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Home My WebLink AboutCOI - Impact Transportation, LLC - Expires 2022-08-01CERTIFICATE OF LIABILITY INSURANCE DATE(MMroDn'YYY) ACORN 07/20/2021 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 be endorsed. If SUBROGATION IS WAIVED, subject to the terns 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 endorsements). PRODUCER CONTACT NAME: Sherri Jackson Commercial Carriers Insurance Agency, Inc. PHONE T 1 FAx 562 733-6636 4 Centerpointe Drive, Suite 300 E-MAIL I A/c No : 5fi2 356-0321 La Palma, CA 90623 ADDRESS: SJackson@Meadowbrook.com _ (562) 404-4900 - INSURER(S) AFFORDING COVERAGE --- _ NA_IC 0 - INSURER A: Allianz Global Corporate & Specialty �2837 INSURED INSURER B : Star Insurance Company 18023 Impact Transportation, LLC ---- -- - -� INSURER C: Williamsburg National Insurance Co. 5780 INSURER D P.O. Box 8530 - --- - - - - ---- Emeryville, CA 94662 INSURER E INSURER F rnVFROPFS CFRTIFICOTF NIIMRFR• RFVISInN NtIMRFR- 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. IHSR ATiDL'SUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LIMITS LTR POLICY NUMBER MM1DD MM1DDIYYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,000 — 1 CLAIMS -MADE OCCUR 15WAGE TO RENTED PREMISES Ea occurrence 5 100,000 -- MED EXP (Any one person) S 5.000 PERSONAL & ADV INJURY S 2,000,000 GENERAL AGGREGATE S 3,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: B POLICY JECT a LOC PRODUCTS - COMPIOP AGG S 3,000,000 5 OTHER. GL0866377 08/01/2021 08/01/2022 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 2,400,000 �Ea accident) _--- -- _ ----- ANY AUTO BODILY INJURY (Per person) $ X ALL AUTOS OWNED SCHEDULED AUTOS BODILY INJURY (Per accident) S X NON -OWNED X PROPERTY DAMAGE HIRED AUTOS AUTOS (Per accident) C X j CA0329924-14 08/01/2021 08/01/2022 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE S - —` EXCESS LIAB j CLAIMS -MADE AGGREGATE S DED 7 RETENTION $ 0 I - _ _ --I $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N -__TS ATUTE_ _ _-- -ER __!—- ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT S ❑, OFFICER/MEMBER EXCLUDED? N / A' - - (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE 5 If yes, describe under DESCRIPTION OF OPERATIONS below - -- _ - - C.L. DISEASE - POLICY LIMIT S C Physical Damage CA0936681-03 08/01/2021 08/01/2022 "'ACV less $1,000 ded C Trailer Interchange ! CA0936681-03 08/01/2021 08/01/2022 $40,000 less $1.000 ded A Cargo- Legal Liability MX193060641 08/01/2021 08/01/2022 $250,000 less $2,500 ded DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) The City of Gilroy is named as additional insured. t r-K 1 IF'IIUA I t MULUtK I:ANt:tLLA I IUN City of Gilroy Attn: Public Works Dept. 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 O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Williamsburg National Insurance Co. ADDITIONAL INSURED ENDORSEMENT THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY This endorsement forms a part of the policy to which attached, effective on the inception date of the policy unless otherwise stated herein. (The following information is required only when this endorsement is issued subsequent to preparation of the policy). Endorsement Effective Date 08/01/2021 at 12:01 am standard time Policy Number CA0329924-14 Policy Effective Date Named Insured 08/01/2021 at 12:01 am standard time Impact Transportation, LLC P.O. Box 8530 Emeryville, CA 94662 Policy Expiration Date 08/01 /2022 12:01 am standard time Countersigned by It is agreed that: The "Persons Insured" provision is amended to include as an ADDITIONAL INSURED the person or organization named below, but solely with respect to liability arising out of operations performed for such ADDITIONAL INSURED by or on behalf of the NAMED INSURED. ame of Person or Organization (Additional Insured) City of Gilroy Attn: Public Works Dept. 7351 Rosanna Street Gilroy, CA 95020 CANCELLATION: Should the above described policy be cancelled before the expiration date thereof, the issuing Company will endeavor to mail 30 days written notice, except for Non -Payment of Premium and then 10 days will be given, to the above named ADDITIONAL INSURED, but failure to mail such notice shall impose no obligation or liability of any kind upon the company. Nothing in this endorsement shall be held to vary, alter, waive or extend any of the terms, conditions, agreements or limitations of this policy other than above stated. Nothing elsewhere in this policy shall be held to vary, alter, waive or limit the terms, conditions, agreements or limitations of this endorsement. CCIA-01