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HomeMy WebLinkAboutCOI - Sierra Installation, Inc. - Expires 2022-07-01�MMINk SIFRR-A OP ID- KC ACaRU� CERTIFICATE OF LIABILITY INSURANCE `644� DATE(MM/DDNYYY) 1 06/30/2021 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 endorsements . PRODUCER 559-233-0123 Agri -Center Insurance Agency 2650 W. Shaw Lane, Suite 102 Fresno, CA 93711 CONTACT Kim Cameron NAME: PHONE 559-233-0123 FAX 559-266-8858 (A/C, No, Ext): (AIC, No): ADDRESS: kim agrlcenterinSurance.Com Martin McCubbin INSURERS AFFORDING COVERAGE NAIC # INSURER A: Travelers Property Casualty 25674 INSURED Sierra Installation, Inc. P.O. Box 9871 INSURER B : Travelers Casualty Insurance 19046 INSURER C : State Compensation Ins. Fund 35076 INSURER Q Fresno, CA 93794 INSURER E : INSURER F : CQVFRAGFS CERTIFICATE NUMBER- 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 SUBR POLICY NUMBER POLICY EFF M DD POLICY EXP DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE a OCCUR X X 6604916M581 07/01/2021 07101/2022 AMAGE TO RENTED PREM IS Ea occurrence) $ 300,000 MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FX1 pcoi LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY COMBINEDtSINGLE LIMIT (EaX $ 1,000,000 BODILY INJURY Perperson) $ ANY AUTO X X BA2N442475 07/01/2021 07/01/2022 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident $ PROPERTY DAMAGE $ X AUTOS ONLY X NON-OWNED SONL� A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 X EXCESS LIAB CLAIMS -MADE X X CU P4024Y321 07/01/2021 07/01 /2022 AGGREGATE $ 3,000,000 DED I X I RETENTION $ 0 Is C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A 911095920 09/01/2020 09/01/2021 X STATUTE ERI PER H- E.L. EACH ACCIDENT 1,000,000 $ E.L. DISEASE - EA EMPLOYEE $ 1 �������� If yes, describe under DESCRIPTION OF OPERATIONS below E.... DISEASE - POLICY LIMIT 1 $ 1,000,000 A UNSCHEDULED EQUIP 6604916MB81 07/01/2021 07/01/2022 LIMIT 100,000 SPECIAL FORM DIED 1,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS ! VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) City Of Gilroy, its officers, elected or appointed officials, employees, agents and volunteers are included as additional insureds with respects to general liability and auto liability per the attached endorsement forms. Waiver of subrogation applies. CERTIFICATE HOLDER CANCELLATION CITYGIL SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Gilroy Chamber of Commerce THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gilroy c/o Public Works Dept 7351 Rosanna Street AUTHORIZED REPRESENTATIVE r Martin McCubbin - �`%r----,,,..� Gilory, CA 95020 s�»� . ACORD 25 (2016/03) ©1988-2016 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SIERRA INSTALLATIONS, INC. POLICY #6604916M581 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED (Includes Products -Completed Operations If Required By Contract —Excess Insurance) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS b. The insurance provided to such additional The following is added to SECTION II — WHO IS AN insured does not apply to: INSURED: (1) Any "bodily injury", "property damage" or Any person or organization that you agree in a "personal injury" arising out of the providing, written contract or agreement to include as an or failure to provide, any professional additional insured on this Coverage Part is an architectural, engineering or surveying insured, but only: services, including: a. With respect to liability for "bodily injury" or "property damage" that occurs, or for "personal injury" caused by an offense that is committed, subsequent to the signing of that contract or agreement and while that part of the contract or agreement is in effect; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the written contract or agreement applies. Such person or organization does not qualify as an additional insured with respect to the independent acts or omissions of such person or organization. The insurance provided to such additional insured is subject to the following provisions: a. If the Limits of Insurance of this Coverage Part shown in the Declarations exceed the minimum limits required by the written contract or agreement, the insurance provided to the additional insured will be limited to such minimum required limits. For the purposes of determining whether this limitation applies, the minimum limits required by the written contract or agreement will be considered to include the minimum limits of any Umbrella or Excess liability coverage required for the additional insured by that written contract or agreement. This provision will not increase the limits of insurance described in Section III — Limits Of Insurance. (a) The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders or change orders, or the preparing, approving, or failing to prepare or approve, drawings and specifications; and (b) Supervisory, inspection, architectural or engineering activities. (2) Any "bodily injury' or "property damage" caused by "your work" and included in the "products -completed operations hazard" unless the written contract or agreement specifically requires you to provide such coverage for that additional insured during the policy period. c. If the written contract or agreement does not require that the insurance provided under this Coverage Part apply on a primary basis, or a primary and non-contributory basis, then this insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. d. The additional insured must comply with the following duties: (1) Give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: CG D2 50 0419 015086 © 2018 The Travelers Indemnity Company. All rights reserved. Page 1 of 2 COMMERCIAL GENERAL LIABILITY (a) How, when and where the "occurrence" or offense took place; (b) The names and addresses of any injured persons and witnesses; and (c) The nature and location of any injury or damage arising out of the "occurrence" or offense. (2) If a claim is made or "suit" is brought against the additional insured: (a) Immediately record the specifics of the claim or "suit" and the date received; and (b) Notify us as soon as practicable and see to it that we receive written notice of the claim or "suit" as soon as practicable. (3) Immediately send us copies of all legal papers received in connection with the claim or "suit", . cooperate with us in the investigation or settlement of the claim or defense against the "suit", and otherwise comply with all policy conditions. (4) Tender the defense and indemnity of any claim or "suit" to any provider of other insurance which would cover such additional insured for a loss we cover. However, this condition does not affect whether the insurance provided to such additional insured is primary or excess to other insurance available to such additional insured which covers that person or organization as a named insured. Page 2 of 2 O 2018 The Travelers Indemnity Company. All rights reserved. CG D2 50 0419 SIERRA INSTALLATIONS, INC. 6604916M581 5. The following is added to the DEFINITIONS Section: "Incidental medical services" means: a. Medical, surgical, dental, laboratory, x-ray or nursing service or treatment, advice or instruction, or the related furnishing of food or beverages; or b. The furnishing or dispensing of drugs or medical, dental, or surgical supplies or appliances. 6. The following is added to Paragraph 4.b., Excess Insurance, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: This insurance is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to any of your "employees" for "bodily injury" that arises out of providing or failing to provide "incidental medical services" COMMERCIAL GENERAL LIABILITY to any person to the extent not subject to Paragraph 2.a.(1) of Section II — Who Is An Insured. L. BLANKET WAIVER OF SUBROGATION The following is added to Paragraph 8., Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: If the insured has agreed in a contract or agreement to waive that insured's right of recovery against any person or organization, we waive our right of recovery against such person or organization, but only for payments we make because of: a. "Bodily injury" or "property damage" that occurs; or b. "Personal and advertising injury" caused by an offense that is committed; subsequent to the execution of the contract or agreement. CIS D1 86 02 19 02017 The Travelers Indemnity Company. All rights reserved. Page 5 of 5 Induces copyrighted material of Insurance Services Office, Inc. with its permission. SIERRA INSTALLATION POLICY #BA2N442475 COMMERCIAL AUTO THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. AUTO COVERAGE PLUS ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GENERAL DESCRIPTION OF COVERAGE - This endorsement broadens coverage. However, coverage for any injury, damage or medical expenses described.in any of the provisions of this endorsement may be excluded or limited by another endorsement to the Coverage Part, and these coverage broadening provisions do not apply to the extent that coverage is excluded or limited by such an endorsement. The following listing is a general cover- age description only. Limitations and exclusions may apply to, these coverages. Read all the provisions of this en- dorsement and the rest of your policy carefully to determine rights, duties, and what is and is not covered. A. BLANKET ADDITIONAL INSURED B. EMPLOYEE HIRED AUTO C. EMPLOYEES AS INSURED D. SUPPLEMENTARY PAYMENTS -INCREASED LIMITS E. TRAILERS -INCREASED LOAD CAPACITY F. HIRED AUTO PHYSICAL DAMAGE G. PHYSICAL DAMAGE - TRANSPORTATION EXPENSES - INCREASED LIMIT A. BLANKET ADDITIONAL INSURED The following is added to Paragraph A.1:, Who Is a= An Insured, of SECTION If - COVERED AUTOS LIABILITY COVERAGE: Any person or organization who is required under a= a written contract or agreement between you and that person or organization, that is signed and executed by you before the "bodily injury" or "property damage" occurs and that is in effect during the policy period, to be named as an addi- tional insured is an Inssured" for Covered Autos Liability Coverage, but only for damages to which ,— this insurance applies and only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained a= In Section 11. B. EMPLOYEE HIRED AUTO 1. The following is added to Paragraph A.1., v= Who Is An Insured, of SECTION II -.COV- ERED AUTOS LIABILITY COVERAGE: An "employee" of yours is an "insured" while operating a covered "auto" hired or rented under a contract or agreement in an "em- ployee's" name, with your permission, while 1•I. AUDIO, VISUAL AND DATA ELECTRONIC EQUIPMENT- INCREASED LIMIT 1. WAIVER OF DEDUCTIBLE GLASS J. PER80NALPROPERTY K. AIRBAGS L. AUTO LOAN LEASE GAP M. BLANKET WAIVER OF SUBROGATION performing duties related to the conduct of your business. 2. The following replaces Paragraph b. in B.5:, Other Insurance, of SECTION IV - BUSI- NESS AUTO CONDITIONS: b. For Hired Auto Physical Damage Cover- age, the following are deemed to be cov- ered "autos" you own: (1) Any covered "auto" you lease, hire, rent or borrow; and (2) Any covered "auto" hired or rented by your "employee" under a contract in an "employee's" name, with your permission, while performing duties related to the conduct of your busi- ness. However, any "auto" that is leased, hired, rented or borrowed with a driver is not a covered "auto". C. EMPLOYEES AS INSURED The following is added to Paragraph A.1., Who Is An Insured, of SECTION 11- COVERED AUTOS LIABILITY COVERAGE: material of Insurance 004904 Its permission. COMMERCIAL AUTO Any "employee" of yours is an "insured" while us- ing a covered "auto" you don't oviln, hire or borrow in your busiriess or your personal affairs. D. SUPPLEMENTARY PAYMENTS —'INCREASED LIMITS 1. The following replaces Paragraph A.2.a.(2) of SECTION 11— COVERED AUTOS LIABILITY COVERAGE: (2) Up .to $3,000 for cost of ball bonds (in- Ouding bonds for related traffic law viola- tions) required because of an "accident" we cover. We do not have to furnish these bonds. 2. The following replaces Paragraph A.2.a.(4) of SECTION .II -- COVERED AUTOS LIABILITY COVERAGE: (4) All reasonable expenses incurred by the "insured" at our request, including actual loss of earnings up to $500 a day be- cause of time off from work. E. TRAILERS — INCREASED LOAD CAPACITY The following. replaces Paragraph C.I. of SEC- TION I — COVERED. AUTOS: I. "Trailers" with a load capacity of -3,000 pounds or less designed primarily for travel. on public roads. F. HIRED AUTO PHYSICAL DAMAGE The following is added to Paragraph AA., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Hired Auto Physical Damage Coverage If hired "autos" are covered "autos" for Covered Autos Liability Coverage but not covered "autos" for Physical Damage Coverage, and this policy also provides Physical Damage Coverage for an owned "auto", then the Physical Damage Cover- age is extended to "autos" that you hire, rent or borrow subject to the following: (1) The most we will pay for "loss" to any one "auto" that you hire, rent or borrow is •the lesser of: (a) $50,000; (b) The actual cash value of the damaged or stolen property as of the time of the "loss"; or (c) The cost of repairing or replacing the damaged or stolen property with other property of like kind and quality. SIERRA INSTALLATION POLICY #BA2N442475 (2) An adjustment for depreciation and physical condition will be made in determirting actual cash value In the event of a total "loss". (3) If a repair or replacement results in better than like. kind or quality, we will not pay for the amount of betterment. (4) A deductible equal to the highest Physical Damage deductible applicable to any owned covered "auto". (5) This Coverage Extension does not apply to: (a) Any "auto" that is hired, rented or bor- rowed with a driver; or (b) Any "auto" that is hired, rented 'or bor- rowed from your "employee". G. PHYSICAL DAMAGE — TRANSPORTATION EXPENSES —INCREASED LIMIT The following replaces the first sentence In Para- graph AA.a., Transportatiori Expenses, of SECTION III — PHYSICAL DAMAGE COVER- AGE: We will pay up to $50 per day to a maximum of $1,500 for temporary transportation expense in- curred by you because of the total theft of a cov- ered "auto" of the private passenger type. H. • AUDIO,. VISUAL AND DATA ELECTRONIC EQUIPMENT— INCREASED LIMIT Paragraph C.1.b. of SECTION III - PHYSICAL DAMAGE COVERAGE is deleted, I. WAIVER OF DEDUCTIBLE — GLASS The following is added to Paragraph D., Deducti- ble, of SECTION III — PHYSICAL DAMAGE COVERAGE: No deductible for a covered "auto" will apply to glass damage if the glass is repaired rather than replaced. J. PERSONAL PROPERTY The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Personal Property Coverage We will pay up to $400 for "loss" to wearing ap- parel and other personal property which is: (1) Owned by an "insured"; and (2) In or on your covered "auto" This coverage only applies in the event of a total theft of your covered "auto". No deductibles apply to Personal Property cover- age. Page .2 of 3 © 2615 The Travelers Indemnity Company. Ail rights reserved. Includes copyrighted 'material of Insurance Services Office, Inc. with its permission. SIERRA INSTALLATION POLICY #BA2N442475 COMMERCIAL AUTO K. AIRBAGS The following is added to Paragraph B.3., Exclu- sions, of SECTION III — PHYSICAL DAMAGE COVERAGE: Exclusion 3.a. does not apply to "loss" to one or more airbags in a covered "auto" you own that in- flate due. to a cause other than a cause of "loss" set forth in Paragraphs A.Cb. and A.1.c., but only: a. If that "auto" Is a covered "auto" for Compre- hensive Coverage under this policy; b. The airbags are not covered under any war- ranty; and c. The airbags were not Intentionally inflated. We will pay up to a maximum of $1,000 for any one "loss". L. AUTO LOAN LEASE GAP The following is added to Paragraph A.4., Cover- age Extensions, of SECTION III — PHYSICAL DAMAGE.COVERAGE: Auto Loan Lease Gap Coverage for Private Passenger Type Vehicles In the event of a total "loss" to a covered "auto" of the private passenger type shown in the Schedule or Declarations for which Physical Damage Cov- erage is provided, we will pay any unpaid amount due on the lease or loan for such covered "auto" less the following: (1) The amount paid under the Physical Damage Coverage Section of the policy for that "auto; and (2) Any: (a) Overdue lease or loan payments at the time of the "loss"; (b) Financial penalties imposed under a lease for excessive use, abnormal wear and tear or high mileage; (c) Security deposits not returned by the les- sor; (d) Costs for extended warranties, Credit Life Insurance, Health, Accident or Disability Insurance purchased with the loan or lease; and (e) Carry-over balances from previous loans orleases. M. BLANKET WAIVER OF SUBROGATION The following replaces Paragraph A.S,, Transfer Of Rights Of Recovery Against Others To Us, of SECTION IV — BUSINESS AUTO CONDI- TIONS: S. Transfer Of Rights Of Recovery Against Others To Us We waive any right of recovery we may have against any person or organization to the ex- tent required of you by a written contract exe- cuted prior to any "accident" or "loss", pro- vided that the "accident" or"loss" arises out of the operations contemplated by such con- tract The waiver applies only to the person or organization designated in such contract. Includes copyrighted material of Insurance Services Office, Inc. with Its permission. 004065