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HomeMy WebLinkAboutCOI - PC, Inc. - Expires 2022-07-02�1 ® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDlYYYY) 2/7J2022 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 Arthur J. Gallagher & Co. Insurance Brokers of CA, Inc. LIC #0726293 500 North Santa Fe Visalia CA 93292 CO ACT NAME: LeXie Huereca PHONE -------- FAX . 559-635-3574 A/C No): ADDRESS: g b.visalia-2.dons leam@ajg.com INSURER(S) AFFORDING COVERAGE NAIC # INSURERA: Nationwide Mutual Insurance Company 23787 INSURED PCINC00-01 Attn I Mark Cris p P.O. Box 2116 Nipomo CA 93444-2116 INsuRERe :State Compensation Insurance Fund of CA 35076 -- INSURER C : Capitol Specialty Insurance Corporation P _ _. _..._ _ 10328 t_- 36940 INSURERD: Indian Harbor Insurance Company INSURER E : Greenwich Insurance Company — 22322 INSURER F : COVERAGES CERTIFICATE NUMBER: 2058517309 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 'ADDLJ IJBR - -- --- -- POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD I WVD I POLICY NUMBER MMIODNYYY MMIDDNYY LIMITS C )( COMMERCIAL GENERAL LIABILITY ! Y CT2020021702 712/2021 7/2/2022 I EACH OCCURRENCE I $ 1,000.000 ! _ i _ 1 CLAIMS -MADE OCCUR I t—diA AGE TO REN1'Eb PREMISES (Ea occurrence)__` --`- - --- $100,000 $ 5,000 - — MED EXP (Any one person)— ! PERSONAL & ADV INJURY $ 1.000.000 $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE POLICY 'L� PRO LOC PRODUCTS - COMP,OP AG — $ 2,000,000 i OTHER: $ A AUTOMOBILE LIABILITY Y X I ANY AUTO I ACP3048452853 1 9/20/2021 ' 9120/2022 COMBINED eSINGLE LIMIT BODILY INJURY (Per person) $1,000.000 $ OWNED SCHEDULED (BODILY INJURY (Per accident) I $ AUTOS ONLY ^J AUTOS HIRED NON -OWNED X I AUTOS ONLY X AUTOS ONLY I i PROPERTY DAMAGE $-._„-_-__.,,, _- C i i V UMBRELLA LIAR X OCCUR X EXCESS LIAR CX2020021602 71212021 7/212022 NCH OCCURRENCE $ $ 5,000.000 I CLAIMS MADE AGGREGATE $ 5,000.000 I DIED I RETENTION $ B WORKERS COMPENSATION i Y AND EMPLOYERS' LIABILITY Y / N 901475522 i 2/1/2022 2/1/2023 ;X STATUTE _ ERH _ J ---- ANYPROPRIETORiPARTNERfEXECUTIVE i OFFICER/MEMBEREXCLUDED? ; N / A E.L. EACH ACCIDENT — $ 1,000,000 -- -- - (Mandatory In NH) l E.L. DISEASE • EA EMPLOYEE $1,000,000 If yes, describe under I - DESCRIPTION OF OPERATIONS below ! I ; E.L. DISEASE - POLICY LIMIT $ 1,000,000 D E ProfessionallPollution Liab i Equipment Floater PECO05460302 2819631 712/2021 ; 7/2/2022 Each Occurrence j Rented/Leased $3,000,000 $250,000 j 9110J2021 9110J2022 DESCRIPTION OF OPERATIONS i LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space is required) Re: City Hall Backup Generator, Project No. 21-PW-268. City of Gilroy, its elected and appointed officers, officials, employees, and volunteers are named additional insured as respects General Liability & Auto Liability per attached forms CG 20 10 12 19, CG 20 37 12 19 & AC 70 04 03 16. Coverage is primary and non-contributory per forms CG 20 01 12 19 & AC 70 04 03 16 attached. Waiver of Subrogation applies to Workers Compensation per attached SCIF Form 10217 REV. 7-2014. Subject to policy terms and conditions. Revised Cancellation Provisions attached. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Risk Manager 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 USA-- i ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 2" of 11 661 POLICY NUMBER: CT2020021702 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL IONAL 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 Ornanization(s) Any person or organization for whom you are performing "your work" when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an Additional Insured on your policy. Location(s) Of Covered Operations All locations where "your work" is performed as specified in the contract or written agreement between you acid the Additional Insured(s). I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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. CG20101219 ©Insurance Services Office, Inc., 2018 Pagel of 2 3' of 11 661 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. Page 2 of 2 © Insurance Services Office, Inc., 2018 CG20101219 4' of 11 661 POLICY NUMBER: CT2020021702 COMMERCIAL GENERAL LIABILITY CG20371219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Any person or organization for whom you are All locations where "your work" is performed as performing "your work", when you and such specified in the contract or written agreement person or organization have agreed in writing in a between you and the Additional Insured(s). contract or agreement that such person or organization be added as an Additional Insured for Completed Operations Coverage on your policy. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". 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 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. CG20371219 O Insurance Services Office, Inc.. 2018 Page 1 of 1 S' of 11 661 POLICY NUMBER: ACP3048452853 COMMERCIAL AUTO AC 70 04 03 16 THIS ENDORSEMENT CHANCES THE POLICY. PLEASE READ IT CAREFULLY. BUSINESS AUTO PROTECTION, PLUS This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM SUMMARY OF COVERAGES A. Effect of This Endorsement B. Temporary Substitute Autos — Physical Damage Coverage C. Employees as Insureds— Nonowned Autos D. Additional Insured by Contract, Permit or Agreement E. Prejudgment Interest Coverage F. Personal Effects and Property of Others Extension G. Expanded Towing Coverage H. Expanded Transortation Expense I. Extra Expense —Stolen Autos J. Emergency Lockout K. Transfer Of Rights Of Recovery Against Others To Us L. Section IV— Business Auto Conditions- Notice of Knowledge of Occurrence AC 70 04 0316 ACP3048452853 Includes copyrighted material of Insurance Services Office, Inc. with its permission LTE6 17264 INSURED COPY AC700=1600 0001 Page 1 of 3 47 0015822 6' of 11 661 AC70040316 A. EFFECT OF THIS ENDORSEMENT Coverage provided under this policy is modified by the provisions of this endorsement. If there is any conflict between the provisions of this endorsement and the provision(s) of any state - specific endorsement also attached to this poli- cy, then the provision(s) of the state -specific endorsement shall apply instead of the provi- sions of this endorsement that are in conflict, but only to the extent of the conflict, and only to the extent necessary to bring such provisions into conformance with the state requirement(s) contained in the provision(s) of the state -specific endorsement. B. TEMPORARY SUBSTITUTE AUTOS — PHYSICAL DAMAGE COVERAGE The following is added to paragraph C. Certain Trailers, Mobile Equipment And Temporary Substitute Autos of the — COVERED AUTOS SECTION: If Physical Damage Coverage is provided by this Coverage Form, the following types of vehicles are also covered "autos" for Physi- cal Damage Coverage: Any "auto" you do not own while used with the permission of its owner as a temporary substitute for a covered "auto" you own that is out of service because of its: a. Breakdown; b. Repair; c. Servicing; d. "Loss"; or e. Destruction The coverage that applies is the same as the coverage provided for the vehicle being replaced. C. EMPLOYEES AS INSUREDS — NONOWNED AUTOS The following is added to paragraph A.1. Who Is An Insured of SECTION II -- COVERED AUTOS LIABILITY COVERAGE: d. Any "employee" of yours is an "insured" while using a covered "auto" you don't own, hire or borrow in your business or your per- sonal affairs. D. ADDITIONAL INSURED BY CONTRACT, PERMIT OR AGREEMENT or signed by you prior to a "bodily injury" or "property damage" occurrence is an "insured" for Covered Autos Liability Coverage. However, with respect to covered "autos", such person or organization is an insured only to the extent that person or organization qualifies as an "insured" under A.1. Who is an Insured of SECTION II — COVERED AUTOS LIABILITY COVERAGE. If specifically required by the written contract or agreement referenced in the paragraph above, any coverage provided by this en- dorsement to an additional insured shall be primary and any other valid and collectible insurance available to the additional insured shall be non-contributory with this insurance. If the written contract does not require this cov- erage to be primary and the additional in- sured's coverage to be non-contributory, then this insurance will be excess over any other val- id and collectible insurance available to the ad- ditional insured. E. PREJUDGMENT INTEREST COVERAGE The following paragraph is added to SECTION II - COVERED AUTOS LIABILITY COVERAGE, Supplementary Payments under item: (7) Prejudgment interest awarded against the "insured" on that part of the judgment we pay. If we make an offer to pay the appli- cable limit of insurance, we will not pay any prejudgment interest based on that period of time after the offer. F. PERSONAL EFFECTS AND PROPERTY OF OTHERS EXTENSION 1. The. Care, Custody or Control Exclusion of the SECTION II — COVERED AUTOS LIABILITY COVERAGE, does not apply to "property damage" to property, other than your property, up to an amount not exceed- ing $250 in any one "accident". Coverage is excess over any other valid and collectible insurance. 2. The following paragraph is added to. Cover- age Extensions of SECTION III — PHYSICAL DAMAGE COVERAGE: c. We will pay up to $500 for your property that is lost or damaged as a result of a covered "loss", without applying a de- ductible. Coverage is excess over any other valid and collectible insurance. The following is added to A.I. Who Is An G. EXPANDED TOWING COVERAGE Insured of SECTION II — COVERED AUTOS 1. We will pay up to: LIABILITY COVERAGE: a. $100 for a covered "auto" you own of Any person or organization that you are the private passenger type, or required to name as an additional insured in a written contract or agreement that is executed Page 2 of 3 Includes copyrighted material of Insurance Services Office, Inc. AC 70 04 0316 with itsermission ACP3048452853 LTE6 17264 INBRED copy AC7004031600 Qa01 47 001'5�'311 66, AC 70 04 0316 111 91 b. $250 for a covered "auto" you own that is not of the private passengertype, for towing and labor costs incurred each time the covered "auto" is disabled. However, the labor must be performed at the place of disablement. 2. This coverage applies only for an "auto" covered on this policy for Comprehensive or Specified Causes of Loss Coverage and Collision Coverages. 3. Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". EXPANDED TRANSPORTATION EXPENSE Paragraph A.4.a. of SECTION III - PHYSICAL DAMAGE COVERAGE SECTION is replaced by the following: We will pay up to $50 per day to a maximum of $1000 for temporary transportation expense in- curred by you because of the total theft of a covered "auto" of the private passenger type. We will only pay for those covered "autos" for which you carry Comprehensive or Specified Causes of Loss Coverage. We will pay for tem- porary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the policy's expiration, when the covered "auto" is returned to use or we pay for its "loss" EXTRA EXPENSE — STOLEN AUTOS The following paragraph is added to Coverage Extensions. of SECTION III — PHYSICAL DAMAGE COVERAGE: c. We will pay for up to $5,000 for the expense of returning a stolen covered "auto" to you. We will pay only for those covered "autos" for which you carry Comprehensive or Spec- ified Causes of Loss Coverage EMERGENCY LOCKOUT — PRIVATE PASSENGER VEHICLES We will reimburse you up to $75 for reasonable expense incurred for the services of a locksmith to gain entry into your covered "auto" of the pri- vate passenger type subject to these provisions: 1. Your door key or key entry pad has been lost, stolen or locked in your covered "auto" and you are unable to enter such "auto", or 2. Your key or key entry pad has been lost or stolen and you have changed the lock to preventan unauthorized entry; and 3. Original copies of receipts for services of a locksmith must be provided before reimbursementis payable. K. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: We waive any right of recovery we may have against any person or organization to the extent required of you by a written con- tract executed prior to any "accident" be- cause of payments we make for damages under this coverage form. L- NOTICE OF AND KNOWLEDGE OF OCCURRENCE SECTION IV — BUSINESS AUTO CONDITIONS, Paragraph A is amended as follows: 6. NOTICE OF AND KNOWLEDGE OF OCCURRENCE a. Your obligation in the Duties in the Event of Accident, Claim, Suit or Loss Condi- tion relative to notification require- ments applies only when the "accident" or "loss" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or insurance manager, if you are a corporation. b. Your obligation in the. Duties in the Event of Accident, Claim, Suit or Loss Condition relative to providing us with documents concerning a claim or "suit" will not be considered breached unless the breach occurs after such claim or "suit" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or insurance manager, if you are a corporation. AC70040316 ACP3048452853 Includes copyrighted material of Insurance Services Office, Inc., with its jp3ermission LTE6 17264 INSURED COPY AC7004031600 0001 Page 3 of 3 47 0015=4 8' of 11 661 ENDORSEMENT AGREEMENT BROKER COPY WAIVER OF SUBROGATION BLANKET BASIS HOME OFFICE SAN FRANCISCO EFFECTIVE FEBRUARY 1, 2022 AT 12.01 A.M. ALLEFFECTIVE DATESARE AND EXPIRING FEBRUARY 1, 2023 AT 12.01 A.M. AT 12;01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME PC, INC. PO BOX 2116 NIPOMO, CA 93444 WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE. THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCf7ET)TTI. F. PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION 9014755-22 RENEWAL NE 5-31-78-84 PAGE 1 OF 1 NOTHING IN THIS ENDORSEMENT CONTAINED SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS OF THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SSANN FFRRANCIS�CO: AUTHORIZED REPRESENT IVE SCIF FORM 10217 IRE V.7-2074) JANUARY 25, 2021 PRESIDENT AND CEO 2572 OLD91M 1217 mi POLICY NUMBER: CT2020021702 COMMERCIAL GENERAL LIABILITY CG 20 01 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ��i ��_ ! i � j'� ��. ( •y, �._. i. 3 •I 3 i• f` .- ;�, i-i f f 1� ` This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: (1) The additional insured is a Named Insured under such other insurance; and (2) You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured. CG2001 1219 O Insurance Services Office, Inc., 2018 Page 1 of 1 10' of 11 661 REVISED CANCELLATION PROVISIONS Should any of the above described policies he cancelled before the expiration date thereof, the issuing insurer i ill endeavor to mail 30 days written notice to the certificate holder nained, but failure to do so sliall impose no obligation or liability of any Bind upon the insurer, its agents or representatives. If the certificate holder is an ADDITIC)NAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsenient(s). If SI_IBR(_--)GATI(_)N IS WAIVED_ ,tj[ jec:l to the ierins <ind conditions of ilie policy. certain policies may require an endorsement. A statement on this certificate does not collier rights to the certificate holder In lieu of Such ondorsement(s). DISCLAIMER 1'llis Certificate of Insurance dot's not constitute a contract bct-N een the issuing insurer(s), aiithoriaed representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded her the policies listed thereon. ACORD 25 (2009/09) 11' of 11 661