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HomeMy WebLinkAboutCOI - iTech Solution - Expires 2024-02-12 (2)cc 0 z 2 0 ITECSOL-01 DATE (MM/DD/YYYY) 10/5/2023 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). CONTACT Karen Weddle NAME: PHONEFAX (A/C, No, EXt): (877) 825-2681 (A/C, No):(951) 231-2572 E-MAIL ADDRESS: cal.cpu@hubinternational.com C.) 22306 141840 Z N N M O) ao cC M N INSURER(S) AFFORDING COVERAGE INSURER A: Massachusetts Bay Insurance Company INSURER B _California Automobile Insurance Company INSURER C : Markel American Insurance Company INSURER D : Allmerica Financial Benefit Insurance Company INSURER E : INSURER F : '4c-omo' CERTIFICATE OF LIABILITY INSURANCE PRODUCER License # 0757776 HUB International Insurance Services Inc. 40 E Alamar Ave Santa Barbara, CA 93105 INSURED iTech Solution Miguel Plascencia P.O. Box 270040 San Jose, CA 95127 U) W C9 ce W O 0 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. E O O O 00 00 O N V3 O O O T.. 69 $ 15,0001 O O O 0000 0000 0 N 63 O O O 0 N 63 O O O 0 N 63 O O O 0 N 69 $ 1,000,000I V3 63 V3 63 $ 3,000,0001 $ 3,000,0001 V3 O O O 00 00 O V3 O O © O I- V3 $ 1,000,000I DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Coverage: Professional Liability Policy Number: WG00006109AB Effective Dates: 1/24/2023 -1/24/2024 Limits: Per Claim/Occurrence: $2,000,000 Aggregate: $2,000,000 Retention: $2,500 SEE ATTACHED ACORD 101 EACH OCCURRENCE DAMAGE TO RENTED PREMISES (Ea occurrence) MED EXP (Any one person) PERSONAL 8 ADV INJURY GENERAL AGGREGATE PRODUCTS - COMP/OP AGG RAILROAD LIABIL COMBINED SINGLE LIMIT (Ea accident) BODILY INJURY (Per person) BODILY INJURY (Per accident)__ PROPERTY DAMAGE (Per accident) EACH OCCURRENCE a Et c9 a a X PER OTH- STATUTE ER EL. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L. DISEASE - POLICY LIMIT POLICY EXP (MM/DD/YYYY) V N O N N N d N 0 N t- CT 2/12/2024 4/2/2024 POLICY EFF (MM/DD/YYYY) M N 0 N N N CO 0 N o 2/12/2023 M O N N et POLICY NUMBER LDFA85503307 Cl) N 0 0 0 0 00 7 0 m MPXS3005335 0 0 O CO N I Cl) cc0 a 0 x J a ? x a z TYPE OF INSURANCE COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR POLICY X PRO- LOC JECT OTHER: ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY OCCUR CLAIMS -MADE DED I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below x UMBRELLA LIAB EXCESS LIAB x x z~ Q m 0 0 Z O J J W 0 2 0 ceZ 0 W W W J J WLIJ U Z m U W J y W U W J 26 O oz z� m LLO O a U a } W W W FJ • O • a Q I W W �~ F Z� W O3 O 1- W • Q Z z p XO W 7 0 0 III I I < AUTHORIZED REPRESENTATIVE U a) a) a) a) w L a, z 0 I- Q 0 174 0 0 0 LY 0 Q ▪ O o N a co C) o � N E d a) To N .a, a) d L Ca O a, O C C a3 a) E C C LY 0 0 a) H ACORD 25 (2016/03) KCHANDRA 0 m 0) a EFFECTIVE DATE: SEE PAGE 1 C a) a) U a) U) a) U C N C C 0 v C L a) 0 C m a I x POLICY NUMBER NAIC CODE T T <CD a W CL ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM TITLE: Certificate of Liability Insurance FORM NUMBER: ACORD 25 C d E Q) y .C. O c CC C O 0 •- d y co a o tU y L L L- a) Q. Y Lo o cam. Q C f0 Y a) v. vi L +- .0 3 O o 0) 0 �U d U L w E o L wL > • mE J 0 ma) `L°a o C - C CI) E a7 a a) aco s�.t 0.Co— a o a i z =�o C ._ C 0 o L � w= aw O �' L a)0 -3 Oao.0 0) w 1.0 o >,T• m C O Cr) t O QV I_^ •. T 460 a a)yta >,E ❑U°3 a, N a) Q) In 0) z 0 I- 0 a 0 U NO LL 0 re a 0 00 as No O Y a) E •0 L a co a' L L m 0 0) O co m a) ca CU C 0 0 U d s F• ACORD 101 (2008/01) Insured: iTech Solution N N N N O NO CO ON L0 LC) co Q v7 - Q a) a)> U z• w >, >' U U O 0 d 0_ THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. SUMMARY OF COVERAGES -O a) a U C a) 7 U C -0 a) U C -o C) 0 C "O a) 0 C -o a) 0 C a a) 0 0 C a a) 0 0 C -O a) O U C $ LC) O 0 CV $1000 -O a) a C -O a) a C Additional Insured by Contract, Agreement or Permit Additional Insured — Primary and Non -Contributory Blanket Waiver of Subrogation Bodily Injury Redefined Broad Form Property Damage — Borrowed Equipment, Customers Goods & Use of Elevators Knowledge of Occurrence Liberalization Clause Medical Payments — Extended Reporting Period Newly Acquired or Formed Organizations - Covered until end of policy period Non -owned Watercraft Supplementary Payments Increased Limits - Bail Bonds - Loss of Earnings Unintentional Failure to Disclose Hazards Unintentional Failure to Notify r N CO el' )i) OJ OD O) r r r r 0) v 0 T 0 (O .0 U U -CC.)_ 0 C 0 o 0 O 0 0 CD O a v) (7, U — a) F O 7 -0 -C C a) L L CO E C U— cO 2 O 0 i O O 0 C CO CC)) — 0 4 o 0) ° U - U 0 L - L a) fl o o >, L .L U o U o 70 ai a) a) 0 a) 3 ci)U - L o m L a) -a Lcli E c o co m c� CII 0 0a) CO00u) J _ cO CD O a) Cl) :Eli— C C U • 0 O a) O) C C :-% Nm cc C T O To } "0 0_ a. 0 >- a) C$ O co 5 lS co c- o O C L H.- .ri N. 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H m o) H s_ 0 C H < 0 0 a. 5 < o "- E o o U Q J C L CD m cn C 2La @ CD I- .E CO I-I-.E .E 3 -`n CO 2 U N a) a) 7 C = CD U a) > 7 C > r N M 24 Method Of Sharing insurance Includes copyrighted material of Insurance Services Office, Inc., with its permission. 421-2915 06 15 SECTION I used in your manufacturing process. 10. Non -Owned Watercraft worked on; or (2) A watercraft you do not own that is: CSD SD ca U E .2U O > O a O_ O U a 0_ -0 U) _ n1 0) a) > 0-° .c 0 L � L a a) a) u) C°Ua).2 O c C co Cco ` _Eo) U C ° .0 - C E o O cn -C-C U! cn y ° ca cn fa .0 X > X H a) Q co a) U 0 0•`) t c O O 0 O a)a. a) u) a Q COC L c L cp O) 0 as -O C 0 o = 0 o a) ° U) 73 ° _ a) a) 'ai CO C.) a c ) c m c C O) 2 C O CO .0 > ,2 O t U L Ufa.cn O J Z a Q> Knowledge of Occurrence a) U a)) co ca 0 a) U) a) a) .0 V) C O Q U a) 11. Supplementary Payments Increased Limits U) a a U _ a) 0 ca Za t CO U° Cr O '� O W Qo ca3Q >c o 2 O o O _ U p (ft U) n O Q ° ° a a �c E 0-a Q o co c a) _co ° > O •U) U L cco 3>- aS a)te ouu) ca ° 0) o�0 >,U° _C cc E Z d ��s >° aso •; Uo4O L 4O, L s W 0 O0- U c ❑m o O 0 04--E Q°o° v-0c0 oUa) 4..a0 J vsn° O aO° a) O , Z O (/) O c6 4— C ..O 0 0' 0 Qa O_ O-_C co C U a) u) U° 7 p O c6 '0 ca co.,) n3 N U ca C) ca - 0 0 j 0 CO a° 01 C 0 Za IiiL O O cm-O L L inns) O Et O Q O W O 0- O> U> U W O 'a -Q 'a CI) U T r T. I}— L a) a c C F a) 0 C a) m U >J > Ev- F L u) m co 0 C O Z a r U O CO `° W 0 L 0 a ° o '� O ° 0 -I ''.0' ° OL❑.E ma co c T W cy U ° U ..O U ° ° o X a °W nai �7 ° ° 2 C O C -0aa) COC 0 Eh 0 O -E- co cLa O U O "ul U) a0 c ° ��-°° O)J N ° -0Q= CQZ 0= a) U O L a) O OWF- 7 U"'' ` 0_ E O °2Z0 Z=n.5.5 co F- OU OU 0 a; Liberalization Clause N U Liberalization Clause 12. Unintentional Failure to Disclose Hazards C O) O U J vj N N > O) O O c IAB C 13. Unintentional Failure to Notify a ( c L N C (a Q a O 0 a) L > OJ aj O >'0O O U owo L Ua o o. O W I V O) 0 a) ca •- C 2Q V Ca L ,_>+i °2ZO _ �a °o OO� I- UU 0 c ° °SD 0 a) L a) (3) I a ° W 0 0 ° @ c UT- C9_ c O L 0 W O 4- re a (I) li a L 0 Q O_ ° a) W a co O U a)Q co > a) oEaa�� �C)n. a� O� L ° w c U a 1-1- >, a0i co - >O CO 0) EL 2 � .0 "= axi O a) a as a) = ca O 5 co en o o .4+ .. o 2 QVi m N ° U x W v# c a) c ca ca F- _c > c 0 U) W OI- W > oZ U� --5 - QZ'-' O eW o '--0 0 I >E c 0 � u)o Q 2 E a Q C (..) a 0 C c co a) J )E>, E ' Qa� x°t C gUaca.vA� aO.0 Z° w">_°dO-IC))U ❑ o w ° Um°g1Lfl°�Jai om 0 en C U W u) ° to a) m a).. --a o cn2 c.cn -c F-U 2 o _ a) "- °U co-0 2 d co O t ca d a) C) a a) 0 U a) 4— O U c O .N > O Q a) C a) a) L O a C ° Q N C) (n co d d C N LU E UI o cn IL 0 O O >, m E. I aa) 0 QZ O L 2Qi F u) d W R? Z V) M C 0 a a) -o L ° QQ U L O ° Q a _c ° °) a o > a) O U ALL OTHER TERMS, CONDITIONS, AND EXCLUSIONS REMAIN UNCHANGED. Includes copyrighted material of Insurance Services Office, Inc., with its permission. U, C9 U, rn N WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT-CALIFORNIA E L L 7 O 0`t • a) U co- t 4- 0 C (1) (0 O .0 C = c 3 a) a) a) a) U — O 0.T N C 0 T a) 0 'O O_ N CO N+- • N O E E > ma)O 7 E D7C m a) c .0 E ms a) 0v0) a) C (0 a▪ te) C O U CCn (0 0 >, a)9 C O @ C O cn a7N c c Eo7 >- N C NCO L L C O 7 (0 - O 0) LO U O L O O c 0 O OU N O TC a 0 3 N (0 .'- C (1) N (0 - • Q)C CO (0 L O 0) O 0 a) L C_ a) a) (0 co C a) a) a) .0 N a) a) 0 O_ E a) 0 O C O a) C E a) a) O) C 0) a) a) a) N 7.) (0 0 U (0 N O U N O 7 > (0 N a= C U .— Cn a7 U % of the California workers' compensation premium otherwise N a) (0 N C a) E a) U, O C C a) N L O C I -I a) 0 a) U co Job Description Person or Organization APPLIES AS BLANKET WAIVER FOR THOSE HAVING A WRITTEN CONTRACT WITH THE POLICY- HOLDER REQUIRING WOS FOR WC POLICYHOLDER EMPLOYEES. Endorsement No. No. W23-H219900-03 0 0 0 Endorsement Effective 4/2/2023 0 cn C Insurance CompanyALLMERICA FINANCIAL BENEFIT INSURANCE Countersigned By WC 04 03 06 (Ed 04-84)