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HomeMy WebLinkAboutCOI - PC, Inc. - Expires 2023-07-02Gallagher does not share your e-mail as detailed in our privacy policy found at htt z 0 3 \ \ n \ Sff e 9 9 9 / c - eemn 0_D2 /§ CD J o 9 §ƒ / co J,/\ƒ\/ / / 0)O : /\/ g•la) O ~ ® 0 % nO & & 7 o 6 z 7 ƒ z z \% /§kk f/J / eJ${ 555. / 3 ID- / / \ § / / § / 2 / e - ® ° = *® ®�\\ °-n \ / $(n ^2 2 ^ 0)J\/ a-4 0/ f k/ k 37 / \\°?o ./J°8o =- j o ° 0.)S CO o' =n3 3 / _ / / § \ °j/ c ¢ ƒ j / / 2 J -.- - o a CD 0 CD )\/ o \ E » 5. § 2 6 ° 3 8 = \ \ ƒ /G/ o/� CL °»-, -0 2 \ -C- C \ % $ E ao 0 z. / 5' 3 x 05- © / /• �m CDe� 3- f® gE CD 0 - § / / 7 e-0 CD 7. n CD $. s n / / / o = -h / @ \ / \ / \ / Co CO \ CA x §. 6 2 We are providing you with a Certificate of Insurance confirming our client's coverage. 301330 SiNN313 A110 AOW119 n • a • E IV CD 1.1769-0Z0g6 VO `J.O2:I-1I0 IS VNNVSOH 1.9EL HgOVNVW NSl2I 1N11d (co/9 1 oa) sa auoov The ACORD name and logo are registered marks of ACORD ©1988-2015 ACORD CORPORATION. All rights reserved. 0 m --I n m 2 0 r D m JD cn o m 0 0 c zmr p"0p 0 1. m-40 Om ,z� x m m03 m0 r 1M 0mm 31 xi O0m zp 00N-0 zNmC mn Fm rm CO mD z pm m p mv 03 m 'm 0 zm 0 z n m r r 0 z DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is rep' Re: City Hall Backup Generator, Project No. 21-PW-268. City of Gilroy, its elected and appointed officers, officis additional insured as respects General Liability & Auto Liability per attached forms CG 20 10 12 19, CG 20 37 1 and non-contributory per forms CG 20 01 12 19 & AC 70 04 03 16 attached. Waiver of Subrogation applies to V 10217 REV. 7-2014. Subject to policy terms and conditions. Revised Cancellation Provisions attached. m o w C1 D o rZ -Irn 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. Professional/Pollution Liab Equipment Floater WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? (Mandatory in NH) II yes, describe under DESCRIPTION OF OPERATIONS below X X X c X m X TYPE OF INSURANCE DED RETENTION $ UMBRELLA LIAB EXCESS LIAR OWNED AUTOS ONLY HIRED X AUTOS ONLY COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X SCHEDULED AUTOS — NON -OWNED AUTOS ONLY OCCUR CLAIMS -MADE Z { { n cn a { N C W o3, PEC005460303 2819631 901475522 c-0 N CDN O 0 Co ACP3048452853 0 NJ 0 CD 0ni O0 POLICY NUMBER 7/2/2022 9/10/2021 `v O N 7/2/2022 CID 0 NIO J NJ POLICY EFF (MM/DD/YYYY) 7/2/2023 9/10/2022 N 0 CONJ 7/2/2023 � N 0 0 N J N 0 NJ co POLICY EXP IMM/DD/YYYY) 7' cop, m(DcD Q CD W 0II 3 -n -j0_ 11W O,K 3 Each Occurrence Rented/Leased E.L. DISEASE - POLICY LIMIT E.L. DISEASE -EA EMPLOYEE E.L. EACH ACCIDENT v • STATUTE I EERH AGGREGATE EACH OCCURRENCE PROPERTY DAMAGE (Per accident)_________ BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT (Ea accident) PRODUCTS - COMP/OP AGG EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL & ADV INJURY GENERAL AGGREGATE I- C cn $3,000,000 $250,000 o 0 0 o 0 0 0 0 0 0 0 0 0 0 0 $ 5,000,000 CM 0 0 0 0 0 $ 1,000,000 N 0 0 0 0 0 $ 1.000.090 $ 2,000,000 $100,000 $ 5,000 -a. o 0 0 O 0 0 m 17 T n m z C W m o3.3 N 07 N v 0) N 37 m O z z 07 m INSURED PCINCDC-01 PC, Inc. Attn: Mark Crisp P.O. Box 2116 Nipomo CA 93444-2116 PRODUCER Arthur J. Gallagher & Co. Insurance Brokers of CA, Inc. LIC #0726293 500 North Santa Fe Visalia CA 93292 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). 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. ACCPRL CERTIFICATE OF LIABILITY INSURA INSURER F: 2 co 0 z a m 0 CD 0 5 0 INSURERD: Indian Harbor Insurance Company INSURER C : Capitol Special Insurance Corporation INSURER B : State Compensation Insurance Fund of CA INSURERA: Nationwide Mutual Insurance Company INSURER(S) AFFORDING COVERAGE E-MAIL ADDRESS: ggb.visalia-2.dons team@ajg.com PHONE /C. No. . Extl: 559-635-3574 I (A/C, No): CONTACT _ NAME: Lexie Huereca 0) CI co 0 0 0) m DATE (MM/DD/YYYY) 7/26/2022 NJ 36940 35076 23787 z N co 0 co D N w # 64 Z4 LE OZ 93 © Insurance Services Office, Inc., 2018 IV_ 3�-*o�cn o ,+ o (D <� en 0 7 '+ (Q o m <co CD IV O (D (D Ort = (D CD = Q. 0 Q Q O0 SD_0 p U) — o yam o f �O 0 c o s ^w 0Pv 1 CT (D a (D = "'1 0 -, 3 rt v= CO 0 0 v CD ,-+ (Q 0 0_ 7' • 7• rt' m -0 (D o '"" (D_ _" Q 0 v o -a 3 sv (ns —0 o w ID <ao (D CD.m -o Q°m Da s'. _ Q0 _ Q cn (o rn _C - rr? rt0'''p '�� N O �O (D �.N 70 -, Ql N 0 rt O (D Q= - o a +_ a) m= C h S Q O cn v -h =- m 7.rt CD 7 p 0 (D ▪ (D 5 Ortn O N c a a 7- v -,, 0 o0a0, -, av, om o o�•�o rna Q rt O =+ o w Q a-, 0... Q (D �. (CD n = co CD co 3 o D- _ _ _ CD CAD m=v3 v No_Q rt 5 Cl) 3< N 3 L% a)7 N (D -o C. a o = Cl) 0 5 0 fl- n 0 O- IV '2 C _ + rn - N ED O CL oiDo(u�n Cr�� Q?Q�-9��o •ssal si aanallolNM a CD S (D 0 -+, 1. Required by the contract or agreement; or a) *.m �, _n0 o a 0 • 3 eL � 0 a(0 ui • Cr N p 7• - 0 p ID a) 0 < 0 • = a CD 0 3 CD p N O v a) 5-- 0_ (.0 CD a-' _r N 0 3 a ✓ rn — = 3 = r+ a) c = �03. a3() _ o -' Ul W co. Q (D co (D 31f1Q3H3S l01 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. £OLIZOOZOZ,LD e138Wf1N ).3IIOd 64Z4040Z00 g l,0Z aul `ao!J4O sao!Aaag aoueJnsul O ? I a 9 5• �_ o a f o 5'@ e m m_ ./ m a d e■ $ E. ƒ CT) 0 CD § k -. 0 fa.-0 /^ 3\ \jM /$3F§- m\-== G o\ r/$ 0 J m I / \ 7 9 o o °— < R o o CD\ &®K = 5m e2G0SJk° 2& \/so—§Ew _-<o_ ¥ x a. 0 _ D)e &o ==k a5®= ® » & - 5.— «o m=e7�= R feon=w \' o_ »c ° <5.n=_. n-0 \ \\ /\ED e.- ] 0k 0 ©ems§? & o = 13 C 0_ ]/ * \• D0 \ �/ ( ��QE r » = 3 . 5- i � 5 5. @ ea° <a -• & q•= 3 ; ' < m i _. ^�00O-w O�/ o ee = _C ee ee mx =« ,<cw \»0aW< \( 0. O (D -O 2 \ R§ 7Q (no 0 St ai0 o a -o 0 CD / 0- e »�&c n& 2 o= m a x =--c=$ 2m \=f\96 &§ • (0 J 3'm = -0 = 2 n = n ° CDe7"£]_ j E 7\5.\y ai \ = m CD_. c a ce f)\\\ <_ 31f103HOS COMMERCIAL GENERAL LIABILITY COVERAGE PART This endorsement modifies insurance provided under the following: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. £OLIZOOZOZ.LD :2�38Wf1N I.CIIOd © Insurance Services Office, Inc., 2018 61,Z6040ZOD Ca N a�/\\/ /.± « k - § ® § ® / \ 8 W E = eon = m ] \ _ ° = m 5' @.o - O. 1 ci_ &/\�5' @§/$ =e=mo0 *__± 3/c3° \ \\ly 0/\\CD Q\�±:t- \%/3/s_ m = o °° -0 m - e 0 2 - - ° m= 0_ '5 _ ° _ . 3 o m - \ \\\^j'ao$ \/ e a - _ = o \//§$E \\\.0).���� in »j R® ¥.� -,eL-7 = 2.� 9@ °s#e7< e& �= / °J = e CO m o e = = nos\_ \]°0§0., /% 7°�\% °JCD CD _� o �e n_.2 EE /j9\/» &/2_&® o ƒ/ *@o§\ /a\/§� -. 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PLEASE READ IT CAREFULLY. £OLIZOOZOZ,LD :2IatI,ITIN KII'IOd £S8ZSt+8V0£d3V AdO3 032IfSNl 91.EOtOOL0V r!--=0?imp0P c-i m x k x- 0 a m 3 m N m 0) N '' _ca 1° -3"Cla 0 D Q = (0 0 0 Z. p 0 a am a) y� co O N O0 CD y O C ci2 N o 5 C N N =- I N 7. N i (D = � a N o w O (0 LU -z a N tom!) 0 C 6 Q m er C E N Y o rt Qar 0 0 ET 8C X co CD m Z y o N (D • CD < co 0 = I a N o 0 m 0 00 3 0 �. cn co =' CD = CuN 0 c F z O m jp o N O_ co T. O = co 0 = o = N — co O cD ( 0. (D Ca CD 0 O 0 luewesaopu3 sRij 1oeJ3 'V S3DVHRAO0 dO Aavvvins BUSINESS AUTO COVERAGE FORM This endorsement modifies insurance provided under the following: C C U} cn 0 m c) 0 z I /C V THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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