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HomeMy WebLinkAboutCOI - First Alarm - Expires 2023-07-01SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 3/14/2023 InterWest Insurance Serv.,LLC License #0B01094 330 Tres Pinos Road Suite A-1 Hollister CA 95023 Lori Wagner 916-609-8457 916-979-7992 lwagner@iwins.com License#:0B01094 Philadelphia Ind.Ins.Co.18058 Arch Insurance Company 11150FirstAlarm 1111 Estates Drive Aptos CA 95003 1414310712 A X 1,000,000 X 1,000,000 X BFPD,XCU 20,000 X E&O 1,000,000 2,000,000 X Y Y PHPK2425290 7/1/2022 7/1/2023 2,000,000 A 1,000,000 X X X Y Y PHPK2425290 7/1/2022 7/1/2023 A X X 10,000,000PHUB8185457/1/2022 7/1/2023 10,000,000 X 10,000 B X N Y ZAWCI9415705 4/1/2022 4/1/2023 1,000,000 1,000,000 1,000,000 Certificate holder as additional insured respects liability only when required by written contract or agreement per the attached policy forms. City of Gilroy,its officers,officials and employes 7351 Rosanna Street Gilroy,CA 95020 THIS CERTIFICATE SUPERSEDES PREVIOUSLY ISSUED CERTIFICATE DocuSign Envelope ID: 94741DE0-42A2-4634-B7D0-74A3C0C779F1DocuSign Envelope ID: 27D86E79-44FD-4870-B9E6-E2E840C0C8E9 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 Blanket Additional Insured As required by written contract As Required by Contract Information required to complete this Schedule,if not shown above ,will be shown in the Declarations. 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. 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. ©Insurance Services Office ,Inc.,2012CG20100413 Page 1 of 2 POLICY NUMBER : PHPK2425290 DocuSign Envelope ID: 94741DE0-42A2-4634-B7D0-74A3C0C779F1DocuSign Envelope ID: 27D86E79-44FD-4870-B9E6-E2E840C0C8E9 DocuSign Envelope ID: 94741DE0-42A2-4634-B7D0-74A3C0C779F1DocuSign Envelope ID: 27D86E79-44FD-4870-B9E6-E2E840C0C8E9 PI-GL-005 (07/12) Page of Includes copyrighted material of Insurance Services Office, Inc., with its permission. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED PRIMARY AND NON-CONTRIBUTORY INSURANCE This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Effective Date: Name of Person or Organization (Additional Insured): SECTION II – WHO IS AN INSURED is amended to include as an additional insured the person(s) or organization(s) shown in the endorsement Schedule, but only with respect to liability for “bodily injury,” “property damage” or “personal and advertising injury” arising out of or relating to your negligence in the performance of “your work” for such person(s) or organization(s) that occurs on or after the effective date shown in the endorsement Schedule. This insurance is primary to and non-contributory with any other insurance maintained by the person or organization (Additional Insured), except for loss resulting from the sole negligence of that person or organization. This condition applies even if other valid and collectible insurance is available to the Additional Insured for a loss or ”occurrence” we cover for this Additional Insured. The Additional Insured’s limits of insurance do not increase our limits of insurance, as described in SECTION III – LIMITS OF INSURANCE. All other terms, conditions, and exclusions under the policy are applicable to this endorsement and remain unchanged. Blanket when required by written contract prior to loss. 07/01/2022 2 2 DocuSign Envelope ID: 94741DE0-42A2-4634-B7D0-74A3C0C779F1DocuSign Envelope ID: 27D86E79-44FD-4870-B9E6-E2E840C0C8E9 PHPK2425290 DocuSign Envelope ID: 94741DE0-42A2-4634-B7D0-74A3C0C779F1DocuSign Envelope ID: 27D86E79-44FD-4870-B9E6-E2E840C0C8E9 PHPK2425290 07/01/2022 DocuSign Envelope ID: 94741DE0-42A2-4634-B7D0-74A3C0C779F1DocuSign Envelope ID: 27D86E79-44FD-4870-B9E6-E2E840C0C8E9 PHPK2425290 DocuSign Envelope ID: 94741DE0-42A2-4634-B7D0-74A3C0C779F1DocuSign Envelope ID: 27D86E79-44FD-4870-B9E6-E2E840C0C8E9 Insured Premium $ Insurance Company Countersigned By ARCH INSURANCE COMPANY INCL.FIRST ALARM 1998 by the Workers’ Compensation Insurance Rating Bureau of California. All rights reserved. From the WCIRB’s California Workers’ Compensation I 1999.nsurance Forms Manual WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURA WC 04 03 06NCE POLICY (Ed. 04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT - CALIFORNIA We have the right to recover our payments from anyone liable for an injury covered by this policy. We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. The additional premium for this endorsement shall be % of the California workers’ compensation premium otherwise due on such remuneration. SCHEDULE PERSON OR ORGANIZATION JOB DESCRIPTION ANY PERSON OR ORGANIZATION WHERE INCL ALL JOBS UNDER CONTRACT WAIVER OF OUR RIGHT TO RECOVER IS PERMITTED BY LAW AND IS REQUIRED BY WRITTEN CONTRACT PROVIDED SUCH CONTRACT WAS EXECUTED PRIOR TO DATE OF LOSS This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective 04-01-22 Policy No. ZAWCI9415705 Endorsement No. DocuSign Envelope ID: 94741DE0-42A2-4634-B7D0-74A3C0C779F1DocuSign Envelope ID: 27D86E79-44FD-4870-B9E6-E2E840C0C8E9