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HomeMy WebLinkAboutCOI - John Hagins dba Skylake Tree Service - Expires 2022-05-09___Om1 SKYLAKE-02 APAIVA ACC7RO"" CERTIFICATE OF LIABILITY INSURANCE DATE (MM1DDlYYYY)5/20/2021 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 e��ngqd��oT�rsement(s). PRODUCER NO E;__._FAx _ Assured Partners of CA Insurance Services, LLC dba: Wateridge Insurance PHONE Services (AIc, Ne, Ext): {858) 452.22Q0 _____ .____ 1 (Alc, No):(858) 452-6004 10717 Sorrento Valley Road AMR_ SS__ San Diego, CA 92121 INSURER(Sj AFFORDING COVERAGE NAIC # INSURED John Hagins dba Skylake Tree Service 1095 Ayer Drive Gilroy, CA 95020 . Of The West) ___127847 �....,�.-....re. /►L�TICIf�ATC u��x�o�n. OC%/ICIf%M Ml luc l=o_ .. 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. IN RI TR TYPE OF INSURANCE ADDL SUBRi POLICY NUMBER POLICY EFF ! POLICY EXP LIMITS A I X ! COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR f GENT AGGREGATE LIMIT APPLIES PER: POLICY n PEA LOC OTHER: I X LAN290135803 I 5/9/2021 5/9/2022 EACH OCCURRENCE $ 1'���'��� DAMAGE TO RENTED PREMISES_Ma o�cu ence _ MED EXP(Any one person)_ 100,000 S — _ $ 5'006 $ PERSONAL & ADV INJURY rGENERAL AGGREGATE $2,000,000 PRODUCTS - COMPIOP AGG $ _ 2,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED FIXY-1 SCHEDULED AUTOS ONLY AUTOS X i HIREp ' X.NpN p1�1�.� p L—, AUTOS ONLY i AUTOS OfV LAA290135803 I I 519/2021 { 5/9/2022 COMBINED SINGLE LIMIT BODILY INJURY (Per person) 1,000,000 $__ S g- - BODILY INJURY -(Per accident) pPerr adentpAMAGE ) _( A1 i; i X UMBRELLA LIAR EXCESS LIAB X OCCUR i CLAIMS -MADE i LAX290135800 5/9/2021 EACH OCCURRENCE 5/912022 i AGGREGATE $ 2,000,000 $ 2,000,000 $ DED RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETowPARTNER/EXEcuTivE _ MFILER'MEMB�� EXCLUDE07 LY j andatory in Nii) If yes, describe under DESCRIPTION OF OPERATIONS below I I l NIA I I WSD606078800 6/2412021 i 6/24/2022 i I X PER OTH- STAILI ` E.L. L. EACH ACCIDENT $ 1,000,000 E.LL.DISEASE - EA EMPLOYEE $ 1,OOa,00a i E.L. DISEASE - POLICY LIMIT 1,000,000 $ ' A Equipment Floater !LAN290135803 519/2021 5/912022 Equipment 66,301 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Insured's operations performed under written contract. The City of Gilroy, its Officers, Officials, Representatives, Agents, Employees and Volunteers are named additional insureds with respects to General Liability when required by written contract per form AGCG201OB(12-16). City of Gilroy 7351 Roseanne 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. AUUTTH,,ORRIZ�EED REPRESENTATIVE ACORD 25 (2016103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION BLANKET - AS REQUIRED BY WRITTEN CONTRACT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Policy Effective Date 5/9/2021 Policy Expiration Date 5/9/2022 Named Insured John Hagins DBA Skylake Tree Service If the reouired nolicv information is not shown above. it will be shown in the Declarations. SCHEDULE Name Of Additional Insured Person(s) Or Orcianization(s): I Location(s) Of Covered Operations Any person or organization with whom you agreed, because of a written "insured contract", written agreement or permit, is an insured during the policy period. 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 Blanket as required by written "insured contract". 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. AG CG 2010 B 1216 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 2 with its permission. 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. Page 2 of 2 Includes copyrighted material of Insurance Services Office, Inc. AG CG 2010 B 1216 with its permission.