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Home My WebLink AboutCOI - Ernie's Mobile Home Transport Inc - Expires 2022-11-03A� o® CERTIFICATE OF LIABILITY INSURANCE i� /2ozi' 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 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 CONTACT NAME: PHONE (530) 365-1009 AX No(530)247-7808 No ExtI. Roberson & Sons Insurance Services, Inc. P.O. Box 491719 EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A. Kinsale Insurance Company 38920 Redding CA 96049-1719 INSURED INSURER B : Northland Insurance Co 24015 INSURER C : Llo ds Of London 26077 Ernie' s Mobile Home Transport Inc INSURER D : PO BOX 1510 INSURER E : INSURER F : Marysville CA 95901 COVERAGES CERTIFICATE NUMBER:2021-11-01 KA 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 POLICY NUMBER POLICY EFF MMIDDlYYYY POLICY EXP MM/DDIYYYY LIMITS X COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE � OCCUR DAMA T R N PREM PREMISES Ea occurrence $ 100,000 X MED EXP (Any one person) $ Excluded $1, 000 BI 6 PD DEDUCTIBLE X 0100033173-6 11/3/2021 11/3/2022 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X PROaLOC JECT PRODUCTS $POLICY 2 000 000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 BODILY INJURY (Per person) S B ANYAUTO ALL OWNED SCHEDULED AUTOS X AUTOS WN314774 11/3/2021 11/3/2022 BODILY INJURY (Per accident) $ NON -OWNED X HIRED AUTOS X AUTOS PROPERTY DAMAGE Per accdent S $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAR CLAIMS -MADE DED I I RETENTION S $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? NIA E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT I S C MOTOR TRUCK CARGO MH10866A21 11/3/2021 11/3/2022 LIMIT: $100,000 DEDUCTIBLE: $10 , 000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Cargo coverage includes Double -Wide & Triple -Wide Endorsements. City of Gilroy is named as Additional Insured. Additional Insured applies to General Liability only. 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 7351 Rosana Street ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 95020 AUTHORIZED REPRESENTATIVE Eric Roberson/KRA ACORD 25 (2014/01) INS025 (201401) 9)1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD NOTICE OF CANCELLATION, NONRENEWAL OR DECLINATION (California) NAME AND . UNITED FINANCIAL CASUALTY COMPANY ADDRESS PO BOX 94739 OFINSURANCE COMPANY CLEVELAND OH 44101 NAME AND . MODULAR SOLUTIONS, INC ADDRESS PO BOX 231 OF INSURED ATWATER CA 95301 TO THE ADDITIONAL INTEREST: KIND OF POLICY: Commercial Automobile POLICY/APPLICATION/BINDER NO.: 01284477-7 Typist: KL EFFECTIVE DATE OF NOTICE: 01/09/2022 12:01 AM (DATE) (HOUR -STANDARD TIME AT THE ADDRESS OF THE INSURED) DATE OF MAILING: 10/28/2021 NAME AND ADDRESS OF AGENT/BROKER: DIBUDUO & DEFENDIS PO BOX 5479 FRESNO CA 93755 (Specific information concerning the cancellation, nonrenewal or declination has been given to the Insured.) You are notified that the above policy is cancelled, nonrenewed or declined effective on and after the hour and date mentioned above. This notice is being provided to you as you have been provided with a certificate of insurance on the above policy. Any interest you may have in the above policy is terminated. AUTHORIZED REPRESENTATIVE NAME AND CITY OF GILROY ADDRESS OF 7351 ROSANNA ST ADDITIONAL INTEREST GILROY CA 95020 (E)GU 351q (Ed. 6-20) Wolters Kluwer I Uniform Forms 0 2020 Walters Kluwer Financial Services, Inc. All rights reserved. ADDITIONAL INTEREST'S COPY Page 1 of 1 POLICY NUMBER: MCP05862I THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL AUTO COVERAGE PART The provisions of the Coverage Form apply unless modified by this endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured Endorsement Effective TRIGO INDUSTRIES LLC AUGUST 13 2021 Endorsement Number GREAT WEST CASUALTY COMPANY NOBLE WEST INSURANCE SERVICES SCHEDULE Policy Expiration Date: AUGUST 13 2022 Name of Additional Insured: CITY OF GILROY PUBLIC WORKS DEPT 7351 ROSANNA ST GILROY CA 95020 Description of Covered "Auto(s)": APPLIES TO ALL TRUCKS, TRACTORS & RENTED, OR BORROWED WHICH ARE USED A. B. C. TRAILERS OWNED, LEASED, HIRED, BY THE NAMED INSURED Section II - Covered Autos Liability Coverage - Who is an Insured is changed to include as an "insured" the person or organization shown in the SCHEDULE on this endorsement only if they are liable for the conduct of an "insured" shown in the Who is an Insured provisions and only to the extent of that liability. Coverage provided by this endorsement applies to "auto(s)" described in the SCHEDULE on this endorsement. The coverage provided by this endorsement ends when the Additional Insured is not liable for your conduct or the Policy Expiration Date, whichever occurs first. D. The Additional Insured shown in the SCHEDULE on this endorsement is covered for an amount up to the Limit of Insurance required in an agreement with you or the policy's Limit of Insurance, whichever is less. E. Any coverage provided by this endorsement is excess over any other valid and collectible insurance available to the Additional Insured whether primary, excess, contingent, or on any other basis unless the contract or agreement you have with them requires that this insurance be primary. CA 49 01 10 15 Includes copyrighted material of Insurance Services office, Inc., with its permission. Page 1 of 1 Allstate Insurance Company PO Box 660598 Dallas, TX 75266-0598 City of Gilroy 7351 ROSANNA ST GILROY CA 95020-6196 Policy number: 099 889 899 Transaction: Endorsement ADDITIONAL THIRD PARTY Amended Deluxe Homeowners Policy Declarations Policy number: 1099 889 899 Policy effective date: August 7, 2021 Your policy documents ,Page'3'of 3 Your Homeowners policy consists of the Policy Declarations and the following documents. Please keep them together. a Deluxe Homeowners Policy - AP2 Lender's Loss Payable Endorsement - AU319 o Amendment of Policy Provisions - AP425 e California Standard Fire Policy Provisions - AP1862-2 • California Deluxe Homeowners Amendatory Endorsement - AP2237 • California Deluxe Plus And Deluxe Homeowners Policy Amendatory Endorsement - AP29-5 • California Deluxe Homeowners Amendatory Endorsement - AP4482-3 Building Structure Reimbursement Extended Limits Endorsement - AP445 Additional Mortgagee Endorsement - AU273 • Wildfire Deductible Endorsement - AP4886 e Marijuana Amendatory Endorsement - AVP504 - California Workers' Compensation And Employers' Liability Coverage For Residence Employees Coverage Form - AP1127 Important payment and coverage information Here is some additional, helpful information related to your coverage and paying your bill: 0- The Property Insurance Adjustment condition applies using the Marshall Swift Boeckh Publications building cost index. 1* Please note: This is not a request for payment. Any adjustments to your premium will be reflected on your next scheduled bill which will be mailed separately. In the meantime, if you have any outstanding or unpaid bills, please pay at least the minimum amount due to assure your policy continues in force. If you have any questions, please contact your agent. Allstate Insurance Company's Secretary and President have signed this policy with legal authority at Northbrook, Illinois. Thomas J. Wilson President 5Z4�� e::;e,54� Susan L. Lees Secretary M Q � N 0 O O M 0 v� f� N 00