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HomeMy WebLinkAboutInsurance Certificate: Chris Gatewood Industries dba CentriTek ACR CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD'"YYY) 02/13/2023 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). PRODUCER CONTACT Rich Graf Whitecap Insurance Services PHONEFAX 1623 5th Ave (AIC.No.Ext): 415 499-7722 (A/C No): (415)479-3962 Ste A E-MAILADSS: Rich@whitecapins.com San Rafael,CA 949011838 INSURERS)AFFORDING COVERAGE NAIC# INSURER A: Colony Insurance Company 39993 INSURED Chris Gatewood Industries,Inc.DBA CentriTek INSURER B: California Automobile Insurance Company 38342 506-508 Stone Road •INSURER c: StarNet Insurance Company • 40045 ` Benicia,CA 94510 INSURER D: INSURER E: • INSURER F: ' COVERAGES CERTIFICATE NUMBER: 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 POLICY EFF POLICY EXP/YLIMITS LTR INSD WVD POLICY NUMBER (MM/DDYYY) (MM/DD!YYYY) COMMERCIAL •. A ✓ X X 600GL0194283-02 02/13/2023 02/13/2024 EACH OCCURRENCE• DAMAGE TO RENTED _$ 1,000,000 CLAIMS MADE OCCUR PREMISES(Ea occurrence) $ 100,000 • MED EXP(My one person) $ - 5,000 __ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE _ $ 2,000,000 i POLICY! JEIa LOC PRODUCTS-COMP/OPAGG $ 2,000,000 O• THER: $ B (Ea AUTOMOBILE LIABILITY BA040000073507 04/28/2022 04/28/2023 COMaccident)BINEDSINGLELIMIT $ 1,000,000- 1 ANY AUTO rBODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ ,„.., AUTOS ONLY AUTOS _ HIRED NON-OWNED - PROPERTY DAMAGE $ 4AUTOS ONLY AUTOS ONLY (Per accident) $ A 1 UMBRELLA LIAB OCCUR XS4273401-2 02/13/2023 02/13/2024 EACH OCCURRENCE $ 1,000,000 EXCESS LIAIB CLAIMS-MADE - AGGREGATE $ 1,000,000 I DED I I RETENTION$ 0.00 $ C WORKERS COMPENSATION X BNUWC0153780 03/24/2023 03/24/2024 1/ PER I W- AND EMPLOYERS'LIABILITY .Y ANYPROPRIETOR/PARTNER/EXECUTIVE Y�I f N/A • E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBEREXCLUDED? (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: THE CITY OF ASHLAND I THE CITY OF ASHLAND,OREGON,and its officers,agents and employees,are named as Additional Insureds if required by written contract for Ongoing Operations per attached endorsement CG 20 10 12 19 and Completed Operations per attached endorsement CG 20 37 12 19.Primary&Non-Contributory, wording per attached endorsement CG 20 01 12 19,with Waiver of Subrogation per attached endorsement CG 24 04 05 09.Evidence of Business Auto Liability coverage.Evidence of Workers Compensation insurance coverage with Waiver of Subrogation per attached'endorsement WC 04 03 06 i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF ASHLAND ACCORDANCE WITH THE POLICY PROVISIONS. 20 East Main Street Ashland,OR 97520 AUTHORIZFDREPRESENTATIVE gid • acie ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 600GL0194283-02 COMMERCIAL GENERAL LIABILITY CG 20 10.12 1.9 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED-OWNERS, LESSEES OR CONTRACTORS -SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: _ COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s)Of Covered Operations • Blanket as required by written contract&/or agreement Information required to complete this Schedule,if not shown above,will be shown in the Declarations. A. Section II —Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury","property This insurance does not apply to "bodily injury"or damage" or "personal and advertising injury" "property damage"occurring after: caused, in whole or in part, by: 1. Your acts or omissions;or 1. All work , including materials, parts or equipment furnished in connection with 'such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the bcation(s) location of the covered operations has been designated above. completed; or • However: 2. That portion of "your work" out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its insured only applies to the extent permitted by intended use by any person or organization law;and other than another contractor or subcontractor engaged in performing operations for a 2. If coverage provided to the additional insured is principal as a part of the same project. 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. CG 20 1012 19 © Insurance Services Office,Inc.,2018 Page 1 of 2 • • C. With respect to the insurance afforded to these 2. Available under the applicable Omits of additional insureds, the following is added to insurance; Section 111 —Limits Of Insurance: whicheveris less. I coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement,the most we applicable Omits of insurance. will pay on behalf of the additional insured is the amount of insurance: - - 1. Required by the contract or agreement;or • • • Page 2 of 2 ©Insurance SeNices Office,Inc.,2018 CG 20 10 12 19 POLICY NUMBER:600GL0194283-02 COMMERCIAL GENERAL LIABILITY CG 20'37 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED -OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations Blanket as required by written contract'84/or agreement • Information required to complete this Schedule,f not shown above,will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following is added to organization(s) shown in the Schedule, but only Section III-Limits Of Insurance: with respect to liability for "bodily injury" or f coverage provided to the additional insured_is "property damage" caused,in whole or in part, by required by a contract or agreement,the most we "your work" at the location designated and will pay on behalf of the additional insured is the described in the Schedule of this endorsement amount of insurance: performed for that additional insured and included inthe"products-completed operations hazard". 1. Required by the contract or agreement;or • However: 2. Available under the applicable limits of 1. The insurance afforded to such additional insurance; insured only applies to the extent permitted by whichever is less. law;and This endorsement shall not increase the 2. If coverage provided to the additional insured is applicable limits of insurance. 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. CG 20 37 1219 ©Insurance SeNices Office,Inc.,2018 Page 1 of 1 COMMERCIAL GENERAL LIABILITY -- POLICY NUMBER: 600GL0194283-02 CG 20 01 12 19 • THIS ENDORSEMENT CHANGES THE POLICY. PLEASEREAD IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER ONCONTRIBUTORY -OTHER INSURANCE CONDITION • This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART • PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and (2) You have agreed in writing in a contract or agreement. . ' supersedes any provision to the contrary: thatthis insurance would be primary and would not Primary And Noncontributory Insurance seek contribution from any other insurance available to the additional insured. 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 - • • CG 20 01 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1- • 600 GL 0194283-02 COMMERCIAL GENERAL LIABILITY CG 24 0405 09 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Person Or Organization: All persons or organizations as required by written contract with the Named Insured • Information required to complete this Schedule, if not shown above,will be shown in the Declarations. I he following is added to Paragraph 8.Transfer Ot Rights Of Recovery. Against Others To Us of Section IV-Conditions: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for injury or damage arising out of your ongoing operations or "your work" done under a contract with that person or organization and included in the "products- completed operations hazard". This waiver applies only to the person or organization shown in the Schedule above. • • s . . • CG 24 04 05 09 ©Insurance Services Office, Inc.,2008 Page 1.of 1 POLICY NUMBER: BNUWC0153780 WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 04 03 06 (Ed.04-84) WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA(Blanket) • We have the right to recover our payments from anyone liable for an injury covered byl this policy.We will not enforce our right against the person or organization named in the Schedule. (This agreement applies only to the extent that you perform work-- under a written contract that requires you to obtain this agreement from us.) You must maintain payroll records accurately segregating the remuneration of your employees while engaged in the work described in the Schedule. • The additional premium for this endorsement shall be 0.020000 %of the California orkers'compensation premium otherwise due on such remuneration: . . Schedule • State Description CA Any party with whom the insured agrees to waive subrogation in a written contract. • • • •This endorsement changes the policy to which it is attached and is effective on the date issued unless otherwise stated. (The information below is required only when this endorsement is issued subsequent to preparation of the policy.) Endorsement Effective Date: 03/24/2022 Policy Number: BNUWC0153780 Endorsement No.: 2 Insured Name: Chris Gatewood Industries,Inc. Insurance Company: Star Net Insurance Company Countersigned By •