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HomeMy WebLinkAboutCOI - Evans & DeShazo, Inc. - Expires 2024-08-14EVANS-1 CERTIFICATE OF LIABILITY INSURANCE OP ID: AG DATE (MMIDD/YYYY) 08/10/2023 PRODUCER Open Door Ins Services, Inc. P.O. Box 428 Occidental, CA 95465 Angela Gianni SURED Evans & DeShazo, Inc. Attn: Sally Evans 1141 Gravenstein Hwy. S. Sebastopol, CA 95472 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). 707-874-2666 I ACT Angela Gianni (4JNEC,o, Ext): 707-874-2666 I FAX Ne):707-874-1233 AoRIEss: angela@opendoorins.com INSURER(S) AFFORDING COVERAGE INSURER A; State Comp. Ins. Fund INSURER B : INSURER C : I INSURER D : I INSURER E : I INSURER F : NAIC # 35076 COVERAGES CERTIFICATE NUMBER: 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 'OLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY 'AID CLAIMS. INSR LTR TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PECOT LOC OTHER: AUTOMOBILE LIABILITY ANY AUTO OWNED AUTOS ONLY FO AUTOS ONLY UMBRELLA LIAB SCHEDULED AUTOS NON-OWNEDT EXCESS LIAB DED I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORR/PARTNER/EXECUTIVE Mandatory in NH) EXCLUDED? If yes, describe under DESCRIPTION OF OPERATIONS below OCCUR CLAIMS -MADE YIN INSD w eo POLICY NUMBER (MMIDDIYYYYI I(Mfkt/DDmYY1 N/A X 9139842-2023 1 LIMIT EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Anv one person) PERSONAL & ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OPAGG COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ EACH OCCURRENCE $ AGGREGATE $ X I STATUTE I OOTTH- 08/14/2023 08/14/2024 E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) PROOF OF INSURANCE WAIVER OF SUBROGATION APPLIES CERTIFICATE HOLDER City of Gilroy, its officers, officals and employees 7351 Rosanna Street Gilroy, CA 95020 CANCELLATION 1,000,000 1,000,000 1,000,000 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD ENDORSEMENT AGREEMENT STATE COMP€NS ATI O N' INSURANCE FUND HOME OFFICE SAN FRANCISCO ALL EFFECTIVE DATES ARE AT 12:01 AM PACIFIC STANDARD TIME OR THE TIME INDICATED AT PACIFIC STANDARD TIME WAIVER OF SUBROGATION BLANKET BASIS EFFECTIVE AUGUST 14, 2023 AT 12.01 A.M. AND EXPIRING AUGUST 14, 2024 AT 12.01 A.M. EVANS & DE SHAZO, INC. 1141 GRAVENSTEIN HWY S SEBASTOPOL, CA 95472 WE HAVE THE RIGHT TO RECOVER OUR PAYMENTS FROM ANYONE LIABLE FOR AN INJURY COVERED BY THIS POLICY. WE WILL NOT ENFORCE OUR RIGHT AGAINST THE PERSON OR ORGANIZATION NAMED IN THE SCHEDULE. THIS AGREEMENT APPLIES ONLY TO THE EXTENT THAT YOU PERFORM WORK UNDER,A WRITTEN CONTRACT THAT REQUIRES YOU TO OBTAIN THIS AGREEMENT FROM US. THE ADDITIONAL PREMIUM FOR THIS ENDORSEMENT SHALL BE 2.00% OF THE TOTAL POLICY PREMIUM. SCHEDULE PERSON OR ORGANIZATION ANY PERSON OR ORGANIZATION FOR WHOM THE NAMED INSURED HAS AGREED BY WRITTEN CONTRACT TO FURNISH THIS WAIVER JOB DESCRIPTION BLANKET WAIVER OF SUBROGATION 9139842-23 RENEWAL NA 8-80-44-25 PAGE 1 OF 1 NOTHING IN THIS ENDORSEMENT SHALL BE HELD TO VARY, ALTER, WAIVE OR EXTEND ANY OF THE TERMS, CONDITIONS, AGREEMENTS, OR LIMITATIONS OF THIS POLICY OTHER THAN AS ABOVE STATED. NOTHING ELSEWHERE IN THIS POLICY SHALL BE HELD TO VARY, ALTER, WAIVE OR LIMIT THE TERMS, CONDITIONS, AGREEMENTS OR LIMITATIONS IN THIS ENDORSEMENT. COUNTERSIGNED AND ISSUED AT SAN FRANCISCO: AUGUST 15, 2023 2572 AUTHORIZED REPRESENT IVE PRESIDENT AND CEO