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HomeMy WebLinkAboutCOI - Rana Creek Habitat Restoration - Expires 2021-07-29A�' �DATE (MMlDDlYYYY) ® DA CCO CERTIFICATE OF LIABILITY INSURANCE 10/23l2020 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 NAMR Andre ni & Company -San Mateo PHO Andreini & Co ripany NE _ FAX 220 West 20th Avenue fAj No. Fxtl@ 650-573-1111 No : 650-3784361 San Mateo CA 94403 E-MAIL amatthews@andreini.com INSURERS AFFORDING COVERAGE NAIC 0 _ _ _ _ INSURER A: State Compensation Ins Fund 35076 INSURED RANAC-2 INSURER B: Evanston Insurance Co 35378 Rana Creek Habitat Restoration-----f-------- 27875 Berwick Drive Ste. A INSURER C : United Financial Casualty Co. 11770 _ Carmel CA 93923 INSURER o : Lloyd's of London I I INSURER F COVERAGES CFRTIFICATF NI IMRFR• a1Rac;aaSr, Rr-vlclnti tit tlulaGQ• 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. ;AOOLjSU9q� LTR 4 TYPE OF INSURANCE i INSO WVD POLICY NUMBER POLICY EFF , POLICY EXP MMIDDIYYYY i MMIDDIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY MKLV5ENV102512 7I29/2020 7/29Q021 EACH OCCURRENCE $1.000.00o CLAIMS MADE ^ OCCUR __- DAMAGE TOR NT PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) �jI_$ 5,000 PERSONAL ADV INJURY { $ 1.000.000 GEN'L AGGREGATE LIMITAPPLIES PER: -- 1 GENERAL AGGREGATE $ 2,000,000 X PRO- - POLICY JECT ^1 LOC +� PRODUCTS COMPiOP AGG $ 2.000,000 ' OTHER: � I i i $_—_--- — C AUTOMOBILE LIABILITY 01261735-2 10/24/2020 4/2412021 Oalvta6aNde lj INGLE LIMIT $1.000.000 ANY AUTO BODILY INJURY (Per person) ; $ OWNED SCHEDULED AUTOS ONLY X AUTOS en, ` BODILY INJURY (Per aoc�dent) I $ HIRED NON -OWNED { 4 _� PROPERT$ Y DAMAGE AUTOS ONLY AUTOS ONLY !f'or accidont)- is B X UMBRELLA LIAB i�—X—+: OCCUR MKLV5EFX100606 7/29/2020 7/29/2021 EACH OCCURRENCE $ 5.000,000 s 5,000,000 EXCESSAB i u _CLAIMS -MADE ? AGGREGATE DED RETENTION $ ; Prod/Comp Ops $ 5,000,000 A WORKERS COMPENSATION 1910088610 4 s EIBE2PER 6/1/2020 R ANYPOPRIIETORARTNRXECUTIVE YIN i C.L.EACH ACCIDENT $ 1,000,000 OFFICERIMEMBER EXCLUDED? N!A' I ( ! _�._.... .__.-.-_ - -.-._ __-..__- -.. (Mandatory In NH) I E.L. DISEASE - EA EMPLOYEE $1,000.000 lII as. describe under I I — DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Professional LiabiGty ` ANE160767520 7/29/2020 7/29/2021 EACH CLAIM LIMIT ! 1,000,000 f AGGREGATE 1.000.000 DESCRIPTION OF OPERATIONS ! LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Service Agreement: Fire Department Personnel Testing City of Gilroy. its officers, officials and employees are included as an additional insured, per the attached Endorsement. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gilroy, its officers, officials and employees 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 2 of 4 3345 s N LO N O W J Y W m D } J a _1 D UL a H Q w Q J a J CL 2 a U z m U) 0 z w 0� U) z W O W I— W W ..J a cjwJh O w Cl W W z I-- W O a. '� I m 00 W C.) C� U� zL0 r Q za 0 �= .� z 00 V a O O O Q W W •a > CD o U Q N J C Q N C J w D z o w E 0 U N W -C 0 O t U w J w U cv a. N a O 'O y t/1 C E IT U m 0 0 o=CD -- o _CL= L 3 N u O c � Q � _ •3 c '� y � � O � � m J c'r a � 0 t N c 0 o a _0 CD � C C m C �_ E L O U 1-0 0 L 4 O a� 4- 0 E z c E 0 C a .D...7,COL p cc��• O C�pci� �� o Oa a 'c E n) V a) N= 'n fV `per 'O 7 N— Waa�Caaaa Uf : V �, N C O C N�T7 `p :3ro ������_m Q N C- O N i• N c•- �= c oa.c N ?'c 0 3:•Vii C m C a a) O i�t�• 0 oc_�...�ca `U,o0C)L) o m �• -- _ o a.0 O C. a) ci w m 0 v 0 O N ti C a 0 a O ,o, POLICY NUMBER: MKLV5ENV102512 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 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): I Location(s) Of Covered Onerations Requircd by written contract [Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: I. All work, including materials, parts or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 2010 07 04 C ISO Properties, Inc., 2004 Page 1 of 1 O 4 of 4 3345 A� �® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDlYYYY) 7/28/2020 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, the pollcy(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 NAME: cT Andreini & Company Andreini & Company -San Mateo PHONE - - �a -- - 220 West 20th Avenue . 650-573-1111 ac Na : 650-378-4361 San Mateo CA 94403 E-MAIL amatthews@.andreini.com INSURERS AFFORDING COVERAGE _ NAIC # INSURERA: State Compensation Ins Fund — 35076 INSURED RANAC-2 INSURER B: Evanston Insurance Co 35378 Rana Creek Habitat Restoration 27875 Berwick Drive Ste. A INsuRER c :United Financial Casualty Co. 11770 Carmel CA 93923 INSURER D : Lloyd's of London COVERAGES CERTIFICATE NI IMRFR- AQ.r,771110 REVISION NUMRER! 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 I I TYPE OF INSURANCE - POLICY EFF ' POLICY EXP r- INSD WVD I POLICY NUMBER MDDIYYYY MwooryYYY LIMITS LTR Ml B X COMMERCIAL GENERAL LIABILITY MKLV5ENV102512 7/29/2020 7/29/2021 EACHOCCURRENCE $1.000.000 CLAIMS -MADE � X _ OCCUR DAMAGE TO RENTED % PREM SES Ea ocarrence $ 50_000 _ MED EXP (Any one person) $ 5.000 j PERSONAL & ADV INJURY $ 1,000.000 GEN'L AGGREGATE LIMIT AP PER: GENERAL AGGREGATE $ 2,000,000 ---' PRO*PLIES %� r --' _ POLICY JECT LOC PRODUCTS COMP/OP AGG I ^_ _ $2,000,000 f--- $ OTHER: i I i C AUTOMOBILE LIABILITY 01261735-1 4/24/2020 10/24/2020 COMBINED SINGLE LIMIT $1.000.000 Ea -Appident ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED ---- X BODILY INJURY (Pet accident): I $ AUTOS ONLY AUTOS HIRED NON -OWNED PROPERTY DAMAGE $ AUTOS ONLY �, AUTOS ONLY _(Per_ accident) - B X UMBRELLA LIAR X OCCUR MKLV5EFX100606 7/29/2020 7129/2021 EACH OCCURRENCE $ 5.000.000 EXCESS LIAB CLAIMS MADE AGGREGATE $ 5,000,000 1 DED RETENTION $ I Prod/Comp Ops _ I $ 5,000,000 A WORKERS COMPENSATION , 910088610 j 6/112020 611/2021 PER 1 STATUTE ERH --- - AND EMPLOYERS' LIABILITY Y/N , $ 1,000,000 ---__ _-----.- ..-_- ANYPROPRIETORIPARTNERJEXECUTIVE E.L. EACH ACCIDENT OFFICERlMEMBEREXCLUDED? : N / A ------------__ _-- (Mandatory In NH) , E.L. DISEASE - EA EMPLOYEE $1,000,000 11 yes, describe under i DESCRIPTION OF OPERATIONS below E.L. DISEASE . POLICY LIMIT $ 1.000,000 D . Professional Liability 1 ANE160767520 7/29/2020 7/29/2021 EACH CLAIM LIMIT 1.000.000 AGGREGATE i 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) Service Agreement: Fire Department Personnel Testing City of Gilroy, its officers, officials and employees are included as an additional insured, per the attached Endorsement. CFRTIFICATF HOI r)FR CANCFI I ATIAN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gilroy, its officers, officials and employees 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 01988-2015 ACORD CORPORATION. All rlgnts reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 2 of 4 4643 POLICY NUMBER: MKLV5ENV102512 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -- OWNERS, LESSEES OR CONTRACTORS -- COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) I Location And Description Of Completed Opera- I L Or Organization(s): tions Required by written contract I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section If — 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products - completed operations hazard". CG 20 37 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 0 3 of 4 4643 POLICY NUMBER: MKLV5ENV102512 COMMERCIAL GENERAL LIABILITY CG 2010 07 04 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): I Location(s) Of Covered Operations Required by written contract LInformation required to complete this Schedule, if not shown above, will be shown in the Declarations A. Section 11 — 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) desig- nated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclu- sions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials parts or equip- ment 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 in- tended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a princi- pal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 Page 1 of 1 O 4 of 4 4643