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HomeMy WebLinkAboutCOI - Innovative Claim Solutions Inc - Expires 2021-12-10ACORD CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD,TYYY) 12/08/2020 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 Doug Jones do Artex Risk Solutions, Inc. 8840 E. Chaparral Rd.; Suite 275 Scottsdale, AZ 85250 INSURED Modern HR Inc Labor Contractor. for co -employees of: Innovative Claim Solutions Inc 7590 N Glenoaks Blvd Suite 200 Burbank, CA 91504 CONTACT NAME: PHONE (A/G,�. Ext): (480) 951-4177 FAX No): (480) 951-4266 E-MAIL SDL.BSD.Certificates@artexrisk.com ADDRESS: QR INSURERS) AFFORDING COVERAGE INSURER A : Zurich -American Insurance Company INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : NAIC 16535 COVERAGES CERTIFICATE NUMBER:20CA155861955 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 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 -ADDL MIFF LTR TYPE OF INSURANCE INSD WVD -- ' POUCY NUMBER POUCY EFF JMMIDD;YYYY) POLICY EXP (MMDDD1YYYY) LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR • GENT AGGREGATE LIMIT APPLIES PER I i EACH OCCURRENCE ! S i DAMAGSTO RENTED PREMISES (Ea occurrence) • S MED EXP (Any one person) S PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ ' POLICY ' LOC OTHER: PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE UABILITY • COMBINED SINGLE LIMIT $ fEa accident1 ANY AUTO OWNED I SCHEDULED ' AUTOS ONLY , AUTOS _ BODILY INJURY (Per person) ~ $ BODILY INJURY (Per accident)' $ • PROPERTY DAMAGE ' $ (Per accident) HIRED NON -OWNED AUTOS ONLY - _ : AUTOS ONLY $ UMBRELLA LIAR OCCUR 1 EACH OCCURRENCE S AGGREGATE $ I EXCESS UAB CLAIMS MADE • DED RETENTIONS S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y N N r A WC 54-70-740-07 1 12/10/2020 12/10/2021 X STATUTE TH. 1,000,000 E L. EACH ACCIDENT $ o F C RMEM$ RE CLUDED? EcurtvE E.L. DISEASE • EA EMPLOYEE. $ E.L. DISEASE - POLICY LIMIT $ 1,000,000 1,000,000 (Mandatory In NH) I1 yes. describe under ' DESCRIPTION OF OPERATIONS below Location Coverage Period: I 12/10/2020 12/10/2021 Client# 10838-CA DESCRIPTION OF OPERATIONS t LOCATIONS' VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) Coverage is provided for Innovative Claim Solutions Inc only those co -employees 11344 COloma Rd Ste 745 of. but not subcontractors Gold River, CA 95670 to: CERTIFICATE HOLDER CANCELLATION City of Gilroy HR Director/Risk Manager 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 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and loco are reaistered marks of ACORD 2•af2 6578