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HomeMy WebLinkAboutCOI - Innovative Claim Solutions, Inc - Expires 2024-04-01'4� &® CERTIFICATE OF LIABILITY INSURANCE DATE (MMI DIY Y) 023 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 Modern Reign Insurance Brokers LLC 27201 Puerta Real Suite 130 Mission Viejo CA 92691 NAMEACT Deborah Chisholm PHONE g49-991-2423 FAC No: wc. N D REss' dchisholm modemrei n.com INSURERS AFFORDING COVERAGE NAIC p INSURER A: Federal Insurance Company 20281 Li ' 60 1386 INSURED INNOCLA-01 Innovative Claim Solutions, Inc 12677 Alosta Boulevard INSURER B: Scottsdale Insurance Company 41297 INSURERC: NSURER D: Suite 335 San Ramon CA 94583 INSURER:: INSURER F: COVERAGES CERTIFICATE NUMBER: 486291003 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. ILTR TYPE OF INSURANCE ADDL 111M SUBft NUMBER POLICYEFF MMIDD POUCYFxP MMDNYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY Y -MAPOLICY 35754610VVUC 4/1/2023 4/112024 EACHOCCURRENCE $1,000.000 CLAIMS -MADE M OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED UP (Any oneperson) $10,000 PERSONAL&ADV INJURY $1.000.000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE 52,000,000 X POLICY DdECT 0LOC PRODUCTS - COMP/OPAGG $Included Agg $ OTHER: A AUTOMOBILE LIABILITY 73513506 4/1/2023 4/1/2024 COMBINED SINGLE LIMIT Ea cadent $1,000,000 BODILY INJURY (Per parson) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Peracdtlent) $ X PROPERTYDAMAGE Per ecdden $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY $ A X UMBRELLA LIAB X OCCUR 79797000 4/1/2023 4/1/2024 EACH OCCURRENCE $5.000,000 AGGREGATE $5,000,000 EXCESS LIAB CLAIMS -MADE DELI I I RETENTION$ $ WORKERSCOMPENSATION ANDEMPLOYERS'UABIUTY YIN PER OTH- BT TUT: ER E.L.EACH ACCIDENT $ ANYPROPRIETOR/PARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED9 ❑ NIA EL. DISEASE -EA EMPLOYEE S (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ B Professional Liability EK13471093 1/1/2023 4/1/1024 Occurrence/Aggregate 3,000.000 A Fidelity/Came 68054061 4/1/2023 41V2024 Occurrence,/Aggregate 2.000.000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule, may be attached if more space is required) City of Gilroy, its officers, representatives, agents and employees are included as additional insured, coverage is primary and noncontributory in regard to General Liability per the attached endorsements. City of Gilroy HR Director/Risk Manager 7351 Rosanna Street Gilroy CA 95020 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MAY 16 20,�3 11 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. GILROYCO CLERK'S OFFICE AUTHORGU DREPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD C H U B B° Liability Insurance Endorsement Policy Period APRIL 1, 2023 TO APRIL 1, 2024 Effective Date APRIL 1, 2023 Policy Number 357546-10 WUC Insured INNOVATIVE CLAIM SOLUTIONS INC. Name of Company FEDERAL INSURANCE COMPANY Date Issued JANUARY 20, 2023 This Endorsement applies to the following forms: GENERAL LIABILITY Under Who Is An Insured, the following provision is added. Who Is An Insured Additional Insured - Persons or organizations shown in the Schedule are insureds, but they are insureds only if you are Scheduled Person obligated pursuant to a contract or agreement to provide them with such insurance as is afforded by Or Organization this policy. However, the person or organization is an insured only: • if and then only to the extent the person or organization is described in the Schedule; • to the extent such contract or agreement requires the person or organization to be afforded status as an insured; • for activities that did not occur, in whole or in part, before the execution of the contract or agreement; and • with respect to damages, loss, cost or expense for injury or damage to which this insurance applies. No person or organization is an insured under this provision: • that is more specifically identified under any other provision of the Who Is An Insured section (regardless of any limitation applicable thereto). • with respect to any assumption of liability (of another person or organization) by them in a contract or agreement. This limitation does not apply to the liability for damages, loss, cost or expense for injury or damage, to which this insurance applies, that the person or organization would have in the absence of such contract or agreement. Liability Insurance Additlanal Insured - Scheduled Person Or Organization Form 80-02-2367 (Rev. 5-07) Endorsement contlnued Page 1 C H U a a a Liability Endorsement (continued) Under Conditions, the following provision is added to the condition titled Other Insurance. Conditions Other Insurance — If you are obligated, pursuant to a contract or agreement, to provide the person or organization Primary, Noncontributory shown in the Schedule with primary insurance such as is afforded by this policy, then in such case Insurance — Scheduled this insurance is primary and we will not seek contribution from insurance available to such person Person Or Organization or organization. Schedule Persons or organizations that you are obligated, pursuant to a contract or agreement, to provide with such insurance as is afforded by this policy. All other terms and conditions remain unchanged. Authorized Representative Liability Insurance Addiffonal Insured - Scheduled Person Or Organization last page Form 80-02 2367 (Rev. 5-07) Endorsement Page 2