-9B41977636A8 DocuSign Envelope ID: EA80C521-0DF8-4608-BED1-9B41977636A8 DocuSign Envelope ID: EA80C521-0DF8-4608-BED1-9B41977636A8 DocuSign Envelope ID: EA80C521-0DF8-4608-BED1-9B41977636A8 DocuSign Envelope ID: EA80C521-0DF8-4608-BED1-9B41977636A8 DocuSign Envelope ID: EA80C521-0DF8-4608-BED1-9B41977636A8 DocuSign Envelope ID: EA80C521-0DF8-4608-BED1-9B41977636A8 DocuSign Envelope ID: EA80C521-0DF8-4608-BED1-9B41977636A8 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA (Blanket) We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be ________ % of the California workers’ compensation premium otherwise due on such remuneration. 0.020000 Schedule This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Countersigned By Endorsement Effective Date: Endorsement No.: Insured Name: Insurance Company:Carolina Casualty Insurance Company POLICY NUMBER: BNUWC0155167 Policy Number:BNUWC0155167 State Description CA Any party with whom the insured agrees to waive subrogation in a written contract. NE Any party with whom the insured agrees to waive subrogation in a written contract. NV Any party with whom the insured agrees to waive subrogation in a written contract. FL Any party with whom the insured agrees to waive subrogation in a written contract. IA Any party with whom the insured agrees to waive subrogation in a written contract. TX Any party with whom the insured agrees to waive subrogation in a written contract. DocuSign Envelope ID: EA80C521-0DF8-4608-BED1-9B41977636A8