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HomeMy WebLinkAboutCOI - Sebring Transport, Inc. - Expires 2022-03-01T 0,DATE CERTIFICATE OF LIABILITY INSURANCE (MM/DD/YYYY) 3/1/2021 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 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 Noble West Insurance Services License #0B10706 205 Natoma Street Folsom CA 95630 CONTACT PHONE FAX (A/c No Ext): 916-355-1300 (A/C, No): 916-355-1306 ADDRESS: PRODUCER CUSTOMER ID #: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Sebring Transport, Inc. 2100 Carden Street San Leandro CA 94577 INSURER A : Great West Casualty Co. 11371 INSURER B : Crum & Forster Specialty 44520 INSURER C : Great American Ins Co 16691 INSURER D : Travelers Insurance Group 25682 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1579626159 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A GENERAL X LIABILITY COMMERCIAL GENERAL LIABILITY X OCCUR Y GWP59740M 3/1/2021 3/1/2022 EACH OCCURRENCE $1,000,000 DAMAGE RENTED PREMISESO(Ea occurrence) $100,000 CLAIMS -MADE MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY PERCQT LOC PRODUCTS - COMP/OP AGG $2,000,000 $ A AUTOMOBILE X X X LIABILITY Y GWP59740M 3/1/2021 3/1/2022 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ $ B X UMBRELLA LIAB EXCESS LIAB X O OCCUR CLAIMS -MADE SE0111991 3/1/2021 3/1/2022 EACH OCCURRENCE $1,000,000 AGGREGATE $ D DEDUCTIBLE RETENTION $ $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A WC4671971 1/18/2021 1/18/2022 WC STATU- OTH- TORY LIMIT; ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000.000 D A A Cargo Bailee (Non -Owned Trailer Physical Damage QT6602L181464TIL20 GWP59740M GWP59740M 4/20/2020 3/1/2021 3/1/2021 4/20/2021 3/1/2022 3/1/2022 $300,000 $1,000 Ded. $75,000 $1,000 Ded. $2,500 Ded. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) **SYMBOL 50 - ANY AUTO EXCEPT A PRIVATE PASSENGER TYPE AUTO, VAN OR PICKUP Evidence of Insurance. Certificate holder is additional insured with regards to the auto and general liability coverage. CERTIFICATE HOLDER CANCELLATION City of Gilroy Public Works Dept. 7351 Rosanna Street Gilroy CA 95020 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL <DAYS> DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE AUTHORIZED REPRESENTATIVE ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD