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HomeMy WebLinkAboutCOI - Cornerstone Environmental Contractors, Inc. - Expires 2021-03-29,4� o® CERTIFICATE OF LIABILITY INSURANCE DATE032/DOD/2YYYY) 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 Aon Risk Services, Inc. of Hawaii 201 Merchant Street Suite 2400 Honolulu HI 96813 USA CONTACT NAME: PHONE (808) 533-4900 FAX (808) 540-4301 (A/C. No. Ext): (A/C. No.): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Cornerstone Environmental Contractors Inc. P.O. Box 5127 Concord CA 94524 USA INSURER A: Great Divide Insurance Co 25224 INSURER B: Nautilus Insurance company 17370 INSURERC: INSURERD: INSURER E: INSURER F: CERTIFICATE NUMBER: 570081128935 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDS INSD SUBFR WVD POLICY NUMBER POLICY EFF— (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS B X COMMERCIAL GENERAL LIABILITY Y ECP2028687-11 This insurance is issued pursuant to the Section 1760 through 1780, and is placed not holding a Certificate of Authority from California Insurance Commissioner. 03/29/2020 California Insurance in an insure- or regulated 03/29/2021 Code or insurers by the EACH OCCURRENCE $1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $100, 000 MED EXP (Any one person) $5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L X AGGREGATE POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC GENERAL AGGREGATE S2,000,000 PRODUCTS - COMP/OPAGG S2,000,000 BI/PD Deductible S5,000 A AUTOMOBILE X LIABILITY ANY AUTO OWNED _ S SCHEDULED BAP2028683-11 03/29/2020 03/29/2021 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 OCCUR CLAIMS -MADE FFX2028688-11 03/29/2020 03/29/2021 EACH OCCURRENCE $5,000,000 AGGREGATE $5,000,000 X DED !RETENTION A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) II yes, describe under DESCRIPTION OF OPERATIONS below Y / N N N / A wCA2028685-11 03/29/2020 03/29/2021 x PER STATUTE OTH- ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 E.L. DISEASE -POLICY LIMIT $1,000,000 B Env Contr Poll ECP2028687-11 03/29/2020 03/29/2021 Contr Pollution Agg Each Pollution Cond• Ded Each Pollution I $2,000,000 $1,000,000 $5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City of Gilroy, its officers, officials and employees is included as Additional Insured as required by written contract, but limited to the operations of the named insured under said contract with respect to the General Liability policy. Thirty (30) days written notice applies. CERTIFICATE HOLDER CANCELLATION City of Gilroy its officers, officials and employees 7351 Rosanna Street Gilroy CA 95020 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Holder Identifier : 570081128935 Certificate No AUTHORIZED REPRESENTATIVE C4.a.ti,la Na,,14u,.a72_, ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 570000078408 LOC #: ACORN® ADDITIONAL REMARKS SCHEDULE Page _ of _ AGENCY Aon Risk Services, Inc. of Hawaii POLICY NUMBER See Certificate Number: 570081128935 CARRIER See Certificate Number: 570081128935 NAIC CODE NAMED INSURED Cornerstone Envi ronmental Contractors EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFFECTIVE DATE (AIM/DO/MN) POLICY EXPIRATION DATE (MM/DD/YVYY) LIMITS OTHER B Env Contr Prof ECP2028687-11 03/29/2020 03/29/2021 Prof Li ab Agg regate $2,000,000 Prof Liab Each Claim $1,000,000 Ded Each Claim $10,000 ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved The ACORD name and logo are registered marks of ACORD