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HomeMy WebLinkAboutCOI - R and M Transport Inc - Expires 2023-12-09ALA o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDYYY) /Y 12/08/2022 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 po icy, 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 James G. Parker Insurance License #0554959 P 0 Box 3947 Fresno CA 93650 CONTACT Nichole Fisher CISR NAME: (A//CNN o Ext): (559) 222-7722 �A Ne); (559) 222-1724 E-MAIL nfisher©jgparker.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC P INSURER A: Crum & Forster Specialty Ins 44520 INSURED R and M Transport Inc 7780 Holsclaw Rd Gilroy CA 95020 INSURER 8 : Oregon Mutual Ins Co 14907 INSURER c : Navigators Specialty Insurance Co 36056 INSURER D : INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 22-23 GL BA IM UM R&M 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 POLIC ES 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 AUUL'SUHR INSD WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY Y GL0092617 12/09/2022 12/09/2023 EACH OCCURRENCEDAMAGE S 1,000,000 CLAIMS -MADE X OCCUR TO RENTED PREMISES (Ea occurrence) S 50,000 MED EXP (Any one person) S Excluded PERSONAL 8 ADV INJURY S 1'000'000 GEM_ AGGREGATE X LIMIT APPLIES PRO JECT PER: LOC GENERAL AGGREGATE S 2'000'000 PRODUCTS - COMP/OPAGG 2'000'000 $ Designated Const. S 2,000,000 B AUTOMOBILE X —J X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY X SCHEDULED AUTOS NON -OWNED AUTOS ONLY CM05011923559 12/09/2022 12/09/2023 COMSMIED SINGLE LIMIT (Ea accident) S 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE (Per accident) S C X UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE SE22EXC8280091C 12/09/2022 12/09/2023 EACH OCCURRENCE $ 4'000'000 AGGREGATE 5 4,000,000 $ DED RETENTION S WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER STATUTE OTH- ER E.L. EACH ACCIDENT S E.L. DISEASE - EA EMPLOYEE S E.L. DISEASE - POLICY LIMIT S B Contractors Equipment Rented/Leased Equipment Equipment CM05011923559 12/09/2022 12/09/2023 $1,000 Deductible $1,000 Deductible $200,000 Per Schedule DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Re: Transportation Permit. City of Gilroy and its officers, employees, and agents are named as additional insured as per form CG2010 1219 attached. aEgiEDWIMID nwr 1 n 2n9' CERTIFICATE HOLDER CANCELLATION IGILROY CITY CLERK'S OFFICE I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gilroy Finance Department 7351 Rosanna St Gilroy CA 95020 AUTHORIZED REPRESENTATIVE dA::4•")24 �hV ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GL0092617 COMMERCIAL GENERAL LIABILITY CG 20 10 1219 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 Any person or organization you have agreed in a written contract to add as an additional insured on your policy provided the written contract is signed prior to the "bodily injury", "property damage" or "personal and advertising injury" Locations and operations covered under this policy when required by written contract signed prior to the "bodily injury", "property damage" or "personal and advertising injury" 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. 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. 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: CG20101219 © Insurance Services Office, Inc., 2018 Page 1 of 2 0 L 5 E .' fa 0 as as 8,U a.. U O- ca � ' (I) 0 a▪ ) a) - '0 C -0 ili • a) 0 N as as = L a) ▪ > u) tY < .0 ▪ N whichever is less. a) u) ca 2 U O C aj C.) C — 2 co .0 Cl)0 co C C o a) u) a)E O 0 C . 3 N co .a I. co N 9- 0 N O O) RS 0 © Insurance Services Office, Inc., 2018 CG 20 10 12 19