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HomeMy WebLinkAboutCOI - Cornerstone Enviornmental Contractors, Inc. - Expires 2022-03-29A �® CERTIFICATE OF LIABILITY INSURANCE OATEO(32/D02/YYYY) 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 AOn Risk Services, Inc. of Hawaii 201 Merchant Street Suite 2400 Honolulu HI 96813 USA CONTACT NAME: (A/CNNo.Ext): (808) 533-4900 FAX No: (808) 540-4301 EMAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURED Cornerstone Environmental Contractors Inc. P.O. BOX 5127 Concord CA 94524 USA INSURER A: Nautilus Insurance Company 17370 INSURER B: Key Risk Insurance Company 10885 INSURER C: Great Divide Insurance Co 25224 INSURER D: INSURER E: INSURER F: 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. Limits shown are as requested INSR LTR TYPE OF INSURANCE ADDL INSD SUB WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP SSMM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Y ECP202868712 03/29/2021 03/29/2022 EACH OCCURRENCE S1,000,000 CLAIMS -MADE X OCCUR DAMAGE 1 O REN I ED PREMISES (Ea occurrence) $100 , 000 MED EXP (Any one person) S10,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO GENERAL AGGREGATE S2,000,000 - POLICY X JECT LOC PRODUCTS - COMP/OP AGG S2,000,000 OTHER: BI/PD Deductible S5,000 B AUTOMOBILE LIABILITY BAP202868312 03/29/2021 03/29/2022 COMBINED SINGLE LIMIT (Ea accident) S1,000,000 X ANY AUTO BODILY INJURY ( Per person) - OWNED SCHEDULED BODILY INJURY (Per accident) - X - AUTOS ONLYAUTOS HIRED AUTOS ONLY - _ NON -OWNED AUTOS ONLY PROPERTY DAMAGE (Per accident) A X UMBRELLA LIAB X OCCUR FFX202868812 03/29/2021 03/29/2022 EACH OCCURRENCE S5,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $ 5 , 000 , 000 X DED RETENTION C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N WCA202868512 03/29/2021 03/29/2022 x PER STATUTE OTH- ER ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED? N N / A E.L. EACH ACCIDENT S1,000,000 (Mandatory In NH) II yos, describe under E.L. DISEASE -EA EMPLOYEE 51,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT 51,000,000 A Env Contr Poll ECP202868712 03/29/2021 03/29/2022 Contr Pollution Agg Each Pollution Cond. Ded Each Pollution t $2,000,000 $1,000,000 $5,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space Is required) city of Gilroy, its officers, officials and employees is included as Additional Insured as required by written contract, but limited to the operations of the named insured under said contract with respect to the General Liability policy. Thirty (30) days written notice applies. CERTIFICATE HOLDER CANCELLATION City of Gilroy its officers, officials and employees 7351 Rosanna Street Gilroy CA 95020 USA 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 Holder Identifier : U ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. 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