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HomeMy WebLinkAboutCOI - ACME Plumbing - Expires 2021-06-18A �� CERTIFICATE OF LIABILITY INSURANCE DATE02i oY1Y) 2 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 FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 OWATONNA, MN 55060 CONTACT NAME: CLIENT CONTACT CENTER PHONE FAX (A/C, No, Ext): 888-333-4949 (A/C No): 507-446-4664 E-MAIL ADDRESS: CLI ENTCONTACTCENTEROFEDI NS.COM INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 392-269-7 ACME PLUMBING, EDWARD MENDOZA PO BOX 6204 SALINAS, CA 93912-6204 INSURER B: INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 53 REVISION NUMBER: 1 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'SUBR 'INSR WVD POLICY NUMBER POLICY EFF (MM/DD/VYYY) POLICY EXP (MMIDD/YYYY) LIMITS A COMMERCIAL GENERAL LIABILITY OCCUR Y N 9087832 06/18/2020 06/18/2021 EACH OCCURRENCE $1,000,000 CLAIMS -MADE X DAMAGE TO RENTED PREMISES (Ea occurrence) $100,000 X GEN'L X BUSINESS OWNER'S LIABILITY MED EXP (My one person) PERSONAL & ADV INJURY $1,000,000 AGGREGATE LIMIT APPUES POLICY I I PRO- JECT OTHER: PER: LOC GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGO $2,000,000 A AUTOMOBILE X X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SEE BELOW - 4A X SCHEDULED N N 9087833 06/18/2020 06/18/2021 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 BODILY INJURY (Per person) BODILY INJURY (Per accident) PROPERTY DAMAGE (Per accident) A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE N N 6035414 06/18/2020 06/18/2021 EACH OCCURRENCE $3,000,000 AGGREGATE $3,000,000 DED l I RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below N N I A OTH- PER STATUTE ER E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may a attathed it more space is required) SYMBOL 4A: AUTOMOBILE LIABILITY INCLUDES OWNED AUTOS OTHER THAN PRIVATE PASSENGER AUTOS ONLY. CITY OF GILROY IS LISTED AS ADDITIONAL INSURED. CERTIFICATE HOLDER CANCELLATION 392-269-7 53 1 CITY OF GILROY 7351 ROSANNA ST GILROY, CA 95020-6141 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 FEDERATED INSURANCE COMPANIES THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: BUSINESSOWNERS LIABILITY COVERAGE FORM SCHEDULE State Or Governmental Agency or Subdivision or Political Subdivision: CITY OF GILROY 7351 ROSANNA ST GILROY CA 95020 The following is added to Paragraph C. Who Is An Insured: 4. Any state or governmental agency or subdivision or political subdivision shown in the Schedule is also an insured, subject to the following provisions: a. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. Insured: ACME PLUMBING *EDWARD MENDOZA DBA PO BOX 6204 SALINAS CA 93912 b. This insurance does not apply to: (1) "Bodily injury", "property damage", or "personal and advertising injury" arising out of operations performed for the state or municipality; or (2) "Bodily injury" or "property damage" included within the "products -completed operations hazard". Place of Issue: FEDERATED MUTUAL INSURANCE COMPANY Home Office 121 East Park Square Owatonna, MN 55060 (507) 455-5200 Includes copyrighted material of Insurance Services Office, Inc., with its permission. BP-F-254 (08-11) Policy Number: 9087832 Transaction Effective Date: 02-22-2021