Loading...
HomeMy WebLinkAboutCOI - Sixty-3 Trucking - Expires 2024-09-21ABRD® CERTIFICATE OF LIABILITY INSURANCE I DATE (MM/DD/YYYY) I 9/25/202 ... .1· THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. • CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI I· i BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR 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 CONTACT NAME: (SM) Heffernan Insurance Brokers fl)gNJo Extl: 650-842-5200 I r:,~ No\: 650-842-5201 1820 Gateway Drive, Suite 330 E-MAIL San Mateo CA 94404 ADDRESS: INSURER($\ AFFORDING COVERAGE NAIC# License#: 0564249 INSURER A: GuideOne National Insurance Comoany 14167 INSURED SIXTTRU-01 INSURER B: The Burlington Insurance Company 23620 Sixty-3 Trucking INSURER c: Insurance Comoany of the West 27847 735 Reed Street Santa Clara CA 95050 INSURER D: Oregon Mutual Insurance Company 14907 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 668359171 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. INSR TYPE OF INSURANCE ADDL SUBR ,~~M%YyWv1 ,~g1i!i'f>M-Vv1 LIMITS LTR IN~D WVD POLICY NUMBER B X COMMERCIAL GENERAL LIABILITY 907BG09860-01 9/21/2023 9/21/2024 EACH OCCURRENCE $1,000,000 ~ 0 CLAIMS-MADE 0 OCCUR DAMAGE TO RENTED PREMISES /Ea occurrence) $100,000 ~ MED EXP (Any one person) $ PERSONAL & ADV INJURY ~ $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 Fl POLICY 0 jrg: □ LOG PRODUCTS -COMP/OP AGG $2,000,000 OTHER: $ D AUTOMOBILE LIABILITY CM0925677 9/21/2023 9/21/2024 (E~~~~~d~~tf lNGLE LIMIT $1,000,000 x ANY AUTO BODILY INJURY (Per person) $ ~ OWNED --SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY --AUTOS X HIRED X NON-OWNED rp~?~~c~le~gAMAGE $ AUTOS ONLY AUTOS ONLY 1-- $ A UMBRELLA LIAB MOCCUR 560003210-01 9/21/2023 9/21/2024 EACH OCCURRENCE $2,000,000 x EXCESS LIAB CLAIMS-MADE AGGREGATE $2,000,000 DED I I RETENTION $ $ C WORKERS COMPENSATION WPH 5073167 00 9/21/2023 9/21/2024 X I ~f~TUTE I I OTH- AND EMPLOYERS' LIABILITY ER Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE □ N/A E.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) RE: As Per Contract Or Agreement On File With The Insured. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, -NOTICE WILL BE DELIVERED IN City of Gilroy ACCORDANCE WITH THE POLICY PROVISIONS. Public Works Department 7351 Rosanna Street AUTHORIZED REPRESENTATIVE Gilroy CA 95020 ~~-· I © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD