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HomeMy WebLinkAboutCOI - Kinnetic Environmental Inc. - Expires 2023-10-12ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXP TYPE OF INSURANCE LIMITS(MM/DD/YYYY)(MM/DD/YYYY) AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE OCCUR $PREMISES (Ea occurrence) MED EXP (Any one person)$ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER:GENERAL AGGREGATE $ PRO- POLICY LOC PRODUCTS - COMP/OP AGG $JECT OTHER:$ COMBINED SINGLE LIMIT $(Ea accident) ANY AUTO BODILY INJURY (Per person)$ OWNED SCHEDULED BODILY INJURY (Per accident)$AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $AUTOS ONLY AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below INSURER(S) AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY Y / N N / A (Mandatory in NH) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE 7/25/2023 ISU INS SERV - BC ENV BROKERAGE 1037 Suncast Ln Ste 103 El Dorado Hills, CA 95762 DINA ATHEY (916)939-1080 (916)939-1085 KINNETIC ENVIRONMENTAL INC. 9057 SOQUEL DRIVE BLDG. C STE B APTOS, CA 95003 ADMIRAL INSURANCE COMPANY 24856 THE TRAVELERS INDEMNITY CO OF CONNECTICUT 25682 STATE COMPENSATION INS. FUND 35076 TRAVELERS PROP.&CAS.CO.OF AMER 25674 A X X X CONT. POLLUTION X Y Y FEI-ECC-35055-01 10/12/22 10/12/23 2,000,000 100,000 10,000 2,000,000 2,000,000 2,000,000 B X X X X Y Y BA-0R843334-23 06/21/23 06/21/24 1,000,000 A X X Y Y FEI-EXS-45022-01 INCL.GL,AUTO,WC 10/12/22 10/12/23 5,000,000 5,000,000 C Y 9264656-22 L&H 905057-22 11/01/22 11/01/22 11/01/23 11/01/23 X 1,000,000 1,000,000 1,000,000 A PROF.E&O(01/01/1990) Y Y FEI-ECC-35055-01 10/12/22 10/12/23 OCC.AGG. $2,000,000 D PROTECTION&INDEMNITY ZOH-81N30571-23 06/21/23 06/21/24 SEE SCHDL $1,000,000 D PROP. 660-0R842534-22 06/21/23 06/21/24 BPP:$635,000 DED. $1,000 RE: ALL OPERATIONS CITY OF GILROY ITS OFFICERS, OFFICIALS AND EMPLOYEES ARE NAMED AS ADDITIONAL INSURED PER THE ATTACHED ENDORSEMENT. THIRTY (30) DAYS WRITTEN NOTICE OF CANCELLATION APPLIES. (ENDORSEMENTS ATTACHED) CITY OF GILROY 7351 ROSANNA STREET GILROY, CA 95020 DocuSign Envelope ID: 151E4EBC-3A56-4FB1-A96E-662991C2059F CG 20 26 07 04 Copyright, Insurance Services Office, Inc., 2004 Endorsement Number: 40 Additional Insured – Designated Person or Organization This endorsement, effective 07/13/2023, attaches to and forms a part of Policy Number FEI-ECC-35055-01. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. In consideration of an additional premium of $150, this endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name and Address of Additional Insured Person(s) or Organizations(s) City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy, CA 95020 Information required to complete this Schedule, if not shown above, will be shown in the Declarations Section II - Who Is An lnsured 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 your acts or omissions or the acts or omissions of those acting on your behalf: A. In the performance of your ongoing operations; or B. In connection with your premises owned by or rented to you. DocuSign Envelope ID: 151E4EBC-3A56-4FB1-A96E-662991C2059F