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HomeMy WebLinkAboutCOI - SSI Express Transport, Inc. - Expires 2024-02-11ACORO® `� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 02/07/2023 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 KGIB, INC. KNOX GENERAL INSURANCE BROKERS 226 SOUTH GLASSELL STREET ORANGE CA 92866 CONTNAME: Carol Carol Knox, Monica Avelar or Kory Butler A/° No, Ext): (714) 744-3300 FAX (A/C,No): (714) 744-6537 E-MAIL Ko ry@kgibinc.com larok Ibinc.com, Monica k nc.com, ADDRESS: C@ g g INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: EMPLOYERS MUTUAL CASUALTY COMPANY 21415 INSURED SSI EXPRESS TRANSPORT INC. SSI EXPRESS INC. 150 S. LARCH AVENUE RIALTO CA 92376-9003 INSURER B: HARCO NATIONAL INSURANCE COMPANY 26433 INSURER C: CRUM & FORSTER SPECIALTY INSURANCE CO 44520 INSURER D : BERKLEY NATIONAL INSURANCE COMPANY 38911 INSURERE: INSURER F : COVERAGES CERTIFICATE NUMBER: 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. INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY 2D1 8813 02/11/2023 02/11/2024 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 500,000 MED EXP (Any one person) $ 10,000 PERSONAL&ADVINJURY $ 1,000,000 GENII_ AGGREGATE X LIMIT APPLIES PRO - PER: LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE XHIRED LIABILITY ANY AUTO AWNED I� eN X SCHEDULED NON -OWNED AUTOS ONLY X RFL0000508-01 02/11/2023 02/11/2024(Per BIaacciNdeEDnt) SINGLE LIMIT (E $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY ident accident) ) $ PROPERTY DAMAGE (Per accident) $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE SE0122498 02/11/2023 02/11/2024 EACH OCCURRENCE $ 2,000,000 AGGREGATE $ 2,000,000 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E yes, describe under DESCRIPTION OF OPERATIONS below Y / N N / A —N/A-- PER STATUTE OTH- ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ D MOTOR TRUCK CARGO M1M1048491-51 02/11/2023 02/11/2024 $1,000,000 LIMIT $5,000 DEDUCTIBLE DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is requi ed) RE: ROAD PERMIT CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED PER FORM CA 2048 10 13 WITH RESPECT TO AUTO LIABILITY. CERTIFICATE HOLDER CANCELLATION CITY OF GILROY 7351 ROSANNA S GILROY R @MIOWC, ( •5020— SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. FEB 1 4 2023 "EET GILROY CITY CLERK'S OFFICE AUTHORIZED REPRESENTATIVE —� CA ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: RFL 0000508 01 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is in- dicated below. Named Insured: SSI EXPRESS TRANSPORT INC Endorsement Effective Date: 2/11/2023 SCHEDULE Name Of Person(s) Or Organization(s): Any person or organization is an additional insured solely with respect to bodily injury or property damage caused by an accident arising out of the ownership, maintenance or use of a covered auto provided you have agreed to add the person or organization as an additional insured pursuant to an express provision in a written insured contract or other written agreement or in a permit issued to you by a governmental or public authority, and your operations under the insured contract or written agreement or the permit take place after you executed the insured contract or written agreement or the permit has been issued to you —and then only to the limited extent and for no higher limits of insurance than required in such insured contract, other written agreement or permit. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Cover- age, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section I — Covered Autos Coveragesof the Auto Dealers Coverage Form. CA 20 48 10 13 © Insurance Services Office, Inc., 2011 Page 1 of nIn