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HomeMy WebLinkAboutCOI - Rana Creek Habitat Restoration - Expires 2023-07-29Andreini & Company -San Mateo 220 W. 20th Avenue San Mateo, CA 94403 2636 2 MB 0.512 2636 IIlIIIIIIIIIIlIuIliuIIiIiIIuiIJI III IIIIiIIIIIJiliiJIuIIITiIuII CITY OF GILROY, ITS OFFICERS, OFFICIALS AND EMPLOY 7351 ROSANNA ST GILROY, CA 95020-6141 R E CCU 7 JD AUG 0 3 2022 GILROY CITY CLERK'S OFFICE 1 of 5 2636 ARD® Rbe CERTIFICATE OF LIABILITY INSURANCE MIDDIYYYY) EWM/WO DATE /26/2022 (M 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 Andreini & Company -San Mateo 220 West 20th Avenue San Mateo CA 94403 CONTACT NAME: Andreini & Company PHONE FAX (A/C, No. Extl: 650-573-1111 1 (A/C No): 650-378-4361 AIL AoDRESS' INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Evanston Insurance Co 35378 INSURED RANAC-2 Rana Creek Habitat Restoration 27875 Berwick Drive Ste. A Carmel CA 93923 INSURER B : United Financial Casualty Co. 11770 INSURER C : Lloyd's of London ensation Ins Fund 35076 INSURER D : State Compensation + - _--------- -- ---- --- ----_ ----- .--- ------------ --- - -- -------------- INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 1117684497 REVISION NUMBER: THIS INDICATED. CERTIFICATE EXCLUSIONS INSR LTR IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED ADDLISUBR — _— TYPE OF INSURANCE I INSD WVD POLICY NUMBER ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, BY PAID CLAIMS. POLICY EFF Y POLICY EXP (MMIDD/YYYY) i (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY OCCUR Y MKLV5ENV103146 7/29/2022 i 7/29/2023 F EACH OCCURRENCE $ 1,000.000 CLAIMS -MADE X ,X DAMAGE TO RENTED PREMISES (-Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ' i I LOC GENERAL AGGREGATE $ 2,000,000 f PRO- X I POLICY 1 I JECT ; PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: $ B AUTOMOBILE LIABILITY ANY AUTO -OWNED ONLY 01261735-5 5/4/2022 11/4/2022 j 1 COMBINED (Ea BODILY SINGLE LIMIT accident) $ 1,000,000 INJURY (Per person) $ OWNED 'AUTOS ONLY IAUTSCHEDOSULED BODILY INJURY (Per accident) $ HIRED AUTOS ONLY I NON AUTOS PROPERTY DAMAGE (Per accident) $ $ • A : UMBRELLA LIAB 1 X OCCUR CLAIMS -MADE MKLV5EFX100804 7/29/2022 7/29/2023 EACH OCCURRENCE $5,000,000 X , EXCESS LIAB I AGGREGATE $ 5,000,000 I DED I i RETENTION $ Products/Completed Op $ 5,000,000 D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR!PARTNER!EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS Y!N N / A 930751222 6/1/2022 6/1/2023 X STATUTE EORH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 below i E.L. DISEASE - POLICY LIMIT $ 1,000,000 C Professional Liability ANE160767521 7/29/2021 ' 7/29/2022 EACH CLAIM LIMIT I AGGREGATE 1,000,000 1.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS! VEHICLES (ACORD 101, Additional Remarks Schedule, may bP Contractors Pollution Liability: Evanston Insurance Co. Policy Number MKLV5ENV1031 Limits: Shared General Aggregate Limit $2,000,000 1 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... AtIerhed II mnre snare la rare Irr rn 9/2023 11V ?Iprr (: tt�SLL�� 0 3 2022 CLERK'S OFFICE AUG GILROY CITY CERTIFICATE HOLDER CANCELLATION I City of Gilroy, its officers, officials and employees 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. AUTHQ, IZED REPRESENTATIVE .T �r -- ,-- ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 2 of 5 2636 AGENCY CUSTOMER ID: RANAC-2 LOC #: ACt ADDITIONAL REMARKS SCHEDULE Page t of t AGENCY Andreini & Company -San Mateo POLICY NUMBER CARRIER NAIC CODE NAMED INSURED Rana Creek Habitat Restoration 27875 Berwick Drive Ste. A Carmel CA 93923 EFFECTIVE DATE: ADDITIONAL REMARKS 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 3 of 5 2636 POLICY NUMBER: MKLV5ENV103146 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies nsurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Location And Description Of Completed Opera - tlons Required by written contrAct Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, bul only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" 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'. CG20370704 ISO Properties, Inc., 2004 Page 1 of 1 D 4 of 5 2636 IOLPCY NUMBER: MKLV5ENV103146 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLUCY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This encorsement modifies insurance provided under the following: COMIVERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Nave Of Additional Insured Person(s) Or Organization( : Location(e) Of Covered Operations Required by wrillan contract Information reeuiretf to complete this Schedule, if not shown above, wilt be shown in the Declarations, A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organizations) shown in the Schedule, but only with respect to liability for "bodily injury", ""property damage" or "personal and advertising injury" caused, in whole or iar part, by: 1. Your acts or omissions; or 2. The acts or ornissians of those acting on your behalf, in the performance of your ongoing operations for the additional insured(s) at the location(s) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the foaming .additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage' occurring after: 1. All work, including materials, parts or equip- ment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed, or 2. That portion of "your wont" 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 ar subcontractor engaged In performing operations for a princi- pal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc.. 2004 Page 1 of 1 0 5 of 5 2636