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HomeMy WebLinkAboutCOI - PC, Inc. - Expires 2024-07-02d► �® CERTIFICATE OF LIABILITY INSURANCE oaTE(mmmonTYY) 7/1012023 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 Arthur J. Gallagher Risk Management Services LLC 501 W Main Street Visalia CA 93291 CONTACT NAME: Lexle HUereCa PNONE . 559-635-3574 FAX No), ADoaSEE. b.visalia-2.dons team a' .com INSURERS AFFORDING COVERAGE NAICa INSURER A: Nationwide Mutual Insurance Company 23787 OD693 INSURED PCINCDD'01 PC, Inc. Attn: Mark Crisp P.O. Box 2116 INSURER B: State Com ensafion Insurance Fund Of CA 35076 INSURER C: Capitol Specialty Insurance Corporation 10328 INSURER D: Indian Harbor Insurance Company 36940 INSURER E: Nipom° CA 93444-2116 INSURER F: COVERAGES CERTIFICATE NUMBER: 1845747383 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. LTR ILTR TYPE OF INSURANCE A POLICYNUMBER MMNM'YYF MMIOOYYYY LIMITS C X I COMMERCIAL GENERAL LIABILITY Y CT2020021704 7/2/2023 7/2/2024 EACH OCCURRENCE $1.000,000 CLAIMS -MADE 1XI OCCUR PREMISES Me occu manta $100,000 MED EXP (Any oneDown) $ 5.000 PERSONAL S ADV INJURY $1.000,000 AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 GEN'L POLICY �JECT 1-1LOC PRODUCTS-COMP/OP AGO $2,000,000 $ OTHER: A AUTOMOBILELIABILITY Y ACPSA3068452853 9/20/2022 9/2012023 (Ea Meddentccide IN LE LIMIT $1,000.000 BODILY INJURY (Per person) $ ANY AUTO OWNEAUTOSOONLY ALTOSULED IX X HIRED X NON -OWNED AUTOS ONLY AUTOSONLV BODILY INJURY (Per arFldem) $ PROPERTYDAMAGE Per actltlwl $ $ C UMSRELLAUAB X OCCUR CX2020021604 7/2/2023 7/2/2024 EACH OCCURRENCE $2,000,000 X AGGREGATE $2,000,000 EXCESSLIAB CLAIMS -MADE DED I I RETENTIONS $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE Y/N OFFICERMIEMBEREXCLUOEDT (Mandatory in NH) N/A Y 801475523 2/1/2023 211,2024 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 If yes, describe under DESCRIPTION OF OPERATIONS belgw D Equipment Floater 2819631 9/10/2022 9/10/2023 Rente l/ eased Equip $250.000 DESCRIPTION OF OPERATIONS / LOCATIONS/VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more apace Is required) Re: City Hall Backup Generator, Project No. 21-PW-268. City of Gilroy, Its elected and appointed officers, officials, employees, and volunteers are named additional insured as respects General Liability & Auto Liability per attached forms CG 20 10 12 19, CG 20 37 12 19 & AC 70 04 03 16. Coverage Is primary and non-contributory per forms CG 20 01 12 19 & AC 70 04 03 16 attached. Waiver of Subrogation applies to Workers Compensation per attached SCIF Form 10217 REV. 7-2014. Subject to policy terms and conditions. Revised Cancellation Provisions attached. rflg� JUL 25 2023 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of Gilroy GILROYCRY CLERK'S OFFICE ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Risk Manager 7351 Rosanna Street AUTHORIZEDREPRESENTATIVE Gilroy CA 95020 n USA I Do 1966.2015 ACURU CUHPUHA I IUIN. An rignrs reservea. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Arthur J. Gallagher Risk Management Services, LLC 501 W Main Street Visalia CA 93291 MDG2023 00000696 02 City of Gilroy { Attn: Risk Manager 7351 Rosanna Street Gilroy, CA 95020 We are providing you with a Certificate of Insurance confirming our client's coverage. Want to get certificates of insurance faster? "Go Green with Gallagher" by receiving digital copies of certificates via e-mail in the future. Or, do you no longer require a certificate of insurance for our client? Please contact us at COI.UpdateMyEmail@AJG.com and provide the following information for processing: 1. Confirmation that a certificate of insurance is no longer required; or 2. E-mail address to send future certificates of insurance in lieu of U.S. Mail delivery 3. Insured Code: PCINC00-01 4. This Certificate Number: 1845747383 To learn more about the Insurance and Risk Management Services offered by Gallagher, please visit us at www.ajg.com/us/about-us/how-we-work/core-360. Gallagher does not share your e-mail as detailed in our privacy policy found at https:// www.ajg.com/us/privacy-pol icy/. EEO POLICY NUMBER: CT2020021703 COMMERCIAL GENERAL LIABILITY CG 20 37 1219 THIS ENDOR. oo2Eoa 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 Op erations Any person or organization for whom you are All locations where "your work" is performed as performing "your work", when you and such specified in the contract or written agreement person or organization have agreed in writing in a between you and the Additional Insured(s). contract or agreement that such person or organization be added as an Additional Insured for Completed Operations Coverage on your policy. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only 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 for that additional insured and included in the "products -completed operations hazard". 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. 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. CG20371219 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: CT2020021703 COMMERCIAL GENERAL LIABILITY CG20101219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CT2020021704 ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) I Location(s) Of Covered Operations Any person or organization for whom you are All locations where "your work" is performed as performing "your work" when you and such specified in the contract or written agreement person or organization have agreed in writing in a between you and the Additional Insured(s). contract or agreement that such person or organization be added as an Additional Insured on your policy. I Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, 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) at the location(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 broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 10 1219 C Insurance Services Office, Inc., 2018 Page 1 of 2 NN d 489900 969000 90 CO 000000 N O u) a7 O O a) 4515 0 o� O E-0 L O E ai m E N N +_ = cD ID -0 N L c a) E a) C c +:'- N M Q U c� .— 0 0= �y E c o o cm ' a }. c N-O = Q ca 3a) Q)co O cu - U N r U Q c 7 N uj N a� O N +. O ._ O U L >, O cn to U- .c ( c U 0 aD >, c .N - O O Q 4) (U cr 'Co � N N ccu jp C > h- O O �0 O > U a 0 lad O U _ N a 2::T'3( r 3 H� c.i N� O O V O 4- a) y �; O (0 O -C w �' >. N cn > � w .Q to :• U O (B c0 L O "O o3cE�� N L -oo '0 c U O a) 3Q'�"��: " C 0 j,O '3 C � "-4):3i 0 Oa)Q �L L ,�, N L LO O (a O L O O .ca)LQ"cm a) c o a)'- *- 00� ONQ- co) c L Q-d) a) O c A� O O O� (U Q. E v�o co O �� N� O E o 0 M atm Q- c c -• , � cn rnw 3 4) CL IZ c uy C c rn a)•`-� c -0 "5QOQM> MnL>+o E OOcaLO - V V Q= QO O AO N� Na0M L 4--}'a)o 0 omwM �'E� cE iccc=o-0 _m �.-N � oEor c fl" .o - CL 00W.Caa)t° -0a,,Q O c O cn �C c .Q +� .a •� - % c L m U L p O aU _C Q cno O C V O Qa)3Eo20 t .^ � C.L o(D� ca L Q" N F- cV m N w 0 N a1 R a AC70040316 A. EFFECT OF THIS ENDORSEMENT Coverage provided under this policy is modified by the provisions of this endorsement. If there is any conflict between the provisions of this endorsement and the provisions) of any state - specific endorsement also attached to this poli- cy, then the provision(s) of the state -specific endorsement shall apply instead of the provi- sions of this endorsement that are in conflict, but only to the extent of the conflict, and only to the extent necessary to bring such provisions into conformance with the state requirements) contained in the provislon(s) of the state -specific endorsement. B. TEMPORARY SUBSTITUTE AUTOS — PHYSICAL DAMAGE COVERAGE The following is added to paragraph C. Certain Trailers, Mobile Equipment And Temporary Substitute Autos of the — COVERED AUTOS SECTION: If Physical Damage Coverage is provided by this Coverage Form, the following types of vehicles are also covered "autos" for Physi- cal Damage Coverage: Any "auto" you do not own while used with the permission of its owner as a temporary substitute for a covered "auto" you own that is out of service because of its: a. Breakdown; b. Repair; c. Servicing; d. "Loss"; or e. Destruction The coverage that applies is the same as the coverage provided for the vehicle being replaced. C. EMPLOYEES AS INSUREDS — NONOWNED AUTOS The following is added to paragraph A.1. Who Is An Insured of SECTION 11— COVERED AUTOS LIABILITY COVERAGE: d. Any "employee" of yours is an "Insured" while using a covered "auto" you don't own, hire or borrow in your business or your per- sonal affairs. D. ADDITIONAL INSURED BY CONTRACT, PERMIT OR AGREEMENT or signed by you prior to a "bodily injury" or "property damage" occurrence is an "insured" for Covered Autos Liability Coverage. However, with respect to covered "autos", such person or organization is an insured only to the extent that person or organization qualifies as an "insured" under A.1. Who is an Insured of SECTION II — COVERED AUTOS LIABILITY COVERAGE. If specifically required by the written contract or agreement referenced in the paragraph above, any coverage provided by this en- dorsement to an additional insured shall be primary and any other valid and collectible insurance available to the additional Insured shall be non-contributory with this insurance. If the written contract does not require this cov- erage to be primary and the additional in- sured's coverage to be non-contributory, then this insurance will be excess over any other val- Id and collectible insurance available to the ad- ditional insured. E. PREJUDGMENT INTEREST COVERAGE The following paragraph is added to SECTION II - COVERED AUTOS LIABILITY COVERAGE, Supplementary Payments under item: (7) Prejudgment interest awarded against the "insured" on that part of the judgment we pay. If we make an offer to pay the appli- cable limit of insurance, we will not pay any prejudgment interest based on that period of time after the offer. F. PERSONAL EFFECTS AND PROPERTY OF OTHERS EXTENSION 1. The. Care, Custody or Control Exclusion of the SECTION II — COVERED AUTOS LIABILITY COVERAGE, does not apply to "property damage" to property, other than your property, up to an amount not exceed- ing $250 in any one "accident". Coverage is excess over any other valid and collectible insurance. 2. The following paragraph is added to. Cover- age Extensions of SECTION III — PHYSICAL DAMAGE COVERAGE: c. We will pay up to $500 for your property that is lost or damaged as a result of a covered "loss", without applying a de- ductible. Coverage is excess over any other valid and collectible insurance. The following is added to A.I. Who Is An G. EXPANDED TOWING COVERAGE Insured of SECTION II — COVERED AUTOS 1. We will pay up to: LIABILITY COVERAGE: a. $100 for a covered "auto" you own of Any person or organization that you are the private passenger type, or required to name as an additional insured in a written contract or agreement that is executed Page 2 of 3 Includes copyrighted material of Insurance Services Office, Inc. AC 70 04 0316 with its permission ACPBA3058452853 LTES 17M INSURED COPY AC700=1600 0001 47 001SM b. $250 for a covered "auto" you own that Is not of the private passengertype, for towing and labor costs incurred each time the covered "auto" is disabled. However, the labor must be performed at the place of disablement. 2. This coverage applies only for an "auto" covered on this policy for Comprehensive or Specified Causes of Loss Coverage and Collision Coverages. 3. Payment applies in addition to the otherwise applicable amount of each coverage you have on a covered "auto". H. EXPANDED TRANSPORTATION EXPENSE Paragraph AA.a. of SECTION III - PHYSICAL DAMAGE COVERAGE SECTION is replaced by the following: We will pay up to $50 per day to a maximum of $1000 for temporary transportation expense In- curred by you because of the total theft of a covered "auto" of the private passenger type. We will only pay for those covered "autos" for which you carry Comprehensive or Specified Causes of Loss Coverage. We will pay for tem- porary transportation expenses incurred during the period beginning 48 hours after the theft and ending, regardless of the pollcy's expiration, when the covered "auto" is returned to use or we pay for its "loss" I. EXTRA EXPENSE —STOLEN AUTOS The following paragraph is added to Coverage Extensions. of SECTION III — PHYSICAL DAMAGE COVERAGE: c. We will pay for up to $5,000 for the expense of returning a stolen covered "auto" to you. We will pay only for those covered "autos" for which you cant' Comprehensive or Spec- ified Causes of Loss Coverage J. EMERGENCY LOCKOUT — PRIVATE PASSENGER VEHICLES We will reimburse you up to $75 for reasonable expense incurred for the services of a locksmith to gain entry into your covered "auto" of the pri- vate passenger type subject to these provisions: 1. Your door key or key entry pad has been lost, stolen or locked in your covered "auto" and you are unable to enter such "auto" , or 2. Your key or key entry pad has been lost AC 70 04 0316 or stolen and you have changed the lock to preventan unauthorized entry; and 3. Original copies of receipts for services of a locksmith must be provided before reimbursement is payable. K. TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US The following is added to the Transfer Of Rights Of Recovery Against Others To Us Condition: We waive any right of recovery we may have against any person or organization to the extent required of you by a written con- tract executed prior to any "accident" be- cause of payments we make for damages under this coverage form. L NOTICE OF AND KNOWLEDGE OF OCCURRENCE SECTION IV — BUSINESS AUTO CONDITIONS, Paragraph A is amended as follows: 6. NOTICE OF AND KNOWLEDGE OF OCCURRENCE a. Your obligation in the Duties in the Event of Accident, Claim, Suit or Loss Condi- tion relative to notification require- ments applies only when the "accident" or "loss" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or insurance manager, If you are a corporation. b. Your obligation in the. Duties in the Event of Accident, Claim, Suit or Loss Condition relative to providing us with documents concerning a claim or "suit" will not be considered breached unless the breach occurs after such claim or "suit" is known to: (1) You, if you are an individual; (2) A partner, if you are a partnership; (3) A member, if you are a limited liability company; or (4) An executive officer or insurance manager, if you are a corporation. i AC 70 04 0316 Includes copyrighted material of Insurance Services Office, Inc., Page 3 of 3 with its permission ACPBA3058452853 LTE6 17264 INSURED COPY AC7004031600 0001 47 001=4 CA 0 n r 0 0 C � 2 m m N ^y^ V Y� m m O c D oD G A c y = O C m 29 O v D -i m N � D �p 2 m m m m D Z 2 A m p 4 z N GJ1 r = -0 O 2 3_ M0 m 0 1 On m x DOOZ� -1 O 2 "+7 w D m D..c 0 O N H 1-4'TJ H O z r E O� 7D 2 z 0 w -C ro x o trl IC) Otr1x po WO�rr1 0 -n < N z a th O -n cn x S D O ►-3 cn E "d 7a x rr3 w cn • y e z m a ►-+ trrl c m2v >C)�Ez �� po 0ITfD aN MN En :0 O H z X M Hw0bx-im?mpN 33 y ,4 Uf rr1 ►-z E H tr1 x O w x 0 O t71 ►-i .b 3 O rrf tTl m 3 HOt7trlwo O taa H�z zo�zz m DD <-3 m C171toz 7d Hr cnCH zC i--i to 3 m m 2 tr1x1-c O 0 O z �zx m 300y-1 :0= 7o M � aov >m►d czf:v�-.H An "Wv� rm 7a7d•V 0" 74 r- 2 O O cn � tz N m tr1 t-' 0 W �-3 3O G - xHzN atr1 '4_-� D Hrrlcna H ►-� OC~ r rrJXcn z-1 xzcH O zx Ha0rr1 3 2 O m W" z f� 'r1 �-3 " O x 0 C ('j m 'n O � W C N a z Cl) w `1 -1-i tom'' �-4 �H 33fJ GiD Cy �x xH�� tn m W C� C:=: m 3 m a1 M mm [Onz-1 • Hx r't+7H 0mZm r O G Y� �"0"> z N v Cn k tri cn H 0 o ff 33 O 0 E x z z rH G) E 0 M > -q ►-+ rn cny3D HC o H � 7d� D O D{ z= H En H z '� Z 1730 z r O tr1 9 M -ri m= N :0 m In t7d cmn[ "0O Nr- * r tzrl o O W = < C MMcnm 'a-1cnDD Uf n3D";r- z0 OZDo6' m ; m o3°m z --�'100 z 2Om3.m nm DomDO O �>33 m -� -1 C) D M m m t1J Im Cy n tzj X y "C C 8.4 zm �m W 7° C �D N � N O 3--� N N CD - wH O x H N O N� N O• N � . O U3 cn m tj o Jb co � r N 1 o NO Odtb "a I.d m v m m -z-1 Q m m m m 4 O X m m 0 O REVISED CANCELLATION PROVISIONS Should any of the above described policies be cancelled before the expiration date thereof, the issuing insurer will endeavor to mail 30 days written notice to the certificate holder named, but failure to do so shall impose no obligation or liability of any kind upon the insurer, its agents or representatives. IMPORTANT If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SLIBROGATION 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). DISCLAIMER This Certificate of Insurance does not constitute a contract between the issuing insurer(s), authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend, extend or alter the coverage afforded by the policies listed thereon. ACORD 25 (2009/09)