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HomeMy WebLinkAboutInsurance Certificate: Chris Gatewood Industries, Inc. DBA Centri TekACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDnriY) 02/21/2025 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 Whitecap Insurance Services 1623 5th Ave Ste A CONTACT Rich Graf NAME:PHONE FAX 415-499-7722 ac No : (415) 479-3962 E-MAIL Rich@whitecapins.com INSURE S AFFORDING COVERAGE NAIC S San Rafael, CA 949011838 INSURER A: James River Insurance Company 12203 INSURED Chris Gatewood Industries, Inc. DBA CentriTek INSURER B : INFINITY SELECT INSURANCE CO 20260 INSURER c : StarNet Insurance Company 40045 506-508 Stone Road Benicia, CA 94510 INSURER D : Ohio Casualty Insurance Company 24074 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 LTR ADDL SUER POLICY NUMBER fmwoorrml fMWDoIYYYYILIMITS A �.. COMMERCIAL GENERAL LIABILITY X X P0000005440 02/13/2025 02/13/2026 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE OCCUR PREMISES Ea occurrence $ 100.000 MED EXP (Any one person) $ 5,000 PERSONAL R ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY JEa LOC ..... _ $ OTHER: B AUTOMOBILE LIABILITY 50007885301 10/28/2024 04/29/2025 CEOMBIINdEDtSINGLELIMIT $ 1.000,000 BODILY INJURY (Per person) $ ANY AUTO OWNED SCHEDULED .AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ _v `HIRED / `. NON -OWNED v AUTOS ONLY C .. AUTOS ONLY $ A-UMBRELLALUIB OCCUR 00152380-1 02/13/2025 02/13/2026 EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 EXCESS LIAR CLAIMS -MADE �/ PER OTH- STATUTE < ER $ DED RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y ANYPROPRIETOR/PARTNER/EXECUTIVE X BNUWC01537BO 03/24/2024 03/24/2025 E.L. EACH ACCIDENT $ 1,000.000 OFFICER/MEMBER EXCLUDED? ❑ ry (Mandatoin NH) NIA E.L. DISEASE - EA EMPLOYEE $ 1 .000,000 E.L. DISEASE - POLICY LIMIT $ 1 .000,000 If yes, describe under DESCRIPTION OF OPERATIONS below D INSTALLATION FLOATER BM063166614 05/25/2024 05/25/2025 Jobsite Limit: $500,000 Deductible: $5,000 Catastrophe Limit: $500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: THE CITY OF ASHLAND THE CITY OF ASHLAND, OREGON, and its officers, agents and employees, are named as Additional Insureds for General Liability for Ongoing Operations and Completed Operations per attached endorsement AP2009US-0410, with Primary & Non -Contributory wording per attached endorsement AP5031 US-0410, and Waiver of Subrogation per attached endorsement CIS 24 04 05 09, and Per Project Aggregate per attached endorsement AP5012US 12-03. Evidence of Business Auto Liability coverage. Evidence of Workers Compensation insurance coverage with Waiver of Subrogation per attached endorsement WC 04 03 06. Excess Liability coverage follows form over the General Liability coverage CERTIFICA I E HULDtR 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 AUTHORIZED REPRESENTATIVE �TI .�` 91 J/_` © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY # P0000005440 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED AS REQUIRED BY WRITTEN CONTRACT This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS SECTION II — Who Is An Insured is amended to include any person or organization you are required to include as an additional insured on this policy by written contract or written agreement in effect during this policy period and executed prior to the "occurrence" of the "bodily injury' or "property damage." The insurance provided to the Additional Insured under this endorsement is limited as follows: 1. The person or organization is only an additional insured with respect to liability arising solely out of "your work" or "your product' which is imputed to the Additional Insured. 2. In the event that the Limits of Insurance provided by this policy exceed the Limits of Insurance required by the written contract or written agreement, the insurance provided by this endorsement shall be limited to the Limits of Insurance required by the written contract or written agreement. This endorsement shall not increase the Limits of Insurance stated in the Declarations. 3. This insurance does not apply to "bodily injury" or "property damage" arising out of "your work" or "your product' included in the "products — completed operations hazard" unless you are required to provide such coverage by written contract or written agreement but only for the period of time required by the written contract or written agreement and only for "bodily injury" or "property damage" that occurs during the policy period arising out of "your work" or "your product'. 4. Any coverage provided by this endorsement to an Additional Insured shall be excess over any other valid and collectible insurance available to the Additional Insured whether primary, excess, contingent or on any other basis. 5. Where no coverage under this policy shall apply for the Named Insured, no coverage or defense shall be afforded to the Additional Insured. 6. This insurance does not apply to "bodily injury' or "property damage" arising out of the sole negligence of the Additional Insured. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP2009US O4-10 Page 1 of 1 POLICY # P0000005440 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NON CONTRIBUTORY ENDORSEMENT This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS Name Of Additional Insured Person(s) I Or Organization(s): If no entry appears above, this endorsement applies to all Additional Insureds covered under l this policy. Any coverage provided to an Additional Insured under this policy shall be excess over any other valid and collectible insurance available to such Additional Insured whether primary, excess, contingent or on any other basis unless a written contract or written agreement specifically requires that this insurance apply on a primary and noncontributory basis. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5031 US O4-10 Page 1 of 1 POLICY NUMBER: P0000005440 COMMERCIAL GENERAL LIABILITY CG 24 04 05 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: Where required by written contract or written agreement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. J The following is added to Paragraph 8. Transfer Of 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. CG 24 04 05 09 © Insurance Services Office, Inc., 2008 Page 1 of 1 13 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 by 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 workers' compensation premium otherwise due on such remuneration. State Schedule 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: 03/24/2024 Policy Number: BNUWC0153780 Endorsement No.: Insured Name. Chris Gatewood Industries, Inc. Insurance Company: StarNet Insurance Company Countersigned By POLICY # P0000005440 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. POLICY LIMITATION - AMENDED AGGREGATE LIMITS OF INSURANCE PER PROJECT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Section III — Limits of Insurance - The General Aggregate Limit applies separately to each "Project' of the Named Insured. Notwithstanding the application of the General Aggregate Limit to each "Project' of the Named Insured, under no circumstances will we pay more than $5,000,000 for all claims under this policy that are subject to the General Aggregate limit. For the purpose of this endorsement, the following definition is added: "Project' means all work done by you or on your behalf, away from premises owned or rented to you, to complete an individual bid or negotiated contract to provide services for a specified period of time. Multiple jobs, work orders, purchase orders, or work done at multiple "locations" under one contract are not separate "projects" within the meaning of this coverage. ALL OTHER TERMS AND CONDITIONS OF THE POLICY REMAIN UNCHANGED. AP5012US 12-03 Includes copyrighted material of Insurance Services Office, Inc., Page 1 of 1 with its permission.