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HomeMy WebLinkAboutCOI - Chrisp Company - Expires 2021-12-01AR /$ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11 /30/2020 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(les) 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 Arthur J. Gallagher & Co. Insurance Brokers of CA, Inc. LIC #0726293 3697 Mt. Diablo Blvd., Suite 300 Lafayette CA 94549 CONTACT NAME: Certificate Department PHONE FAX (c. No Extl' 925-299-1112 (A/C, No 925-953-6270 ADDRESS: CertRequests@iajg.com INSURERS) AFFORDING COVERAGE NAIC I( INSURER A: American Guarantee and Liability Ins Co 26247 INSURED Chrisp Company 43650 Osgood Road Fremont, CA 94539 INSURER B : Starr Indemnity & Liability Company 38318 INSURER C: INSURER D: INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:917801322 REVI ION 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. INBR. LTR —A151IC TYPE OP INSURANCE INSD 9I.i 4i WVD _ __, _W. r.._...Fa POLICY NUMBER , EFF 110M/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y 1000025634201 12/1/2020 12/1/2021 EACH OCCURRENCE $2,000,000 CLAIMS -MADE X I OCCUR IMAGE TO RENTED PREMISES (Ea occurrence) $1,000,000 X BI/PD: $50,000 MED EXP (Any one person) $ X DEDJOCC PERSONAL S ADV INJURY $ 2,000,000 GEN'L ___.-. AGGREGATE POLICY I X LIMIT APPLIESPER: d�Q I.� LOC GENERAL AGGREGATE PRODUCTS - COMP/OP AGO $4,000,000 $ 4,000,000 OTHER: $ B AUTOMOBILE X LIABILITY ANY AUTO Y 1000196720201 12/1/2020 12/1/2021 E aBrnaent; INGLE LIMIT BODILY INJURY (Per person) $2,000,000 $ OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY (Per accident) $ v HIRED AUTOS ONLY X NON -OWNED AUTOS ONLY PROPERTY DAMAGE _(Per acoidentL___ ___ ,_ _ $ A UMBRELLALIAB X OCCUR AUCO217902-05 12/1/2020 12/1/2021 EACH OCCURRENCE $10,000,000 X EXCESS LIAR CLAIMS -MADE AGGREGATE $10,000,000 DED X RETENT ON $ 1 n flnn $ B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y 1000004442 12/1/2020 12/1/2021 X laATUTE OTH- ER ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) Y/N N / A E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE $1,000,000 $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 (See attached suppl. pegs) DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) ADDITIONAL INSURED: City of Gilroy, it's officers, officials, employees, agents and volunteers. Project: RE: Encroachment Permit Cert CERTIFICATE HOLDER City of GilroyGilroy City Hall 7351 Rosanna Street Gilroy CA 95020 USA 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. AUTHORIZED REPRESENTATIVE 41988-2015 ACORD CORPORATION. Ail rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 2"'of10 1873 Indemnity & Liability Company Dallas, TX 1-866-519-2522 ADDITIONAL INSURED- OWNERS, LESSEES OR CONTRACTORS COMPLETED OPERATIONS Policy Number: 1000025834201 Effective Date: 12/01/2020 Named Insured: Chrisp Company This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE NAME OF ADDITIONAL INSURED PERSON OR ORGANIZATION: AS REQUIRED PER WRITTEN CONTRACT LOCATION AND DESCRIPTION OF COMPLETED OPERATIONS: AS REQUIRED PER WRITTEN CONTRACT ADDITIONAL PREMIUM: (If No entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) SECTION II - WHO IS AN INSURED is amended to include as an insured; The person or organization shown in the Schedule, but only with respect to liability arising out of "your wore at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". All other terms and conditions remain unchanged. OG 185 (04/12) Page 1 of 1 Copyright C. V. Starr & Company and Starr indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with Its permission. 3"` of 10 1873 ~ Indemnity �� ����.^8��. �`«^ �-��� 2���.�� wnmvu��00��U^ �� w~x�"x�KoK�� "~^x�����N�lP / / Company Dallas, TX 1-866-519-2522 ���U~������� U������������� LESSEES, �����*uuo��omx~wu� un�v��wuu�~�� ����o��~uu��x u~�~w�~��~�~��, ��nu CONTR��^���������� � SCHEDULED �������� ���� ACTORS uuu�x»� n �*nn�� ~���: n�~�m��u~u~�� n-�~nu�o��nn �*n u ����������K����~�U���� ��no����n�x����nu��m� Policy Number: 1000025834201 Effective Date: 12/01/2020 Named Insured: Chrisp Company This endorsement modifies insurance provided under the COMMERCIAL GENERAL LIABILITY COVERAGE FORM SCHEDULE NAME {JFPERSON 0RORGANIZATION: ASREQUIRED PER WRITTEN CONTRACT (K no entry appears above, information required \ocomplete this endorsement will be shown in the Declarations as applicable to the endorsement.) A. SECTION U-WHO |SANINSURED ioamended 0oinclude oamninsured; The person or organization ohnvvn in the schedule, but only with respect hmliability arising out of your ongoing operations performed for that additional insured. B. With respect to the insurance afforded to these additional insureds, SECTION | - COVERAGES, COVERAGE A ' BODILY INJURY AND PROPERTY DAMAGE LIABILITY, 2. -Exo|uoiono, in amended to include the following additional exclusion; This insurance does not apply to "bodily injury" or "property damage" occurring sdtoc (1) all work, including matoria|o, parts or equipment furnished in connection with such work, on the project (other than aemioa, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site o(the covered operations has been completed; or, (2) that portion of "your work" out of vvh|oh the injury or damage ori000 has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for o principal as o part of the same project. All other terms and conditions remain unchanged. OG180K4/1Page 1wf1 Copyright CC. xStarr aCompany and Starr Indemnity Liability Company. All rights . Includes copyrighted material m18mProperties, mp,used with its permission. 4* ofm 1873 all voo%�voxwv^y*m�wax nxvxy n-m1111j"ony Dallas, TX 1-866-519-2522 Primary and Non -Contributory Condition Policy Number: 1000025834201 Named Insured: Chdsp Company This endorsement modifies insurance provided under the: Commercial General Liability Coverage Part Effective Date: 12/01/2020 A. SECTION IV -CONDITIONS, condition 4. Other Insurance is amended as follows: 1. The following imadded toparagraph 4.m.ofthe Other Insurance condition: This insurance is primary insurance as respects our coverage to the additional insured, where the written contract or written agreement requires that this insurance he primary and non-contributory. In that event. we will not seek contribution from any other inmUrmOoo policy available to the additional insured onwhich the additional insured |oaNamed Insured. ALL OTHERTERM8AND CONDITIONS REMAIN UNCHANGED. Signed for STARRINDEMNITY &ALIABILITY COMPANY Steve Blakey, President Nehemiah E. Ginsburg, General Founsel KJG1O7(0NK11) Page 1mf1 Copyright 000.0Starr aCompany and Starr Indemnity Liability Company. All rights resemed. Includes copyrighted material of ISO Properties, Inc., used with Its permission. 5*mm 1873 POLICY NUMBER: 1000025834201 COMMERCIAL GENERAL LIABILITY CG 24 04 05 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: Any person or organization to whom you become obligated to waive your rights of recovery against, under any contract or agreement you enter into prior to the occurrence of loss. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products -completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. CG 24 04 05 09 Insurance Services Office, Inc., 2008 Page 1 of 1 6" of 10 1873 Starr Indemnity & Liability Company Dallas, TX 1-866-519-2522 Additional Insured Where Required Under Written Contract or Written Agreement Endorsement Policy Number: 1000198720201 Effective Date: 12/01/2020 at 12:01 AM. Named Insured: Chrisp Company This endorsement modifies the insurance coverage form(s) listed below that have been purchased by you and evidenced as such on the declarations page. Please read the endorsement and respective policy(ies) carefully. Business Auto Coverage Form THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. It is hereby agreed that SECTION II — COVERED AUTOS LIABILITY COVERAGE, A. Coverage, 1. Who Is An Insured, is amended to include the following: d. Any person or organization whom you become obligated to include as an additional insured under this policy, as a result of any written contract or written agreement you enter into which requires you to furnish insurance to that person or organization of the type provided by this policy, but only with respect to liability arising out of use of a covered "auto". However, the insurance provided will not exceed the lesser of: (1) The coverage and/or limits of this policy, or (2) The coverage and/or limits required by said written contract or written agreement. All other terms and conditions of this Policy remain unchanged. Signed for STARR INDEMNITY & LIABILITY COMPANY Steve Blakey, President and Chief Executive Officer SICA 1016 (04/14) AlYtivt.,e, if: • Nehemiah E. Ginsburg, General Consel Paige 1 of 1 Copyright CO Starr indemnity & Liability Company. All rights reserved, Includes copyrighted material of ISO Properties, Inc., used with its permission. 7" of 10 1873 Starr Indemnity & Liability Company Dallas, TX 1-866-519-2522 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. INSURANCE PRIMARY AS TO CERTAIN ADDITIONAL INSUREDS Policy Number: 1000198720201 Effective Date: 12/01/2020 at 12:01 AM Named Insured: Chrisp Company This policy is amended as follows: BUSINESS AUTO COVERAGE FORM Section IV — Business Auto Conditions, B., General Conditions, 5., Other Insurance, c., is amended by the addition of the following sentence: The insurance afforded under this policy to an additional insured will apply as primary insurance for such additional insured where so required under an agreement executed prior to the date of accident. We will not ask any insurer that has issued other insurance to such additional insured to contribute to the settlement of loss arising out of such accident. All other terms and conditions remain unchanged. Signed for STARR INDEMNITY & LIABILITY COMPANY Steve Blakey, President an Chief Executive Officer tv--ey,49 Nehemiah E. Ginsburg, General Colinsel SICA 1017 (02/12) Page 1 of 1 Copyright © C. V. Starr & Company and Starr Indemnity & Liability Company. All rights reserved. Includes copyrighted material of ISO Properties, Inc., used with Its permission. 8* of 10 1873 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04K3C6 (Ed.O4-84) WAIVER OFOUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT -CALIFORNIA \Nehave the right torecover our payments from anyone liable for eninjury covered bythis policy. VVnwill not enforce our right against the person or organization named in the Sohedu|8. (Thh; agreement applies onk/bo the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll naouvdu onnunuie|y segregating the remuneration of your employees vvh||e engaged in the work described in the Schedule. The additional premium for this andoraementshall be 2'0`4 ofthe California workers' compensation premium otherwise due oUsuch remuneration. Schedule Person prOrganization Job Description Where required by contract Any person urorganization howhom you become obligated tuwaive your rights ofrecovery against, under any contract oragreement you enter into prior to the occurrence of loss. This endorsement changes the policy mwhich it isattached and iseffective onthe date issued unless otherwise stated. (The Information below Is requIred only when this endorsement Is Issued subsequent twpmpummonvfthe »o|icy.> Endnm*mentEffeu|wu: 12/01/2020 Policy Nu.:1ODD0O4442 EndomammntNu.: insured: ChrispCnmpony Insurance Company: Starr Indemnity & Liability Company Countersigned by: WC 040300 Page Imf1 9*wm 1873 AGENCY CUSTOMER ID: LOC #: ACCIRE) ADDITIONAL REMARKS SCHEDULE Page of AGENCY NAMED INSURED POLICY NLIMBER CARRIER MAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER; FORM TITLE: Additional information GENERAL LIABILITY: *Additional Insured if required by written contract per attached Form' OG 185 (04/12) and OG 180 (04/12) *Coverage IS Primary/Non-Contributory if required by written contract per attached OG 107 (04/11) *Waiver of Subrogation if required by written contract per attached Form CC 24 04 05 09 AUTOMOBILE LIABILITY: • Additional Insured if required by written contract per attached Form SICA 1016 (04/14) WORKERS' COMPENSATION: • Covered States: California, Nevada, Oregon • Waiver of Subrogation if required by written contract attached Form WC 04 03 06 UMBRELLA LIABILITY: *Underlying: General Liability, Automobile Liability and Employer's Liability. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 'veto 1873