Loading...
HomeMy WebLinkAboutCOI - Stinger Transport Company - Expires 2022-08-15ACCPR"® CERTIFICATE OF LIABILITY INSURANCE DATEosn 7/2021 /YYYYj 021 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 Sentry Insurance 1800 North Point Drive CONTACT Sentry Customer Service PHONE FAX • 800-4 3- 8 9 • 800-514-7191 EMAIL ADDRESS: business roducts direct0sen .com Stevens Point, WI 54461 INSURER(S) AFFORDING COVERAGE NAIC 9 INSURER A: Sentry Select Insurance Company 21180 INSURED INSURER B : Middlesex 23434 Stinger Transport Company $69 S Van Buren St INSURER C INSURER D : Placentia, CA 92870 INSURER E INSURER F COVERAGES CERTIFICATE NUMBER: 1242600 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 ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD/Y POLICY EXP MM/DD/Y LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE Xn OCCUR X 4949236004 08/15/2021 08/15/2022 EACH OCCURRENCE $ 1.000,000 DAMAGE TO RENTED PREMISES a occurrent S 100,000 MED IXP (Any one person) S 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ji C - LOC OTHER: GENERAL AGGREGATE S 1,000,000 X PRODUCTS - COMP/OP AGG S 1,000,000 $ A AUTOMOBILE LIABILITY X ANY AUTO OW1T05 ONLY SCHEDULED HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 4949236005 08/15/2021 08/15/2022 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE Per accident $ S A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 4949236006 08/15/2021 08/15/2022 EACH OCCURRENCE S 5,000,000 X AGGREGATE S 15,000,000 DED I I RETENTION S PRODUCTS - COMP/OP AGG S 15.000,000 B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE LiN OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ft yes, describe under DESCRIPTION OF OPERATIONS belowE.L. / A 4949236012 08/15/2021 08/15/2022 X PER OTM- STATUTE ER E.L. EACH ACCIDENT S 1,000,000 E.L. DISEASE - EA EMPLOYEE S 1,000.000 DISEASE - POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Refer to attached CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna St Gilroy, CA 95020-6141 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 /4- �—/vV1 y ` ACORD 25 (2016/03) 4949236 Sentry Select Insurance Company 3 00003 0000000727 21168 N A 0 Page 1 of 2 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 06/17/2021 7112945D-A381-497B-A017-BE4139644E1EC 0027020044361253739795020619651 AGENCY CUSTOMER ID: )OW=3771 AC�RU® Loc #: `...•�" ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY Scott Deaver NAMED INSURED Stinger Transport Company POLICY NUMBER 4949236004 CARRIER Senty Select Insurance Company NAIC CODE 21180 EFFECTIVE DATE: 08/15/2021 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certdicate of Liability Insurance General Liability CITY OF GILROY IS NAMED ADDITIONAL INSURED.. ACORD 101 (2008/01) ® 2008 ACORD CORPORATION. All rights reserved. 4949236 The ACORD name and logo are registered marks of ACORD 06/17/2021 Sentry Select Insurance Company POLICY NUMBER: 4949236004 COMMERCIAL GENERAL LIABILITY CG 2010 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) Location(s) Of Covered Operations City of Gilroy All Locations Description: City of Gilroy I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. I 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. CG 2010 0413 4949236 r Sentry Select Insurance Company 5 00003 0000000727 21168 N A 0 a Insurance Services Office, Inc., 2012 5A64EF55-634A-447A-B617-8A526FCFF520 0027020044361254066495020819651 Page 1 of 2 06/17/2021 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. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 2010 0413 4949236 06/17/2021 Sentry Select Insurance Company