The URL can be used to link to this page

Home My WebLink AboutCOI - Quirino Vazquez - Expires 2023-11-27Ali " CERTIFICATE OF LIABILITY INSURANCE DATE (mM/DD yr YI 6/6/2023 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 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 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 CANE: SUZie Nichols PHo" o (831) 661-5697 ac N0: (831)661-5741 SCUrlch Insurance Services E-MAIL suzie@scurichinsurance.com ADDRESS: License #0436405 P.O. BOX 1170 INSURERS AFFORDING COVERAGE NAIC p INSURERA: Covington Specialty Ins. Co. Watsonville CA 95077-1170 INSURED INSURER B: Evanston Insurance Company INSURERC:SCIF State Compensation Insurance Fund 00123 Quirino Vazquez INSURERD:Golden Bear Ins. Co. INSURER E: 835 Green Valley Road INSURER F: Watsonville CA 95076 COVERAGES CERTIFICATE NUMBER: CL236607540 REVISION NUMBER: THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMEDABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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 SUER POLICYNUMBER EFF YY/YYYY MM/DD/YY MMIDDPOLICY Y EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ea.'T'mmce $ 100,000 MED EXP(Any one person) $ 5,000 VBA891025 00 11/27/2022 11/27/2023 PERSONAL a AOV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE S 2,000,000 PRO - PRO- ❑ X POLICY DJECTLOC PRODUCTS - COMP/OPAGG S 2,000,000 S OTHER: E LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO BODILY INJURY (Per accident) $ RMOBIL ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE Per aoodent $ HIREDAUTOS NON -OWNED AUTOS $ X UMBRELLALIAS OCCUR EACH OCCURRENCE $ 1 000 000 AGGREGATE S 1,000,000 B EXCESS LIAR CLAIMS -MADE DEO I X I RETENTION $ 10,000 $ EZM3090078 11/27/2022 11/27/2023 WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YINSTATUTE ANY PROPRIETOR/PARTNERIEXECUTIVE / X PER OTH- ER E.L. EACH ACCIDENT $ 1,000,000 C OFFICERNEMBER EXCLUDED? (Mandatory In NH) NIA (/ 9090477-2023 6/1/2023 6/1/2024 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS bel. E.L. DISEASE -POLICY LIMIT $ 1,000,000 D Liquor Liability TED 5/11/2023 5/11/2024 Each Common Cause: 1,000,000 Aggregate: 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) re Project Description: sidewalk job The City of Gilroy, its officers, officials, and employees are additional insureds per the attached endorsement GBA 105014 1219. VCR I IrliAl C nVLUMM aLIk.11 1V 1I x1i ICI VJa VgryVCLLMI IVIY I "^ ^9 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE JUN (- (. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy 7351 Rosanna Street ^ ACCORDANCE WITH THE POLICY PROVISIONS. Gilroy, CA 9so2o GILROX- ; -: ::'r'., a ;per AUTHORIZED REPRESENTATIVE zie Nichols/VIKKI ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD INS025 (201401) Additional Named Insureds Other Named Insureds Club Vasco de Quiroga Not for profit org lFour Seasons Gardening Individual, Doing Business As ILa Michuacana Taqueria Doing Business As jPacos Tacos Doing Business As ITaqueria Monarca Doing Business As I OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC COVINGTON SPECIALTY INSURANCE COMPANY This Endorsement Changes The Policy. Please Read If Carefully. CONTRACTOR COVERAGE EXTENSION ENDORSEMENT - BLANKET ADDITIONAL INSURED - OWNERS, LESSEES, OR CONTRACTORS; PRIMARY AND NONCONTRIBUTORY; BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION II — WHO IS AN INSURED is amended to include as an additional insured any owner, lessee or contractor for whom you are performing operations or working at their premises when you have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy, 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) described 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. Any entity requiring to be specifically listed as additional insured per the terms of the contract or agreement may be listed in the schedule below: Name of Additional Insured Person(s) or Organization(s): B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. 2. Claims, "suits" and/or damages arising out of the acts, omissions and/or negligence of the additional insured(s). 3. "Bodily injury" or "property damage" occurring after: Policy No.: VBA891025 00 GBA 105014 1219 Page 1 of 2 a. 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 site of the covered operations has been completed; or b. 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. D. Primary and Noncontributory Provision 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, provided such contract or agreement was in place prior to the "occurrence". E. Waiver of Subrogation Provision The Transfer of Rights of Recovery Against Others To Us Condition (SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: If required as part of a written contract or agreement, we will waive any right of recovery we may have against those who are added as additional insureds by this endorsement because of payment we make for injury or damage arising out of your ongoing operations performed under a contract with them. This waiver applies only when you are solely negligent. This waiver shall not apply to claims, "suits" and/or damages arising in whole or in part out of the acts, omissions, and/or negligence of those added as additional insureds by this endorsement. F. Any written contract or agreement as required by the conditions of paragraphs A, D, or E of this endorsement must be currently in effect or becoming effective during the term of the policy and executed prior to the "bodily injury", "property damage", or "personal and advertising injury'. All other terms and conditions of this policy remain unchanged. GBA 105014 1219 Page 2 of 2