Loading...
HomeMy WebLinkAboutCOI - SSI Express Transport, Inc. - Expires 2022-02-11A CO,R O CERTIFICATE OF LIABILITY INSURANCE PATE(MM/DD/YYYY) 02/08/2021 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 CONTACT Carol Knox, Debbie Taylor or Debbie Waller KGIB, INC. KNOX GENERAL INSURANCE BROKERS PHONE 714 744-3300 FAx 714 744-6537 (A/C No, Est);( ) (A/c, No): ( ) E-MAIL k ADDRESS: Carol @ gibinc.com, Debbie@kgibinc.com, DWaller@kgibinc.com 226 SOUTH GLASSELL STREET INSURER) AFFORDING COVERAGE NAIC # ORANGE CA 92866 INSURER A: EMPLOYERS MUTUAL CASUALTY COMPANY 21415 INSURED INSURER B : ACCEPTANCE CASUALTY INSURANCE CO 10349 SSI EXPRESS TRANSPORT, INC INSURER C ; OHIO CASUALTY INSURANCE COMPANY 24074 SSI EXPRESS, INC INSURER D ; 150 S. LARCH AVENUE INSURER E ; RIALTO CA 92376-9003 INSURER F: ATE NUMBER' I\L V I.JIVII II VIVID 11.• 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 X COMMERCIAL GENERAL LIABILITY 2D1 88 13 02/11/2021 02/11/2022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE X LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED X 2E1 8813 02/11/2021 02/11/2022 COMBIaccident)NED SINGLE LIMIT (Ea $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE XL00019706 02/11/2021 02/11/2022 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A --N/A-- PER STATUTE OTH- ER E,L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ C MOTOR TRUCK CARGO BMO 60 65 34 75 02/11/2021 02/11/2022 $1,000,000 LIMIT $5000 DEDUCTIBLE DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) RE: ROAD PERMIT CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED PER FORM CA 7421 7-14 WITH RESPECT TO AUTO LIABILITY. nrnrlrin A 4P 11n1 �'.� CANCELLATION CITY OF GILROY 7351 ROSANNA STREET 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 POLICY NUMBER: 2E1 88 13 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the coverage form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. SECTION II — LIABILITY COVERAGE, A.1. Who Is An Insured is amended by adding the following: d. Any person or organization who is a party to a written agreement or contract with you in which you agree to provide the type of insurance afforded under this Business Coverage Form. This provision applies to claims for "bodily injury" or "property damage" which occur after the execution of any written agreement or contract. CA7421(7-14) Includes copyrighted material of ISO Properties, Inc. with its permission. Page 1 of 1