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HomeMy WebLinkAboutCOI - Alfonso Cervantes - Expires 2022-05-14A� `0® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 5/18/2021 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 endorsement(s). PRODUCER Leaders Choice Insurance Services Inc. 700 E Street Sacramento CA 95814 CONTACT PHONE FAX . 866-211-2123 A/C No): 866-913-7036 EIAADDRESS: info leaderschoiceins.Com INSURERS AFFORDING COVERAGE NAIC # INSURER A: United Financial Casualty Company 11770 Licenset OG80276 INSURED CERVANAL01 INSURER B : Alfonso Cervantes 5059 Kimball Hill Cir INSURER C : INSURER D : Stockton CA 95210 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER:998765942 RFVISInN Nl1MRFR- 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 ADDL SUER POLICYNUMBER POLICY EFF MMIDDIYYYYI POLICY EXP (MMIDD/YYYY1 LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS -MADE 1-1 OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC GENERAL AGGREGATE $ PRODUCTS • COMP/OP AGG $ $ OTHER: A AUTOMOBILE LIABILITY Y 00712322-2 5/14/2021 5/14/2022 COMBINED SINGLE LIMIT Ea accident $ 750,000 BODILY INJURY (Per person) $ ANY AUTO OWNED X SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ EACH OCCURRENCE $ UMBRELLA LIAR OCCUR ACipFGATE $ EXCESS LIAR CLAIMS -MADE DED RETENTION $ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y / N STATUTE ER E.L. EACH ACCIDENT ANYPROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? N / A (Mandatory In NH) E.L. DISEASE - EA EMPLOYE If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIN.:'. a DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Gilroy named as additional Insured per the attached form(s) CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna St Gilroy CA 95020 USA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORI D REPRESENTATIVE ft ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AC V CERTIFICATE OF PROPERTY INSURANCE DATE(MM/DD/YYYY) 5/18/2021 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. PRODUCER CONTACT Leaders Choice Insurance Services Inc. PHONE FAX 700 E Street . 866-211-2123 (A/C. No): 866-913-7036 Sacramento CA 95814 A DRIESS: info@leaderschoiceins.com PRODUCER CERVANAL01 PRODUCER 11. License#: OG80276 INSURERS AFFORDING COVERAGE NAIL # INSURED INSURER A: Ohio Casualty Insurance Company 24074 Alfonso Cervantes 5059 Kimball Hill Cir INSURER B : Stockton CA 95210 INSURER C : INSURER D : INSURER E : INSURER F COVERAGES CERTIFICATE NIIMRFR* 17QQn9AA" RFVISInKI AIIIMRRR- LOCATION OF PREMISES I DESCRIPTION OF PROPERTY (Attach ACORD 101, Additional Remarks Schedule, It more space Is required) 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 EFFECTIVE DATE (MMIDDNYYY) POLICY EXPIRATION DATE (MMIDDIYYYY) COVERED PROPERTY LIMITS PROPERTY CAUSES OF LOSS DEDUCTIBLES BUILDING PERSONALPROPERTY BUSINESS INCOME EXTRA EXPENSE RENTAL VALUE BLANKET BUILDING BLANKET PERS PROP BLANKET BLDG & PP $ $ BASIC BUILDING $ BROAD $ CONTENTS SPECIAL $ EARTHQUAKE $ WIND $ FLOOD $ $ $ A INLAND MARINE OF LOSS NAMED PERILS TYPE OF POLICY Cargo 5/13/2021 5/13/2022 X Per Vehicle Deductible $ 50,000 CAUSES X $1,000 POLICY NUMBER BM059840492 $ $ CRIME TYPE OF POLICY $ $ BOILER & MACHINERY/ EQUIPMENT BREAKDOWN $ $ $ SPECIAL CONDITIONS / OTHER COVERAGES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) City of Gilroy named as additional Insured per the attached form(s) 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 7351 Rosanna St Gilroy CA 95020 AUTHORIZED REPRESENTATIVE USA . I / ..oz ©1995-2015 ACORD CORPORATION. All rights reserved. ACORD 24 (2016/03) The ACORD name and logo are registered marks of ACORD LEADERS CHOICE INSUR 700 E STREET SACRAMENTO, CA 95814 PRO9REJ.r1YF COMMERCIAL Named insured ALFONSO CERVANTES A & C TRUCKING 5059 KIMBALL HILL CIR STOCKTON, CA 95210 Commercial Auto Insurance Coverage Summary This is your revised Renewal Declarations Page Your policy information has changed Policy number: 00712322-2 Underwritten by: United Financial Cas Co May 6, 2021 Policy Period: May 14, 2021 - May 14, 2022 Pagel of 4 progress iveage nt.com Online Service Make payments, check billing activity, print policy documents, or check the status of a claim. 1-866-211-2123 LEADERS CHOICE INSUR Contact your agent for personalized service. 1-800-444-4487 For customer service if your agent is unavailable or to report a claim. This Renewal Declarations Page is effective only if the minimum amount due to renew your policy is received or postmarked by May 14, 2021. Your coverage begins on May 14, 2021 at 12:01 a.m. This policy expires on May 14, 2022 at 12:01 a.m. This coverage summary replaces your prior one. Your insurance policy and any policy endorsements contain a full explanation of your coverage. The policy limits shown for an auto may not be combined with the limits for the same coverage on another auto, unless the policy contract allows the stacking of limits. The policy contract is form 6912 (02/19). The contract is modified by forms 2852CA (02/19), 4757 (02/19), MC1632 (06/04), 1198 (01/04), 4852CA (02/19), 4881 CA (02/19) and Z228 (01/11). The named insured organization type is a sole proprietorship. Policy changes effective May 14, 2021 ............................................................................................................................................................................. Premium change: $16,108.76 ............................................................................................................................................................................. Changes: The auto coverage schedule has changed. The driver information has changed. The history of violations has changed. The changes shown above will not be effective prior to the time the changes were requested. 10 Continued Form 6489 CA (06/10) Policy number: 00712322-2 ALFONSO CERVANTES Page 2 of 4 Outline of coverage Description limits Deductible Premium ............................................................................................................................................................................. Liability To Others $23,379 Bodily Injury and Property Damage Liability ............................................................................................................................................................................. $750,000 combined single limit Uninsured/Underinsured Motorist ............................................................................................................................................................................. $750,000 combined single limit 272 Uninsured Motorist Property Damage ........................................................................................................................................... Rejected -- Medical Payments ............................................................................................................................................................................. $5,000 each person 42 Comprehensive 1,315 See Auto Coverage Schedule .................................................................. Limit of liability less deductible .................................................................................................... Collision 5,012 See Auto Coverage Schedule Limit of liability less deductible Subtotal policy premium $30,020.00 ............................................................................................................................................................................. California Vehicle Assessment Fee ............................................................................................................................................................................. 3.52 Fees 100.00 ............................................................................................................................................................................. Total 12 month policy premium and fees $30,123.52 Important information about fees An installment fee of $6.00 has been included in each payment. You may avoid paying installment fees by paying your premium of $30,123.52 in full by May 14, 2021. You may reduce the amount you pay in installment fees by paying your premium in larger amounts and fewer installments. Please call your agent for details. The following additional fees may apply: Late payment fee $10.00 Fee for returned checks or refused payments $20.00 Rated drivers ..................................................................... 1. ALFONSO CERVANTES ..................................................................... 2. EDUARDO CERVANTES Auto coverage schedule 1. 2013 KW T60 VIN: 1 XKAD49X6DJ315972 Liability Premium Physical Damage Premium Liability UWulM BI ............................... $11,496 $136 Comp Comp Deductible Premium ............................. $500 $354 Stated Amount: *$20,000 (including Permanently Attached Equip) Garaging Zip Code: 95206 Radius: 300 Med Pay ......................................................................................................................... $42 Collision Collision Deductible Premium Auto Total ............................................................................................................................ $2,500 $1,449 $13,477 2. 2010 NON Owned Trailer Stated Amount: *$20,000 (including Permanently Attached Equip) VIN: XXXXXXXXXXXXXXXXX Garaging Zip Code: 95206 Radius: 300 Liability Liability ........................................................................................................................... Premium ....................................... $487 Comp Comp Collision Collision Physical Damage Deductible Premium Deductible Premium Auto Total Premium$............................................................ 2................ ........................................................................ 500 $138 $2,500 $37$997 .10 Continued Form 6489 CA (06/10) Policy number: 00712322-2 ALFONSO CERVANTES Page of 4 3. 2017 Peterbilt 579 Stated Amount: *$73,840 (including Permanently Attached Equip) VIN: 1 XPBDP9X9HD420445 Garaging Zip Code: 95210 Radius: 300 Liability .BI .... it.............UMIUIM..................................................................................................................................... Premium $10,909 $136 Comp Comp Collision Collision Physical Damage Deductible Premium Deductible Premium Auto Total ....... ....... ....... ................................................................... Premium $500 $685 $2,500 $2,819 $14,549 4. 2021 NON Owned Trailer Stated Amount: *$20,000 (including Permanently Attached Equip) VIN: NONE Garaging Zip Code: 95206 Radius: 300 Liability Liabil.ity ................................................................................................. ................................................................ Premium$487 Comp Comp Collision Collision Physical Damage Deductible Premium Deductible Premium Auto TotaI ......................................................................................................................................................... Premium $500 $138 $2,500 $372 $997 *A vehicle's stated amount should indicate its current retail value, including any special or permanently attached equipment. In the event of a total loss, the maximum amount payable is the lesser of the Stated Amount or Actual Cash Value, less deductible. Be sure to check stated amount at every renewal in order to receive the best value from your Progressive Commercial Auto policy. Premium discounts Policy ................................................................................................................................................................. 00712322-2 Business Experience and CDL Experience Loss Payee information .................................................................................................................................................................... 1 . Loss Payee Auto 1 TRANSPORT FUNDING PO BOX 25934 OVERLAND PARK, KS 66225 2013 KW T60 (1 XKAD49X6DJ315972) .................................................................................................................................................................... 2. Loss Payee Auto 3 PACCAR FINANCIAL COR PO BOX 2374 DENTON, TX 76202 2017 Peterbilt 579 (1 XPBDP9X9HD420445) Additional Insured information 1 . .................................................................................................................................................................... Additional Insured GOLDEN STATE MODULA 3158 GRILLO DR COULTERVILLE, CA 95311 2. .................................................................................................................................................................... Additional Insured TF LEASING CO & ASS PO BOX 25934 OVERLAND PARK, KS 66225 3. .................................................................................................................................................................... Additional Insured ADVANCED TRUCKING 1852 W 11 TH ST TRACY, CA 95376 4. .................................................................................................................................................................... Additional Insured TF LEASING CO & ASS PO BOX 25934 OVERLAND PARK, KS 66225 5. .................................................................................................................................................................... Additional Insured CUSTOM TRANSPORT IN PO BOX 230 LOCKIFORD, CA 95237 6. ................................................................................................................................................................... Additional Insured COUNTY OF GLENN PO BOX 1070 WILLOWS, CA 95988 0 Continued Form 6489 CA (06/10) Policy number: 00712322-2 ALFONSO CERVANTES Page 4 of 4 7. Additional Insured CITY OF PERRIS 24 S. D ST. PERRIS, CA 92570 8. .................................................................................................................................................................... Additional Insured CITY OF SALINAS 200 LINCOLN AVE SALINAS, CA 93901 9. .................................................................................................................................................................... Additional Insured CITY OF GILROY 7351 ROSANNA ST GILROY, CA 95020 10. .................................................................................................................................................................... Additional Insured ALAMEDA COUNTY 399 ELMHURST ST HAYWARD, CA 94501 11 . .................................................................................................................................................................... Additional Insured CITY OF FREMONT PO BOX 5006 FREMONT, CA 94537 12. .................................................................................................................................................................... Additional Insured CITY OF LIVERMORE 1025S LIVERMORE LIVERMORE, CA 94550 Company officers w � e! � 7 U. i --M j%4 16 President Secreta ry Form 6489 CA (06/10)