Loading...
HomeMy WebLinkAboutCOI - Crane Pest Control - Expires 2022-01-01,ace CERTIFICATE OF LIABILITY INSURANCE Page 1 of 2 DATE IMMJDDYYYY) 12/23/2020 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, If SUBROGATION IS WAIVED, subject to the terms and conditions this certificate does not confer rights to the certificate holder in lieu the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. of the policy, certain policies may require an endorsement. A statement on of such endorsement(s). PRODUCER Willis insurance Services of Georgia, Inc. Five Concourse Corporate Center, 18th Floor Atlanta, GA 30328 INSURED Crane Pest Control 2700 Geary Blvd San Francisco, CA 94118 CONTACT Willis Towers Watson Certificate Center NAME: A C. No Ext): 1-877-945-7378 FAX Na)_ 1-888-467-2378 E-MAIL ADDRESS: certificates@willis.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Old Republic Insurance Company 24147 INSURER B: ACE Property & Casualty Insurance Company 20699 INSURER C : AIU Insurance Company 19399 INSURER D : National Union Fire Insurance Company of P INSURER E : 19445 INSURER F : COVERAGES CERTIFICATE NUMBER: W19479093 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDLSUBR. POLICY EFF ' POLICY EXP JNSD WVD POLICY NUMBER (MMiDD'YYYY) (MM,DD'YYYY) NAMED ABOVE FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS. '' - - LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 3,000,000 CLAIMS -MADE I X I OCCUR DAMAGE TO RENTED 3,000,000 PREMISES (Eaocu{rrencp)- A X Pesticide/Herbicide Coverage MED EXP (Any one person) I $ 10, 000 X Peat Control Professional Y Y MWZY 312034-21 01/01/2021 '. 01/01/2022 PERSONAL & ADV INJURY I $ 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 3,000,000 POLICY I X jE 9 X ' LOC PRODUCTS - COMP/OP AGG , $ 3,000,000 OTHER: $ AUTOMOBILE LIABILITY _-_ COMBINED SINGLE LIMIT (Ea accident) $ 2,000,000 )( ANY AUTO BODILY INJURY (Per person) $ A X OWNED � II SCHEDULED AUTOS ONLY I AUTOS MWTB 312033-21 01/01/2021,01/01/2022 BODILY INJURY (Per accidenq,,S X HIRED X AUTOS ONLY NON -OWNED AUTOS ONLY PROPERTY DAMAGE $ (Per accident) I $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 5,000,000 EXCESSLIAB 'iCLA1MS-MADE XEU G27927683 006 01/01/2021 01/01/2022 AGGREGATE g 5,000,000 DED X RETENTIONS $0, 000 ' $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y N X SPERTUTE I 1 ERH TA E.L. EACH ACCIDENT , $ 2,000,000 C ANYPROPRIETOR,PARTNER,EXECUTIVE OFFICER'MEMBEREXCLUDED? (Mandatory In NH) No N/A WC 058240125 01/01/2021 01/01/2022 -_--- - ---- E.L. DISEASE • EA EMPLOYEE! $ 2,000, 000 II yes, describe under DESCRIPTION OF OPERATIONS be:ow E.L. DISEASE • POLICY LIMIT 1 $ 2, 000, 000 D Excess,Workers Comp XWC 1647238 01/01/2021 01/01/2022 E.L. Each Accident 152,000,000 E.L. Disease -EA Emp $2,000,000 E.L. Disease- Pol Lim $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS ' VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is requiredh //jj/� / Service Location: Pigeon Exclusion: 340 West 6th Street, Gilroy, CA 95020 (,r:jl i`6r(f (712ki C'c-''/ City of Gilroy, its officers, officials, employees and volunteers are included as Additional Insureds arespects to General Liability but solely in regards to work performed by or on behalf of the Named Insured. General Liability policy shall be Primary and Non -Contributory with any other insurance in force for or which may be CERTIFICATE HOLDER CANCELLATION City of Gilroy Attn: Dan Johnson 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. AUTHORIZED REPRESENTATIVE © 1988-2016 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 20505611 BATCH: 1926110 ACORD 25 (2016/03) 2 of 4 40708 AGENCY CUSTOMER ID: LOC #: ACCORD® ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Willis Insurance Services of Georgia, Inc. POLICY NUMBER See Page 1 CARRIER See Page 1 NAIC CODE See Page 1 NAMED INSURED Crane Peat Control 2700 Geary Blvd San Francisco, CA 94118 EFFECTIVE DATE: See Page 1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER- 25 FORM TITLE: Certificate of Liability Insurance purchased by Additional Insureds. Waiver of Subrogation applies in favor of Additional Insureds with respects to General Liability. ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 20505611 BATCH: 1926110 CERT: W19479093 Rollins, Inc. Policy Term: 1/1/2021 to 1/1/2022 Workers' Compensation and Employers Liability Policies Coverage Policy Number Work Comp/EL WC 058240125 Carrier AIU Insurance Co. - covers states of AL,AR,AZ,CO,CT,DC,DE,HI,IA,ID,IL.IN, KS,KY,LA,MD,ME,MI,MN,MO,MS,MT,NC, NE,NH,NJ, NM,NV,NY, OK, OR,PA, RI,SC, SD, TN,TX,UT,VA,VT,WV Work Comp/EL WC 058240123 AIU Insurance Company - covers state of CA Work Comp/EL WC 058240124 New Hampshire Ins. Co. - covers states of MA and WI - This policy also provides Stop Gap coverage for WA, WY Excess Work Comp/EL Excess Work Comp/EL XWC 1647238 XWC 1647239 National Union Fire Insurance Company of Pittsburgh, PA - coverage applies to the qualified self insured states: GA & OH National Union Fire Insurance Company of Pittsburgh, PA and coverage applies to the qualifed self insured state of FL WC Coverage Statutory Statutory Statutory Statutory Statutory EL Limits $2,000,000 Bodily Injury by Accident - Each Accident/$2 000,000 Each Employee Bodily Injury by Disease/$2.000,000 Policy Limit Bodily Injury by Disease $2,000,000 Bodily Injury by Accident - Each Accidentl$2 000,000 Each Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease $2,000,000 Bodily Injury by Accident - Each Accident/$2,000,000 Each Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease $2,000,000 Bodily Injury by Accident - Each Accident/$2,000,000 Each Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease $2,000,000 Bodily Injury by Accident - Each Accident/$2,000,000 Each Employee Bodily Injury by Disease/$2,000,000 Policy Limit Bodily Injury by Disease 3 of 4 40708 POLICY NUMBER: MWZY 312034-21 COMMERCIAL GENERAL LIABILITY CG20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations as required by written contract as required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG20101219 B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment 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 work' out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. © Insurance Services Office, Inc., 2018 Page 1 of 2 MWZY 312034-21 Rollins, Inc. 01/01/2021 - 01/01/2022 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG 20 1012 19 MWZY 312034-21 Rollins, Inc. 01/01/2021 - 01/01/2022 4 of 4 40708 r POLICY NUMBER: MWZY 312034-21 COMMERCIAL GENERAL LIABILITY CG20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations as required by written contract as required by written contract Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but 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". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG20371219 B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever is Tess. This endorsement shall not increase the applicable limits of insurance. © Insurance Services Office, Inc., 2018 Page 1 of 1 MWZY 312034-21 Rollins, Inc. 01/01/2021 - 01/01/2022