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HomeMy WebLinkAboutCOI - Goodfellow Bros. California, LLC - Expires 2022-06-01AeaRo® CERTIFICATE OF LIABILITY INSURANCE DATE (MMI AE(MMI o21Wn 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 Risk Solution Partners, LLC 800 Bethel Street Suite 201 CONTACT NAME: Christine Yamashita FAX c 808 954-7475 fAIC.No): 80$ 954-7444 ADDR1ESS: cyamashita@-woodruffsawyer.com Honolulu HI 96813 INSURERS AFFORDING COVERAGE NAIC# INSURERA: American Contractors Insurance Co RRG 12300 INSURED GOODFELLOW INSURER B : Goodfellow Bros. California, LLC Goodfellow Top Grade Construction, LLC INSURERC: INSURER D : 50 Contractors Street Livermore CA 94551 INSURER E : INSURER F : COVERAGES CERTIFICATE NUMBER: 102891668 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 INSD SUBR WVVD POLICY NUMBER POLICY EFF MM1DD POLICY EXP MMIDD LIMITS A A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR Y Y GL21AO0015 G L21 B00015 GL21C00015 6/1/2021 6/1/2021 6/1/2021 6/1J2022 6/1 J2022 6/1/2022 EACH OCCURRENCE $10,000,000 PREMISES Ea occurrence $100,000 MED EXP (Any one person) $10,000 X Deductible: $0 PERSONAL & ADV INJURY $10,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO - POLICY a ECT LOC OTHER: GENERAL AGGREGATE $ 10,000,000 PRODUCTS - COMP/OP AGG $ 10,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED Ix NON -OWNED AUTOS ONLY AUTOS ONLY AL21000017 6/1/2021 6J112022 COMBINED SINGLE LIMIT Ea accident $ 5,000,000 X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE Per accident $ UMBRELLALIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED7 (Mandatory in NH) If es, describe under D> SCRIPTION OF OPERATIONS below NIA WCF000009921 6/1/2021 6/1/2022 X PER ERH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $1,000.000 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: PERMITS. Additional Insured if required by written contract: City of Gilroy. Endorsement 933 CERTIFICATE HOLDER CANCELLATION 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 7351 Rosanna Street AUTHORIZEDREPRTATIVE Gilroy CA 95020-6141 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: GWP93311J THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE FORM The provisions of the Coverage Form apply unless modified by this endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured Endorsement Effective DE PAOLI EQUIPMENT INC APRIL 1 2021 Endorsement Number GREAT WEST CASUALTY COMPANY NOBLE WEST INSURANCE SERVICES SCHEDULE Policy Expiration Date: APRIL 1 2022 Name Of Additional Insured Person(s) Or Organization(s): CITY OF GILROY 7351 ROSANNA ST GILROY CA 95020 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Who is an Insured is changed to include as an additional insured the person(s) or organization(s) shown in the SCHEDULE on this endorsement but only to the extent that the liability arises: 1. In the performance of your ongoing operations; or 2. In connection with your premises owned by or rented to you; and only to the extent that the additional insured is vicariously liable for your conduct. 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. The coverage provided by this endorsement shall be subject to all the terms, conditions, and exclusions of the policy and all endorsements attached thereto. C. With respect to the insurance afforded to these additional insureds, the following is added to 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. CG 49 0412 19 Includes copyrighted material Insurance Services Office, Inc. with its permission. Page 1 of 2 4- :a aC:i6�o(Da O U _ L E O m L �c�c�•- O -0 ca O .O O U CIS L N N p U -p O U N O N X �07 O >+Q O N � 20= 2'a) ccca E N CD N CU E N > .L CO O O > U L co U N c0 .O �+ L D �•• >, U :- a) E Q N .E � O a •Q n i O N 0 C1 ar a O O d- U (WABBstate. You'ro In good hands. CERTIFICATE OF INSURANCE Cl CW A02 10 11 This certificate is issued for informational purposes only. It certifies that the policies listed in this document have been issued to the Named Insured. It does not grant any rights to any party nor can it be used, in any way, to modify coverage provided by such policies. Alteration of this certificate does not change the terms, exclusions or conditions of such policies. Coverage is subject to the provisions of the policies, including any exclusions or conditions, regardless of the provisions of any other contract, such as between the certificate holder and the Named Insured. The limits shown below are the limits provided at the policy inception. Subsequent paid claims may reduce these limits. Certificate Holder THE CITY OF GILROY AND ITS MAYOR AND CITY COUNCIL, AGENTS, OFFICERS AND EMPLOYEES 7351 ROSANNA ST GILROY, CA USA 950206141 Named Insured: A. MUNOZ LANDSCAPE CONSTRUCTION INC. 1540 SAN PEDRO AVE MORGAN HILL CA 95037-9651 Automobile Uability Insurer Name: Allstate Insurance Company PolicyNumber 648795266 X 1 -- Any Auto 2 - Owned Autos Only 3 — Owned Priv. Pass. Autos Only 4 -- Owned Autos Other Than Priv. Pass. Autos Only 5 - Owned Autos Subject to No Fault 6 — Owned Autos Subject to a Compulsory UM Law 7 -- Specifically Described Autos 18 - Hired Autos Only 9 — Nonowned Autos Only Policy Effective Date: 0 8- 2 3- 2 0 21 1 Policy Expiration Date: 0 8- 2 3- 2 0 2 2 Limits of $2, 000, 000 Combined Single Limit (each accident) Insurance. BI Per Person BI Per Accident PD Per Accident Description of Operations/Locations/Vehicles /Endorsements /Scial Provisions Interested Party Type: Additional Insured - All Other THIS CERTIFICATE DOES NOT GRANT ANY COVERAGE OR RIGHTS TO THE CERTIFICATE HOLDER. IF THIS CERTIFICATE INDICATES THAT THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED, THE POLICY(IES) MUST EITHER BE ENDORSED OR CONTAIN SPECIFIC LANGUAGE PROVIDING THE CERTIFICATE HOLDER WITH ADDITIONAL INSURED STATUS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED ONLY TO THE EXTENT INDICATED IN SUCH POLICY LANGUAGE OR ENDORSEMENT. Producer FULLER-AGUILERA INS Authorized Representative: Date:06-10-21 Includes copyrighted material of Insurance Services Office, Inc., with its permission BG114-3 CI CW A021011 Allstate Insurance Company Additional Insured Copy Page 1 of 1 QiAlstate. You're in good hands. COMMERCIAL AUTO AA CW 23 0914 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON-CONTRIBUTORY ENDORSEMENT Coverage provided under this policy is modified by the attachment of this endorsement If there is any conflict in coverage provisions between this form and any state specific endorsement also attached to this policy, the provision(s) of the state specific form shall apply. This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM Endorsement Effective: 0 8- 2 3- 2 0 21 Countersigned By: (Authorized Representative) Named Insured: A. MUNOZ LANDSCAPE CONSTRUCTION SCHEDULE Name of Person(s) or Organization(s): THE CITY OF GILROY AND ITS MAYOR AND CITY COUNCIL, AGENTS, OFFICERS AND EMPLOYEES 7351 ROSANNA ST IGILROY, CA USA 950206141 If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement. SECTION IV — BUSINESS AUTO CONDITIONS,B.General Conditions, 5.Other Insurance is modified by this endorsement, only as it applies to any coverage provided to the person or organization designated in the schedule of this endorsement and only to the extent that such person or organization qualifies as an "insured" under this policy. If the named insured has entered into an agreement with the person or organization designated in the Schedule of this endorsement, which requires that the insurance available to them under this policy be applied on a primary and non-contributory basis, the following provision applies: Any coverage provided under this policy to the person or organization designated in the Schedule of this endorsement is primary, and we will not seek contribution from any other Automobile Liability insurance otherwise available to the designated person or organization. 4 Includes copyrighted material of Insurance Services Office, Inc., with its permission BIA14-3 AA CW 23 0914 Allstate Insurance Company Page 1 of 1 Additional Insured Copy QMIIstate.i You're In good hands. POLICY NUMBER: 648795266 COMMERCIAL AUTO CA20481013 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED FOR COVERED AUTOS LIABILITY COVERAGE This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" for Covered Autos Liability Coverage under the Who Is An Insured provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: A. MUNOZ LANDSCAPE CONSTRUCTION Endorsement Effective Date: 0 8- 2 3- 2 0 21 SCHEDULE Name Of Person(s) Or Organization(s): THE CITY OF GILROY AND ITS MAYOR AND CITY COUNCIL, AGENTS, OFFICERS AND EMPLOYEES 7351 ROSANNA ST GILROY, CA USA 950206141 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Each person or organization shown in the Schedule is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "insured" under the Who Is An Insured provision contained in Paragraph A.1. of Section II — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph D.2. of Section 1 — Covered Autos Coverages of the Auto Dealers Coverage Form. tW14-3 CA20481013 © Insurance Services Office, Inc., 2011 Additional Insured Copy Page 1 of 1 RLI INSURANCE COMPANY P.O. Box 3967 1 Peoria, li_ 61612-3967 1 P (800)645-2402 I F (309)683-1610 suretyil@rlicorp.com I www.riisurety.com May 11, 2021 City of Gilroy 7351 Rosanna St. Gilroy, CA 95020 This notice sent certified mail. Return receipt requested. No. 921489690099979016385490 74 NOTICE OF CANCELLATION RE: Bond No: CMS0282648 Amount: $ 1,287,370.00 Principal: Performance Food Group, Inc. Principal's Address: 12500 West Creek Pkwy. Richmond, VA 23238 Obligee: City of Gilroy Description: Property Improvement Agreement -Warehouse Distribution Facility WHEREAS, RLI Insurance Company (hereinafter called the Surety) executed, on the date indicated in the caption, a certain bond as described for and on behalf of the Principal and in favor of the Obligee whose name is written above, and WHEREAS, by the terms of said bond, it is provided that the said Surety shall have the right to terminate its suretyship thereunder by serving notice of its election so to do upon the said Obligee, and WHEREAS, the said Surety desires to take advantage of the terms of said bond as above referred to and does hereby elect to terminate its liability in accordance with the provisions thereof, NOW, THEREFORE, you are hereby notified that RLI Insurance Company shall, on 07/2012021, consider itself released from all liability by reason of any default committed thereafter by said Principal. Signed May 11, 2021 RLI Insurance Company l Michelle Curtale Operations Representative commercial.surety@rlicorp.com MCurtale Obligee Copy Copy sent to Producer - Principal - Obligee L0048_ACT616