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HomeMy WebLinkAboutCOI - Flagship Facility Services, Inc. - Expires 2022-07-01A`R b® CERTIFICATE OF LIABILITY INSURANCE DATE(MMI02 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 Woodruff Sawyer 50 California Street, Floor 12 San Francisco CA 94111 CONTACT NAME: PHONE 415-391-2141 FAX N, : 415-989-9923 E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURER A: Zurich American Insurance Company 16535 INSURED FLAGENT-01 Flagship Facility Services, Inc. 1050 N. Fifth Street INSURER B : American Zurich Insurance Company I 40142 INSURER C :American Guarantee and LiabilityInsurance 26247 INSURER D : San Jose, CA 95112 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 606144700 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 ADDLISUBR POLICY NUMBER POLICY EFF I POLICY EXP MMIDD MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY OCCUR GLO829847720 7/1/2021 7/1/2022 j EACH OCCURRENCE $ 2,000,000 DAMACLAIMS-MADE PREMI NTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) S 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO LOC POLICY X JECT OTHER: GENERAL AGGREGATE $ 4.000.000 PRODUCTS -COMP/OP AGG $4,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO AUTOS ONLY AUTOS SCHEDULED HIRED NON -OWNED OWNED IXX AUTOS ONLY AUTOS ONLY 5K Com Sche 5K Coll-Sche I I BAP829847820 7/1/2021 7/1/2022 COMBINED SINGLE LIMIT Ee accident $2.000,000 X X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accidentX _ $ $ C X UMBRELLALIAB EXCESS LIAR X OCCUR CLAIMS -MADE AUC 0969916-00 7/1/2021 7/1/202-2 EACH OCCURRENCE S 15,000,000 AGGREGATE $15,000,000 DED I RETENTION S $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILI Y Y I N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? (Mandatory In NH) If Dyes, describe under DESCRIPTION OF OPERATIONS below N / A I WC829803622 7/1/2021 7/1/2022 X STATUTE I I ERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT S 1,000,000 i DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may bo attachod If more space Is required) The City of Gilroy, its officers, employees, agents, council members & other representatives are included as Additional Insureds with respect to General Liability as required by written contract per attached endorsements. CERTIFICATE HOLDER CANCELLATION 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 4111� A� 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GLO 8298477-20 COMMERCIAL GENERAL LIABILITY CG20100413 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 ANY PERSON OR ORGANIZATION TO WHOM ALL LOCATIONS OR TO WHICH YOU ARE REQUIRED TO PROVIDE ADDITIONAL INSURED STATUS IN A WRITTEN CONTRACT OR WRITTEN AGREEMENT EXECUTED PRIOR TO LOSS, EXCEPT WHERE SUCH CONTRACT OR AGREEMENT IS PROHIBITED BY LAW. CITY OF GILROY, ITS OFFICERS, EMPLOYEES, AGENTS, COUNCIL MEMBERS & OTHER REPRESENTATIVES 7351 ROSANNA STREET G I L ROY, CA 85020 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 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) designated above. 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 additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment 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 intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. 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 2010 0413 © Insurance Services Office, Inc., 2012 Page 2 of 2 Policy underwritten by KEMPER Infinity Insurance Company Named insured: Felipe Vasquez De Jesus Kemper i• •f,.� Claim number: 21000023498 PO Box 2843 Date of loss: January 14, 2021 Clinton, IA 52733 Date of mailing: May 7, 2021 0014562 01 AB 0.425 "AUTO T1 1 7289 95020-619651-001-P14576-1 IIIIIIIIIIIIIIII�IIIIIIIII'I�IIIII111'IIII�IIII''�IIIIIIIIIIIII�I CITY OF GILROY 7351 ROSANNA ST GILROY, CA 95020-6196 Dear CITY OF GILROY: We are writing to acknowledge our receipt of the loss referenced above and to let you know that we are currently investigating this matter. Our goal is to provide you with excellent claim service and your cooperation with us can make it possible. I am assigned to handle your claim. If have not already been in contact with you, please call me to discuss the claims process. Please note that this letter does not guarantee or imply acceptance of liability by Infinity Insurance Company. Also please note that you have a duty to mitigate your damages. We are not responsible for any charges for excessive storage or loss of use which may be incurred as a result of this accident while we are completing our investigation. If your vehicle is incurring storage fees, you should make arrangements to move it to a location with no charges for storage to avoid additional costs to you. California state regulations require that we ask whether a child passenger restraint system was in use by a child during an accident or was in the vehicle at the time of the loss, please provide us with this information. If you have any questions, please contact us and have the claim number available so we can assist you as quickly as possible. Sincerely, Jesus Felix Claims Team T 800.353.6737, ext.1351727 F 888.976.2123 jesus.felix@kemper.com Infinity Insurance Company 7289.01-00-0014562-0001-0019241 n -0 M. m tA m 0 v 0 0 :E CL=r 3 0 0- m c m n rt 0 m 0. 0 -h 3' m 3 m rt rt m O p 0 ora m m rt LA v m 0 v 0 c m rt n �i 3� 0 rt m .O cu 3 m 0 0 a�a c 0 -h n v 0 O 0 c .0 0 m n rt o' n 0 H m .0 m 0 r+ m 0 0 OIq rt 0 Di m m 0 0 3 D 0