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HomeMy WebLinkAboutCOI - Quirino Vazquez - Expires 2024-11-27ACC®® CERTIFICATE OF LIABILITY INSURANCE DATE M/ 11/28/2023 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 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 Scurich Insurance Services License #0436405 P.O. Box 1170 CONTACT Suzie Nichols NAME: PHONEAX Ext): (831) 661-5697 (Ac No): (831)661-5741 E-MAIL ADDRESS: suzie@scurichinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # Watsonville CA 95077-1170 INSURER A : Covington Specialty Ins. Co. INSURED Quirino Vazquez, dba: Four Seasons Gardening and La Michuacana Taqueria 835 Green Valley Road Watsonville CA 95076 INSURER B :Evanston Insurance Company INSURERC:SCIF State Compensation Insurance Fund 00123 INSURER D : North American Capacity Insurance Compa INSURER E : INSURERF: COVERAGES CERTIFICATE NUMBER: CL23112807755 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. NOTWITHSTANDINGANY 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 LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF (MM/DD/YYYY) POLICY EXP (MM/DD/YYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY VB24951351 00 11/27/2023 11/27/2024 EACH OCCURRENCE $ 1,000,000 DAMAGE RENTED PREM SESO(Ea occurrence) $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Any one person) $ 5,000 PERSONAL &ADVINJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE X POLICY OTHER: LIMIT APPLIES PRO- JECT PER: LOC PRODUCTS-COMP/OPAGG $ 2,000,000 $ AUTOMOBILE — LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accident) $ $ B X UMBRELLALIAB EXCESS LIAB OCCUR CLAIMS -MADE EZXS3137821 11/27/2023 11/27/2024 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 $ DED X RETENTION $ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below Y / N N /A 9090477-2023 6/1/2023 6/1/2024 X PER STATUTE OTH- ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Liquor Liability 88G2300158-00 8/7/2023 8/7/2024 Liquor Liability Each Common Cause 1,000, 000 Aggregate: 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) re Project Description: sidewalk job The City of Gilroy, its officers, officials, and employees are additional insureds per the attached endorsement GBA 105014 1219. CERTIFICATE HOLDER CANCELLATION City of Gilroy 9/ 7351 Rosanna Street Gilroy, CA 95020 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 Suzie Nichols/VIKKI ACORD 25 (2014/01) INS025 (201401) © 1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Additional Named Insureds Other Named Insureds Club Vasco de Quiroga Not for profit org Four Seasons Gardening Individual, Doing Business As La Michuacana Taqueria Doing Business As Pacos Tacos Doing Business As Taqueria Monarca Doing Business As OFAPPINF (02/2007) COPYRIGHT 2007, AMS SERVICES INC COVINGTON SPECIALTY INSURANCE COMPANY This Endorsement Changes The Policy. Please Read It Carefully. CONTRACTOR COVERAGE EXTENSION ENDORSEMENT - BLANKET ADDITIONAL INSURED - OWNERS, LESSEES, OR CONTRACTORS; PRIMARY AND NONCONTRIBUTORY; BLANKET WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. SECTION 11— WHO IS AN INSURED is amended to include as an additional insured any owner, lessee or contractor for whom you are performing operations or working at their premises when you have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy, but only with respect to liability for 'bodily injury", property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) described above However. 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. Any entity requiring to be specifically listed as additional insured per the terms of the contract or agreement may be listed in the schedule below: Name of Additional Insured Person(s) or Organization(s): B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply_ 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. 2. Claims, "suits" and/or damages arising out of the acts, omissions and/or negligence of the additional insured(s). 3. "Bodily injury" or "property damage" occurring after: Policy No.: VBA951351 00 GBA 105014 1219 Page 1 of 2 a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the site of the covered operations has been completed; or b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to SECTION III — LIMITS OF INSURANCE: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement or 2. Available under the applicable limits of insurance; whichever is less. This endorsement shall not increase the applicable limits of insurance. D. Primary and Noncontributory Provision This insurance is primary to and will not seek contribution from any other insurance available to an additional insured under your policy provided that: 1. The additional insured is a Named Insured under such other insurance; and 2. You have agreed in writing in a contract or agreement that this insurance would be primary and would not seek contribution from any other insurance available to the additional insured, provided such contract or agreement was in place prior to the "occurrence'. E. Waiver of Subrogation Provision The Transfer of Rights of Recovery Against Others To Us Condition (SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS) is amended by the addition of the following: If required as part of a written contract or agreement, we will waive any right of recovery we may have against those who are added as additional insureds by this endorsement because of payment we make for injury or damage arising out of your ongoing operations performed under a contract with them. This waiver applies only when you are solely negligent. This waiver shall not apply to claims, "suits" and/or damages arising in whole or in part out of the acts, omissions, and/or negligence of those added as additional insureds by this endorsement. F. Any written contract or agreement as required by the conditions of paragraphs A, D, or E of this endorsement must be currently in effect or becoming effective during the term of the policy and executed prior to the "bodily injury', `property damage', or "personal and advertising injury". All other terms and conditions of this policy remain unchanged. GBA 1 050141219 Page 2 of 2