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HomeMy WebLinkAboutCOI - CableCom LLC - Expires 2024-01-311 ® ACORO CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDlYYYY) 01/27/2023 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 "'Marsh USA, Inc. Two Alliance Center 3560 Lenox Road, Suite 2400 Atlanta, GA 30326 CN102986923--GAWU-23-24 CONTACT P PHHON: ONE FAX INC o. ExtJ (A/C, No): EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : Liberty Mutual Fire Insurance Company 23035 INSURED CableCom LLC 19910 North Creek Parkway North, Suite 100 Bothell, WA 98011 INSURER B : LM Insurance Corporation 33600 INSURER C : Liberty Surplus Insurance Corp 10725 INSURER D : Liberty Insurance Corporation 42404 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: ATL-005415663-05 REVISION NUMBER: 2 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 TB2-631-510625-233 01/31/2023 01/31/2024 EACH OCCURRENCE $ 5,000,000 DAMAGE PREMISESO(Ea occurrence) S 1,000,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ 5,000,000 GENERAL AGGREGATE $ 10,000,000 GEN'L AGGREGATE X LIMIT APPLIES JET PER: LOC PRODUCTS - COMP/OP AGG $ 10,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO OWNED x SCHEDULED AUTOS NON -OWNED AUTOS ONLY AS2-631-004260-023 01/31/2023 01/31/2024 COMBINED SINGLE LIMIT (Ea accident) $ 5,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE RFE-631-510733-143 01/31/2023 01/31/2024 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ DED RETENTION $ B B D WORKERS COMPENSATION EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNER/EXECUTIVE (MandOFFICER/MEMBERrrinNEXCLUDED7 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below YIN N NIA WA5-63D-004260-033 (AOS) WC5-631-004260-043(MN,WI) y,/A7-63D-510689-513 MA ( ) 01/31/2023 01/31/2023 01/31/2023 01/31/2024 01/31/2024 01/31/2024 X PER STATUTE OTH- ER ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,00C DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Gilroy is/are included as additional insured where required by written contract wilt respect to general liability and auto liability. Waiver of subrogation is applicable where required by written contract and subject to policy terms and conditions. CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna St. Gilroy, CA 95020 FEB - 9 2023 GILROY CITY CLERK'S OFFICE 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 'zali ?1.5",44 47ctc. © 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 6 r) 0