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HomeMy WebLinkAboutCOI - PCC Logistics - Expires 2021-10-011'{2(012HO02 ACOle'V CERTIFICATE OF LIABILITY INSURANCE 09/28 20220 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(les) 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 CA LIC OB29370 1-925-244-7700 Edgewood Partners Insurance Centers (EPIC) [San Ramon - Branch ID 14394] P. 0. Box 5003 CONTACT Certificates Department PHONE FAX .925-244-7700 A/c No: 925-901-0671 ADDRESS: EPICcerts@epicbrokers.com INSURERS AFFORDING COVERAGE NA1C 9 INSURERA: StarStone National Insurance Company 25496 San Ramon, CA 94583 INSURED PCC Logistics INSURER B : INSURER C : INSURERD: 432 Estudillo Avenue INSURER E : INSURERF: San Leandro, CA 94577 COVERAGES CERTIFICATE NUMBER: 60350228 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 LTR TYPE OF INSURANCE ADDL SUBRI WvDPOLICY NUMBER POLICY EFF MMIDDNYYY) POLICY EXP (MM/DDNYYYI LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR EACH OCCURRENCE $ DAMAGE TO REWFED— PREMISES Me urrence $ MED EXP (Any one person) $ GEN'L _ PERSONAL & ADV INJURY $ AGGREGATE LIMIT APPLIES PER: POLICY JECT 7 LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMPIOP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Pet person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per -accident) $ a UMBRELLA LIAR EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE S DED RETENTION S $ WORKERA AND AND EMPLOYERS' LIABILITY EMPLOYERTIONS' ANYPROPRIETOR/PARTNER/EXECUTIVE Y� OFFICER/MEMBER EXCLUDED? (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below NIA T10201103 10/01/20 10/01/21 X STATUTE ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101. Additional Remarks Schedule, may be attached It more apace Is required) Confirmation of Coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE City of Gilroy THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 7351 Rosanna St. AUTHORIZED REPRESENTATIVE Gilroy, CA 95020 &..— USA e�. ©1988-2015 ACORD CORPORATION. All rights reserved. N ACORD 25 (2016103) kstubbs 60350228 The ACORD name and logo are registered marks of ACORD CERTHOLDER COPY NF P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 06-24-2020 CITY OF GILROY, CA NF 7351 ROSANNA ST GILROY CA 95020-6141 GROUP: POLICY NUMBER: 9103671-2020 CERTIFICATE ID: 145 CERTIFICATE EXPIRES: 06-24-2021 06-24-2020/06-24-2021 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the policy described herein is subject to all the terms, exclusions, and conditions, of such policy. Z��e"v 141, . Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #OOIS ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2019-06-24 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: CITY OF GILROY, CA ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 06-24-2015 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #1651 - ROBERT MCKENNEY, SEC,TRES - EXCLUDED. ENDORSEMENT H1651 - ROBERTA PECKHAM, PRESIDENT - EXCLUDED. EMPLOYER PECKHAM & MCKENNEY, INC. NF 300 HARDING BLVD N 203D ROSEVILLE CA 95678 M0408 (REV.7-2014) PRINTED : 05-18-2020