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HomeMy WebLinkAboutCOI - Jensen Landscape Holdings, LLC - Expires 2022-05-01CERTIFICATE OF LIABILITY INSURANCE DATE(MMJD02YYYY) 05/05/2021 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 Aon Risk Insurance Services west, Inc. Los Angeles CA Office 707 Wilshire Boulevard Suite 2600 CONTACT NAME' PHONE (A/C. No. Ext): (866) 283-7122 aC No.):(800) 363-0105 EMAIL ADDRESS: Los Angeles CA 90017-0460 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Liberty Mutual Fire Ins Co 23035 Jensen Landscape Holdings, LLC; Jensen Landscape Contractor, LLC; Jensen Landscape Services, LLC;Jensen Landscape INSURERB: Starr Indemnity & Liability Company 38318 INSURERC: LM Insurance Corporation 33600 & Construction Company,LLC 1250 Ames Ave. INSURERD: Navigators Specialty Insurance Company 36056 INSURER E: Milpitas, CA 45035 USA INSURER F: COVERAGES CERTIFICATE NUMBER: 570087221126 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X❑ OCCUR TB General Liability EACH OCCURRENCE S1,000,005 PREMISES Ea occurrence $1,000,000 IVIED EXP (Any one person) $10, 000 PERSONAL & ADV INJURY $1, 000, 000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY D PRO- a LOC JECT PRODUCTS - COMP/OPAGG $2,000,000 OTHER: A AUTOMOBILE LIABILITY A52-661-067138-021 Automobile Liability 05/01/202105/01/2022 COMBINED SINGLE Lima (Ea accident) $2,000,000 BODILY INJURY ( Per person) X ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIREDAUTOS NON -OWNED ONLY AUTOS ONLY BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident B UMBRELLA LIAR OCCUR 1000585092211 05 01 2021 05 01 2022 EACH OCCURRENCE $5,000,006 X EXCESS LIAB H CLAIMS -MADE Excess Liability AGGREGATE S5,000,000 DED RETENTION Products / Completed Ops $ 5 , 000 , 000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR / PARTNER EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A wA566DO67138011 workers Compensation. 05 01 2021 05 0 202 X PER STATUTE OTH. ER E.L. EACH ACCIDENT S1,0001000 E.L. DISEASE -EA EMPLOYEE $1, 000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1, 000, 000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) RE: JLS will provide Landscape Maintenance Services to The city of Gilroy at their parks, sound walls, street medians & islands, City buildings, downtown areas and water facility sites. These routine services include plant & tree care, weed/pest control, litter/debris removal, irrigation maintenance and general maintenance such as seasonal leaf removal. City of Gilroy, its officers, officials and employees are included as Additional Insured in accordance with the policy provisions of the General Liability policy. CERTIFICATE HOLDER a L d N T N n 00 0 0 ti uO S R S 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, its officers, officials AUTHORIZED REPRESENTATIVE 7351 and employees Gilroy r Rosanna Street Gilr` CJ�t4�Gf�t GLt x,4 /� ✓ oy CA 95020 USA 01988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD CANCELLATION AGENCY CUSTOMER ID: 570000071309 LOC #: ACORO� ADDITIONAL REMARKS SCHEDULE 0 Page _ of _ AGENCY Aon Risk Insurance Services West, Inc. NAMEDINSURED Jensen Landscape Holdings, LLC; Jensen POLICY NUMBER See Certificate Number: 570087221126 CARRIER See certificate Number: 570087221126 NAIC CODE EFFECTIVE DATE: ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: ACORD 25 FORM TITLE: Certificate of Liability Insurance INSURER(S) AFFORDING COVERAGE NAIC # INSURER INSURER INSURER INSURER ADDITIONAL POLICIES If a policy below does not include limit information, refer to the corresponding policy on the ACORD certificate form for policy limits. INSR LTR 'TYPE OF INSURANCE ADDL INSR S1JRR 1VVD POLICY NUNIBER POLICY EFFECTIVE UA'I'E (AIAI/DD/YYYY) POLICY EXPIRATION UA'1'F. (MNI/DD/YYYY) LIMITS EXCESS LIABILITY D LA21Excz04ZT61C xS Liability $5m xs S5M 05/01/2021 05/01/2022 Aggregate S5,000,000 Each occurrence $5,000,000 Products/Com pleted o 55,000,000 ACORD 101 (2008/01) ® 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ME Policy Number TB2-661-067138-031 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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 A. Section I I— Who I s An I nsured is a mended t o include as a n addi tional i nsured t he p erson(s) or organization(s) s hown i n t he S chedule, but onl y 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 addi tional i nsured(s) at t he I ocation(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 b roader t han t hat w hich y ou ar e required by the contract or agreement to provide for such additional insured. B. With r espect t o t he i nsurance of forded t o t hese additional i nsureds, t he f ollowing addi tional exclusions apply: This insurance does not apply to "bodily injury" or "property dam age" oc curring of ter: 1. All work, including m aterials, parts or equipment f urnished i n connection with s uch work, on the project (other than service, maintenance or repairs) to be performed by or on be half of t he addi tional i nsured(s) at t he location of t he c overed operations has bee n completed; or 2. That po rtion of " your work" out of which t he injury or d amage a rises has be en put t o i is intended use by an y person or organization other than another contractor or subcontractor engaged i n per forming ope rations f or a principal as a part of the same project. C. With r espect t o t he i nsurance of forded t o t hese additional insureds, the following is added to Section III — Limits Of Insurance: If c overage pr ovided t o t he addi tional i nsured i s required by a contract or agreement, the most we will pay on b ehalf of the additional i nsured i s the amount of insurance: 1. Required by the contract or agreement; or 2. Available u nder t he a pplicable Li mits of Insurance shown in the Declarations; whichever is less. This endorsement shall not i ncrease the applicable Limits of Insurance shown in the Declarations. xi CG 20 10 0413 © ISO Properties, Inc., 2012 Page 1 of 2 WE M SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Locations Of Covered Operations Any person or organization whom you are required All locations as required by a written contract or to add as an additional insured on this policy under agreement entered into prior to an "occurrence" a written contract or written agreement prior to an or offense "occurrence." Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Page 2 of 2 © ISO Properties, Inc., 2012 CG 2010 0413 Policy Number T132-661-067138-031 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 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 whom you are required to add as an additional insured on this policy under a written contract or written agreement prior to an "occurrence." All locations as required by a written contract or agreement entered into prior to an "occurrence" or offense. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section I I — Who I s An I nsured is a mended to include as an additional insured the person(s) or organization(s) shown i n t he S chedule, but onl y 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 f or t hat a dditional i nsured and included i n t he" products -completed operations hazard". However: 1. The i nsurance of forded t o s uch add itional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is r equired b y a c ontract or ag reement, t he insurance afforded to such additional insured will not b e b roader t han t hat w hich y ou ar e required by the c ontract or agr eement t o provide for such additional insured. B. With r espect t o the i nsurance of forded t o t hese additional insureds, the following is added to Section III — Limits Of Insurance: If c overage provided t o t he addi tional i nsured i s required by a contract or agreement, the most we will pay on b ehalf of t he additional i nsured i s t he amount of insurance: 1. Required by the contract or agreement; or 2. Available u nder t he appl icable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number TB2-661-067138-031 Issued by LIBERTY MUTUAL FIRE INSURANCE COMPANY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. OTHER INSURANCE AMENDMENT — SCHEDULED ADDITIONAL INSURED This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART Schedule Name of Person(s) or Organization(s): All persons or organizations with whom you have entered into a written contract or agreement, prior to an "occurrence" or offense, to provide additional insured status. If you are obligated under a written agreement to provide liability insurance on a primary, excess, contingent, or any other basis for any person(s) or organization(s) shown in the Schedule of this endorsement that qualifies as an additional insured on this Policy, this Policy will apply solely on the basis required by such written agreement and P aragraph 4. Other I nsurance of Section IV — Conditions will not appl y. W here t he applicable w ritten agreement does not specify on what basis the liability insurance will apply, the provisions of Paragraph 4. Other Insurance of Section IV — Conditions will apply. However, this insurance is excess over any other insurance available to the additional insured for which it is also covered as an additional insured for the same 'occurrence", claim or "suit". LC 24 20 11 18 © 2018 Liberty Mutual Insurance Page 1 of 1 Includes copyrighted material of Insurance Services Office, Inc., with its permission.