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Home My WebLink AboutCOI - Central Square Technologies, LLC - Expires 2022-08-31.AcoREP CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDIYYYY) 09101/2021 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 MARSH USA, INC. TWO ALLIANCE CENTER CONTACT NAME: PHONE FAX Alc No)* E-MAIL ADDRESS. 3560 LENOX ROAD, SUITE 2400 ATLANTA, GA 30326 INSURERS AFFORDING COVERAGE NAIC # INSURER A: The Charter Oak Fire Insurance Co. 25615 CN130114897-EO/C-GAWU-21-22 INSURED Y CentralSquare Technologies, LLC 1000 Business Center Drive INSURER B : Phoenix Insurance Company 25623 INSURER C : Travelers Property Casualty Company Of America 25674 INSURER D : Travelers Casualty And Surety Company 19038 Lake Mary, FL 32746 INSURER E : Columbia Casualty Company 31127 INSURER F : COVERAGES CERTIFICATE NUMBER: ATL-005307032-03 REVISION NUMBER: 0 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 MMIDDIYYYY POLICY EXP MMIDDIYYYY OMITS A X COMMERCIAL GENERAL LIABILITY 630-6S758660-COF-21 08/31/2021 08/3112022 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE a OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,OM,000 POLICY PRO LOC X JECT PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY BA-6S783539-21-13-G 0813112021 031/2022 COMBINED SINGLE LIMIT Ea accident $ 1,000,OW BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ X HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY X UMBRELLA LIAB OCCUR CUP-6S801390-21-13 08/31/2021 08/31/2022 EACH OCCURRENCE $ 10'W0,0W AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED X RETENTION $10 000 $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y 1 N ANYPROPRIETORIPARTNER/EXECUTIVE OFFICERIMEMBEREXCLUDED? �N (Mandatory in NH) N I A UB-6S783668-21-13-G 0813112021 08/31 X STATUTE EH R E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 It yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 E E80/Cyber 652031687 08/31/2021 08/31/2022 Limit 5,000,000 SIR 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) City of Gilroy is included as additional insured where required by written contract with respect to General and Auto Liability. CERTIFICATE HOLDER CANCELLATION City of Gilroy 7351 Rosanna Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Gilroy, CA 95020 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 01988-2016 ACORD CORPORATION. All rights reserved. ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORD V W n L 33 0. � o �/ co Q Cl) CD AGENCY CUSTOMER ID: CN130114897 LOC #: Atlanta A4C<> ADDITIONAL REMARKS SCHEDULE Page 2 of 2 AGENCY MARSH USA, INC. NAMEDINSURED CentralSquare Technologies, LLC 1000 Business Center Drive Lake Mary, FL 32746 POLICY NUMBER CARRIER NAIC CODE EFFECTIVE DATE: AUUI I IUNAL KtMAKK5 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability Insurance Excess E&O/Cyber: Carrier: Certain Underwriters at Lloyd's, London Policy Number. ACX1007921 Effective Date: 08131/2021 Expiration Date: 08/3112022 Limit: $5M x $5M ACORD 101 (2008/01) 0366-01-00-0003299-0002-0007423 O 2008 ACORD CORPORATION. All rights i The ACORD name and logo are registered marks of ACORD Dear Certificate Holder: As many companies have moved to a remote working environment, mailing Certificates of Insurance to a physical address can cause unnecessary delays in providing you proof of insurance. To streamline delivery and in an effort to support our firm's commitment to sustainability, going forward, we would like to distribute your Certificates of Insurance electronically if possible. We are kindly requesting Certificate Holders provide us an email address where we can deliver your COI in the future. Please send your response to: USOperations.email@marsh.com and provide the following information so that we can expedite your COI delivery: • Certificate # (Shown below Insured Name —e.g.: ABC-123456789-01) • E-Mail for future delivery: For undeliverable email addresses, our system is configured to automatically redirect the Certificate for deliveryvia USPS. Lastly, if you no longer need this COI please respond to USOperations.emaiI(@marsh.com with the Certificate number and we will inactive the record in our system to avoid future automatic delivery. Thank you. US Operations, Marsh USA, Inc.