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HomeMy WebLinkAboutCOI - Performance Transport - Expires 2025-01-01P5260028002. IIG.� - CERTIFICATE OF LIABILITY INSURANCE OATS (MMIDDIYYYY) 12/26/2023 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($), 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). PRODUCER 1-801-505-6500 Brown, & Brown Inc. 257 East 200 South Suite 700 Salt Lake City, UT 84111 CONTACT NAME: aennifer Stires PHONE FAX _(A10. No WI, 8015056500 (A/C. No): 801-505-6501 E-MAIL ADDRESS: ennifer.stires bbrown.cnm INSURER(51AFFONOINOCOVERAGE NAICII INSURER A: NATIONAL INTERSTATE INS CO 32620 INSURED Performance Transport 11408 Cactus Avenue Bloomington, CA 92316 INSURERS: Upland Specialty Ins Co 16988 INSURER C: VANLINER INS CO 21172 INSURERD: INSURERS: INSURER F: COVERAGES CERTIFICATE NUMBER: 70268635 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 LTR TYPE OF INSURANCE ADDL INSD SOUR WVD POLICY NUMBER POLICY EFF (MMIDDIYYYY) POLICY EXP (MMIDDIYYYY) LIMITS A X COMMERCIAL GENERAL LIABILITY SCG 0000509-06 01/01/24 01/01/25 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 100, 000 MED EXP (Any one person) $ 5,000 PERSONAL&ADVINJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APP_LIESPER: 1 EC L_7 LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS- COMP/OP AGO $ 2,000,000 $ A AUTOMOBILE X LIABILITY ANY AUTO OWNED AUTOS ONLY HIRED AUTOS ONLY SCHEDULED AUTOS NON.OWNED AUTOS ONLY SCR 0000509-06 01/01/24 01/01/25 COMBaccldenqINEDSINGLELIMIT (Ea $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE _Per accident $ $ X UMBRELLALIAB EXCESSLIAB X OCCUR CLAIMS -MADE USXTL0517024 01/01/24 01/01/25 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 DED RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANYPROPRIETOR/PARTNER/EXECUTIVE i N N 1 OFFICER/MEMBEREXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA SCW 0000509-06 01/01/24 01/01/25 g 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 A Motor Truck Cargo CRC 5500509-06 01/01/24 01/01/25 $10,000 Ded 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more apace la required) City of Gilroy is listed as additional insured in regards to the general liability and auto liability polioies per the attached forms. CERTIFICATE HOLDER City of Gilroy 7351 Rosanna Street Gilroy, CA 95020 USA CANCELLATION 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) astiree 70268635 (I 1988.2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD P5260028002 ACORI AGENCY CUSTOMER ID: LOC ft: ADDITIONAL REMARKS SCHEDULE Page AGENCY Brown & Brown Inc. POLICY NUMBER CARRIER ADDITIONAL REMARKS NAIC CODE NAMEDINSURED Performance Transport 11408 Cactus Avenue Bloomington, CA 92316 FPECTIVE DATE; THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: FORM TITLE• ACORD 101 (2008/01) © 2008 ACORD CORPORATION. All rights r The ACORD name and logo are registered marks of ACORD erved, P5260028002 Policy #: SCR0000500-06 COMMERCIAL AUTO NI CA50 570614 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED ENDORSEMENT This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM AUTO DEALERS COVERAGE FORM TRUCKERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. Who Is An Insured under COVERED AUTOS LIABILITY COVERAGE is amended to include as an "insured", any person or organization you are req: tired to add as an additional insured on this policy under a written c:ontract, agreement or permit which must be: a. currently in effect or becoming effective during the term of the policy; and b. executed prior to the "bodily injury" or "property damage." The insurance provided to this additional insured is limited as follows: 1. That person or organization Is an additional insured only with respect to liability arising out of your operations perfermed for that additional insured as specified in the written contract, agreement or permit. 2. The limits of insurance applicable to the additional insured are those in written contract, agreement, permit or in the Declarations for this policy, whichever are less. These limits of insurance are inclusive of and not in addition to the Limit of Insurance for Liability Coverage shown in the Declarations. 3. Coverage is not provided for "bodily injury" or "property damage" arising out of the sole negligence of the additional insured. Any coverage provided hereunder will be excess over any other valid and collectible insurance available to the additional insured whether primary, excess, contingent or on any other basis unless a contract specifically requires that this insurance be primary. VVhen this insurance Is in excess, we will have no duty to defend the additional insured against any "suit" if any other Insurer has a duty to defend the additional Insured against that "suit." If no other Insurer defends, vve will undertake to do so, but we will be entitled to the additional insurer's rights against all those other insurers. All other terms and conditions of this policy remain unchanged. Ni CA 50 57 06 14 Includes copyrighted material of Insurance Services Office, Inc. Page 1 of 1 with its permission. Copyright, Insurance Services Office, Inc.