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HomeMy WebLinkAboutCOI - Stages Unlimited - Expires 2023-09-15STAGUNI DATE (MM/DDNYYY) 09/23/2022 ACO/z,^JA CERTIFICATE OF LIABILITY INSURANCE 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(les) 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 831.475-4314 UVIS Donald R Hardy Agency P.O. Box 308 CONNAMY CT Charmane Phillips, CSR PRONE 831.475-4314 FAX 831-475-9524 ac, No Exe : A/C, No E-MAIL . C armanep ardylns.com Capitola, CA 95010 David J. Martini, AAI INSURERNU AFFORDING COVERAGE NAIC d INSURER A: Burlington Insurance Co. 23620 INSURED Kathryn Mary Bazurto dba: Stages Unlimited INSURER B:Ohlo Security Insurance Co. 24082 INSURER C: State Compensation Insure Fund 35076 P.O. Gilroyy,, CACA 95021 Liberty Mutual Insurance Co INSURER D: rtY 23043 INSURER E : INSURER F : COVERAGES CFRTIFIr:ATFNIIMRFP- RFVICIr1NNIL 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 SUB MILLPOUCYNUMBER POLICY EFF POUCYEXP-LIEL LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X 931 BG0498002 09/15/2022 09/15/2023 EACH OCCURRENCE 11000,000 DAMAGE TO RENTED 260,00 MED EXP (Anyone arson $ 5,000 X PER PROJECT AGG PERSONAL S ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY �X JELPT �LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: B AUTOMOBILE UABILITY COMBINED SINGLE LIMIT (Ea accident) 8 1,000,000 BODILY INJURY Perperson) $ ANY AUTO BAS62263281 10/2612022 10126/2023 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS eER rt AMAGE $X OS ONLY UTgppp AAWW Hired Phys Dmg 50,000 UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS UAB CLAIMS -MADE DED I I RETENTION$ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYYIN OFFICERIMEMBER EXCLUDED?ECUTIVE (Msntlatory in NH) Ms, e undo describe RIPTION FOPERATI NS below NIA 9123183 01/23/2022 01/23/2023 X PER I I OTH. STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 D Liberty Mutual Ins BFS62263281 10/26/2022 10/26/2023 Ramps etc 21,208 All Risk $1,000 Ded. DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) additional insured per attached CG2010 endorsement. Waiver of SubrogationDand Primary Wording included per attached CG2404 and IFGG0094. General The City of Gilroy, its officers, officials and employees are named rGILROYCITY'CLERKYS Liability Limits modified per attached IFGG0065 endorsement. T12 2022 OFFICE CITYGII City of Gilroy 7351 Rosanna Street Gilroy, CA 95020-6197 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 ACORD 25 (2016/03) © 1988.2015 ACORD CORPORATION. All rights reserved. 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O 0 �-a -0 O mO � rnZ 3 m L "d O a>-.- © m N— mra ca� o� i ?. m E = m-0 m CD- o a0 .� O 0 0 1 m C m) m- c L- O ca `) m) m a) D .0 ma o -0 M O o-� m 0 0-a .-- c N= Q or�70-" 0 3 Lac m m m M o m �z� '� c 0 E N t c_ 3 o ma CO 3 e� O 'O _ oC s�Ea�70 m c0 > ��a m p a> > m=mn=a'� w o t` Z U) is ac �'c �3Co pout�N c I—._t� arnc 3Lm2 � CL 0 �j0rn-->-o U O i C O LZ_�"v 2 0 O i t� " Q U tt — I r t Q THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT AND GENERAL AGGREGATE FOR ALL CONSTRUCTION PROJECTS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: Limits: Designated Construction Project General Aggregate Limit General Aggregate For All Projects Combined 'it nn Pntry annears above. information required to as applicable to this endorsement.) A. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which can be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: Each construction project described in a separate written contract. If multiple construction projects are grouped together under one written contract, all such projects will be considered one project and subject to a single general aggregate limit for that contract. General Aggregate Limit as shown in the Commercial General Liability Declarations, IFG-G-0002-DL $ 5,000,000 this endorsement will be shown in the 2. The Designated Construction Project General Aggregate Limit is the most we will pay for the sum of all damages under Coverage A, except damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard", and for medical expenses under Coverage C regardless of the number of: 1. A separate Designated Construction Project a. Insureds; General Aggregate Limit applies to each b. Claims made or "suits" brought; or designated construction project, and that limit is c. Persons or organizations making claims or equal to the amount of the General Aggregate Limit shown in the Declarations. bringing "suits IFG-G-0065 03 17 Includes copyright material of Page 1 of 2 ISO Properties, Inc., with its permission. 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. B. For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A, and for all medical expenses caused by accidents under Section I - Coverage C, which cannot be attributed only to ongoing operations at a single designated construction project shown in the Schedule above: 1. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the amount available under the General Aggregate Limit or the Products -Completed Operations Aggregate Limit, whichever is applicable; and 2. Such payments shall not reduce any Designated Construction Project General Aggregate Limit. C. The most we will pay as damages caused by "occurrences" for all Construction Projects whether designated or not is the General Aggregate For All Construction Projects Combined Limit shown in the Schedule above. D. When coverage for liability arising out of the "products -completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products -completed operations hazard" will reduce the Products -Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction Project General Aggregate Limit. E. If the applicable designated construction project has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. F. The provisions of Section III - Limits Of Insurance not otherwise modified by this endorsement shall continue to apply as stipulated. All other terms and conditions of this Policy remain unchanged. IFG-G-0066 03 17 Includes copyright material of Page 2 of 2 ISO Properties, Inc., with its permission. o 3 Q U cr-I Mi L U ! # m za to > i ; 0; pi CL Q 0�� Q U 3 16Cal u LU f.0 LL V Off. m W f- c r O �-- m CD m co Q¢- E -Q N (' U) w v z ; ..�� sm LLj o j 10 o O �- C.)o 0 . C Q 111 36 ' = C O m U LV I-- �¢ i �`l Oo�`oo�odp a ua LL U) !U : m m °1 0 -0 ma c° e v T :C m co 0z 3 =.�, =o `�uc�'=ems CD O �Q -C 3- COm0(D=- m LL. 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