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HomeMy WebLinkAboutCOI - JT Martin Trucking, Inc. - Expires 2022-04-27ITMARTI-01 TNOLAN CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 6/28/2021 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 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 endorsements . PRODUCER co TACT Tammy Nolan, CISR E. CoreMark Insurance Services Inc. 4430 Duckhorn Drive Sacramento, CA95834 PHONE FAX Arc, No, Extl: (916) 779-6984 A/C, No):(916) 923-2797 &MAIL .tnolan coremarkins.com INSURERS AFFORDING COVERAGE NAIC # INSURER A: Rockingham Insurance Company 10214 INSURED INSURER B : Williamsburg National Insurance 25780 INSURER C : Preferred Professional Insurance Company 36234 JT Martin Trucking, Inc. INSURER D :The Ohio Casually Insurance Company 24074 P.O. Box 741 Winters, CA 95694 INSURER E INSURER F : COVERAGES CERTIFICATE Nt1MRFR- RFVI-glnN NI IMRFR- 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXPLTR LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS MADE X OCCUR X RCAA30781300 4/27/2021 4/27/2022 EACH OCCURRENCE S 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence) 100,000 $ MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY S 1,000,000 GEN'L X AGGREGATE LIMIT APPLIES PER: POLICY jP&- 1-1 LOC OTHER: GENERAL AGGREGATE S 2,000,000 PRODUCTS - COMP/OP AGG S 2,000,000 S B AUTOMOBILE LIABILITY ANY AUTO OWNED X SCHEDULED AUTOS ONLY AUTOS X A�TOS ONLY X AUTOS ONLY X CA095067202 4/27/2021 4127/2022 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY Per rson S BODILY BODILY INJURY Per accident S PerOa�den�AMAGE S $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE S DED I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANY PROPRIETOR/PARTNER/EXECUTIVE �FFICER/MEMg�� EXCLUDED? Vlandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N /A ON1080101 1117/2021 1/17/2022 X I PER OTH- STATUTE R E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYE S 1'000'000 E.L. DISEASE - POLICY LIMIT S 1,000,000 D Motor Truck Cargo BM059412398 4/27/2021 4/27/2022 Deductible $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS r VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) City of Gilroy is additional insured respects General Liability per attached form AG1960 0515 and respects Auto Liability per attached form CCIA 01 1a;ei111I!1:qV City of Gilroy 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 ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and Iran are renistered marks nf ACORD .. . POLICY NUMBER: RCAA307813-00 AG 19 60 05 15 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU TO INCLUDE WAIVER OF SUBROGATION PROVISION AND PRIMARY AND NONCONTRIBUTORY PROVISION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Additional Insured Status — Ongoing Operations 1. "Section II Who is an Insured" is amended to provide automatic coverage as an Additional Insured in conformity with the terms and conditions of the CG 20 10 0413 endorsement, a copy of which is attached hereto and incorporated by reference. Automatic Additional insured coverage provided by this endorsement only applies to the extent permitted by law; and if coverage provided to the additional insured is required by and agreed in writing in a contract or agreement, the insurance afforded such additional insured will not be broader than that which you are required by the contract or agreement, only if such contract agreement is executed by each party prior to the start of your work to provide for such additional insured. B. Additional Insured Status — Completed Operations 1. "Section II -Who is an Insured" is amended to provide automatic coverage as an Additional Insured in conformity with the terms and conditions of the CG 20 37 0413 endorsement, a copy of which is attached hereto and incorporated by reference. Automatic Additional insured coverage provided by this endorsement only applies to the extent permitted by law; and if coverage provided to the additional insured is required by and agreed in writing in a contract or agreement, the insurance afforded such additional insured will not be broader than that which you are required by the contract or agreement, only if such contract agreement is executed by each party prior to the start of your work to provide for such additional insured. 2. The coverage provided to the additional insured as outlined in paragraph B. Additional Insured Status -- Completed Operations does not apply to Any "bodily injury", "property damage" or "personal and advertising injury" arising out of, related to, caused by, or associated with, in whole or in part, to operations and "your work", conducted by you or on your behalf, or work or operations conducted by an unrelated party, involving "residential property". C. Primary and Noncontributory Provision 1. Insurance afforded the Additional insured, when required by written contract or agreement, is primary and noncontributory in the event of an occurrence" caused, in whole or in part, by your acts or omissions, or the acts or omissions of those acting on your behalf that occurs while performing ongoing operations for the additional insured, or in connection with premises owned by or rented to you. Page 1 of 5 AG 19 60 05 15 D. Waiver of Subrogation Provision 1. "Section IV -Commercial General Liability Conditions Paragraph 8 The Transfer of Rights Of Recovery Against Others To Us" is amended to add the following: We waive any right of recovery we may have against those added as Additional Insured by this endorsement because of payments we make for injury or damage arising out of your ongoing operations or "your work" perfomled under written contract or agreement with them. This waiver applies only when you are solely negligent. This waiver shall not apply to claims, "suits" and/or damages arising in whole or in part out of the acts, omissions and/or negligence of those added as Additional Insured by this endorsement. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. E. The following are added to SECTION V — DEFINITIONS: "Residential property" means structures intended for use or used for human dwelling, in whole or in part, including but not limited to single family dwellings, multi -family dwellings, townhomes, condominiums, and appurtenant structures. Page 2 of 5 AG 19 60 05 15 COMMERCIAL GENERAL LIABILITY CG 20 10 0413 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) Locations Of Covered Operations See Terms and Conditions of Coverage on page 1 of this endorsement All 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 This insurance does not apply to "bodily injury" or include as an additional insured the person(s) or "property damage" occurring after: organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", 1. All work, including materials, parts or "property damage" or "personal and advertising equipment furnished in connection with such work, on the project (other than service, injury„ caused, in whole or in part, by: maintenance or repairs) to be performed by or 1. Your acts or omissions; or on behalf of the additional insured(s) at the 2. The acts or omissions of those acting on your location of the covered operations has been behalf; completed; or in the performance of your ongoing operations 2. That portion of "your work" out of which the for the additional insured(s) at the location(s) injury or damage arises has been put to its designated above. intended use by any person or organization However: other than another contractor or subcontractor engaged in performing 1. The insurance afforded to such additional operations for a principal as a part of the insured only applies to the extent permitted same project. by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are C. With respect to the insurance afforded to these required by the contract or agreement to additional insureds, the following is added to provide for such additional insured. Section III —Limits Of Insurance: B. With respect to the insurance afforded to these if coverage provided to the additional insured is additional insureds, the following additional required by a contract or agreement, the most we exclusions apply: will pay on behalf of the additional insured is the amount of insurance: CG 20 10 04 13 O Insurance Services Office, Inc., 2012 Page 3 of 5 AG 19 60 0616 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 4 of 6 AG 19 60 05 15 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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 PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations See Terms and Conditions of Coverage on page 1 of this endorsement This endorsement does not apply to your work on "residential property" Information 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" 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". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 5 of 5 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 04/27/2021 at 12:01 am standard time Policy Number CA0950572-02 Policy Effective Date Named Insured 04/27/2021 at 12:01 am standard time J T Martin Trucking, Inc. PO Box 741 Winters, CA 95694 Policy Expiration Date 04/27/2022 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. me of Person or Organization (Additional Insured) ,ity of Gilroy '351 Roseanne Street ;ilroy, 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