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HomeMy WebLinkAboutCOI - Giacalone Design Services, Inc. - Expires 2024-06-26ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? INSR ADDL SUBR LTR INSD WVD 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 EXPTYPE 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 RENTEDCLAIMS-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 AGGJECT 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 LIMITDESCRIPTION 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.ACORD 25 (2016/03) CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) $ $ $ $ $ The ACORD name and logo are registered marks of ACORD 8/31/2023 (408) 680-0234 25674 Giacalone Design Services, Inc. 8080 Santa Teresa Boulevard Suite 240 Gilroy, CA 95020 29599 A 2,000,000 X 6801S4383372347 6/26/2023 6/26/2024 1,000,000 5,000 2,000,000 4,000,000 4,000,000 1,000,000A BA1S4406342347G 6/26/2023 6/26/2024 5,000,000A CUP1S45536A2347 6/26/2023 6/26/2024 5,000,000 0 5,000,000 B Professional Liabili USS2333903 6/26/2023 Per Occurrence 3,000,000 B Professional Liabili USS2333903 6/26/2023 6/26/2024 Aggregate 3,000,000 Re: Job #23-171, Gilroy Gourmet Alley, Gilroy, CA. City of Gilroy, its officers, officials and employees are included as an additional insured on General Liability policy per the attached endorsement. City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy, CA 95020 GIACDES-02 SJAYAVARAPU Bozzuto & Associates Insurance Services 34 S 2nd Street Campbell, CA 95008 Mayra Vargas mayrav@dbinsurance.com Travelers Property Casualty Company of America US Specialty Insurance Company P/CO 6/26/2024 X X X X X X X DocuSign Envelope ID: 3A2D5864-FD0E-432E-82E5-DDB70A0C8DD6 DocuSign Envelope ID: 3A2D5864-FD0E-432E-82E5-DDB70A0C8DD6 DocuSign Envelope ID: 3A2D5864-FD0E-432E-82E5-DDB70A0C8DD6 08/14/2023 Marsh Affinity a division of Marsh USA LLC. PO BOX 14404 Des Moines, IA 50306-9686 Marsh Affinity 800-743-8130 ADPTotalSource@marsh.com AIU Insurance Company 19399 A 07/01/2023 07/01/2024 2,000,000 2,000,000 2,000,000 ADP TotalSource DE IV, Inc. 5800 Windward Parkway Alpharetta, GA 30005 L/C/F: Giacalone Design Services, Inc. 8080 SANTA TERESA BLVD STE 240 Gilroy, CA 950200000 WC 034281416 CAX All worksite employees working for Giacalone Design Services, Inc. paid under ADP TOTALSOURCE, INC.'s payroll, are covered under the above stated policy. WAIVER OF SUBROGATION IN FAVOR OF City of Gilroy, its officers, officials and employees AS RESPECTS OF JOB PERFORMED BY Giacalone Design Services, Inc. AS REQUIRED BY WRITTEN CONTRACT. RE: 23-171 Gilroy Gourmet Alley, Gilroy, CA. City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy, CA 95020 X DocuSign Envelope ID: 3A2D5864-FD0E-432E-82E5-DDB70A0C8DD6 WAIVER OF SUBROGATION IN FAVOR OF City of Gilroy, its officers, officials and employees AS RESPECTS OF JOB PERFORMED BY Giacalone Design Services, Inc. AS REQUIRED BY WRITTEN CONTRACT. City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy, CA 95020 RE: 23-171 Gilroy Gourmet Alley, Gilroy, CA. 07/01/2023 WC 034281416 CA AIU Insurance Company ADP TotalSource DE IV, Inc. 5800 Windward Parkway Alpharetta, GA 30005 L/C/F: Giacalone Design Services, Inc. 8080 SANTA TERESA BLVD STE 240 Gilroy, CA 950200000 DocuSign Envelope ID: 3A2D5864-FD0E-432E-82E5-DDB70A0C8DD6 08/10/2023 Marsh Affinity a division of Marsh USA LLC. PO BOX 14404 Des Moines, IA 50306-9686 Marsh Affinity 800-743-8130 ADPTotalSource@marsh.com AIU Insurance Company 19399 A 07/01/2023 07/01/2024 2,000,000 2,000,000 2,000,000 ADP TotalSource DE IV, Inc. 5800 Windward Parkway Alpharetta, GA 30005 L/C/F: Giacalone Design Services, Inc. 8080 Santa Teresa Blvd Ste 240 Gilroy, CA 95020 WC 034281416 CAX All worksite employees working for Giacalone Design Services, Inc. paid under ADP TOTALSOURCE, INC.'s payroll, are covered under the above stated policy. WAIVER OF SUBROGATION IN FAVOR OF City of Gilroy, its officers, officials and employees AS RESPECTS OF JOB PERFORMED BY Giacalone Design Services, Inc. AS REQUIRED BY WRITTEN CONTRACT. RE: 23-171 Gilroy Gourmet Alley, Gilroy, CA City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy, CA 95020 X DocuSign Envelope ID: 3A2D5864-FD0E-432E-82E5-DDB70A0C8DD6 WAIVER OF SUBROGATION IN FAVOR OF City of Gilroy, its officers, officials and employees AS RESPECTS OF JOB PERFORMED BY Giacalone Design Services, Inc. AS REQUIRED BY WRITTEN CONTRACT. City of Gilroy, its officers, officials and employees 7351 Rosanna Street Gilroy, CA 95020 RE: 23-171 Gilroy Gourmet Alley, Gilroy, CA 07/01/2023 WC 034281416 CA AIU Insurance Company ADP TotalSource DE IV, Inc. 5800 Windward Parkway Alpharetta, GA 30005 L/C/F: Giacalone Design Services, Inc. 8080 Santa Teresa Blvd Ste 240 Gilroy, CA 95020 DocuSign Envelope ID: 3A2D5864-FD0E-432E-82E5-DDB70A0C8DD6