Loading...
HomeMy WebLinkAboutCOI_ Pavement Coatings Co_9.26.24SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. INSURER(S) AFFORDING COVERAGE INSURER F : INSURER E : INSURER D : INSURER C : INSURER B : INSURER A : NAIC # NAME:CONTACT (A/C, No):FAX E-MAILADDRESS: PRODUCER (A/C, No, Ext):PHONE INSURED REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES 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). 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. OTHER: (Per accident) (Ea accident) $ $ N / A SUBR WVD ADDL INSD 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. $ $ $ $PROPERTY DAMAGE BODILY INJURY (Per accident) BODILY INJURY (Per person) COMBINED SINGLE LIMIT AUTOS ONLY AUTOSAUTOS ONLY NON-OWNED SCHEDULEDOWNED ANY AUTO AUTOMOBILE LIABILITY Y / N WORKERS COMPENSATION AND EMPLOYERS' LIABILITY OFFICER/MEMBER EXCLUDED? (Mandatory in NH) DESCRIPTION OF OPERATIONS below If yes, describe under ANY PROPRIETOR/PARTNER/EXECUTIVE $ $ $ E.L. DISEASE - POLICY LIMIT E.L. DISEASE - EA EMPLOYEE E.L. EACH ACCIDENT EROTH-STATUTEPER LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCESS LIAB UMBRELLA LIAB $EACH OCCURRENCE $AGGREGATE $ OCCUR CLAIMS-MADE DED RETENTION $ $PRODUCTS - COMP/OP AGG $GENERAL AGGREGATE $PERSONAL & ADV INJURY $MED EXP (Any one person) $EACH OCCURRENCE DAMAGE TO RENTED $PREMISES (Ea occurrence) COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO-JECT LOC CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) CANCELLATION AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. CERTIFICATE HOLDER The ACORD name and logo are registered marks of ACORD HIRED AUTOS ONLY 9/26/2024 Alliant Insurance Services,Inc. 333 S Hope St Ste 3750 Los Angeles CA 90071 Yvonne Galvan 213-402-0232 800-383-1852 yvonne.galvan@alliant.com St.Paul Surplus Lines Insuran 30481 PAVERE Travelers Property Casualty Co of America 25674PavementCoatingsCo. 10240 San Sevaine Way Jurupa Valley,CA 91752 1359320172 B X 2,000,000 X 300,000 10,000 2,000,000 4,000,000 X Y Y VTC2J-CO-9325B35A-TIL-24 10/1/2024 10/1/2025 4,000,000 B 2,000,000 X X Physical Dam X Comp/Coll De Y Y VTC2J-CAP-9325B361-TIL-24 10/1/2024 10/1/2025 B X X 5,000,000YCUP-4R62990A-24-25 10/1/2024Y 10/1/2025 5,000,000 B X N Y UB-9K16850A-24-25-K 10/1/2024 10/1/2025 1,000,000 1,000,000 1,000,000 A Pollution Liability Y Y ZCE -41N82484 10/1/2024 10/1/2025 Each Condition Aggregate 2,000,000 4,000,000 Re:MSA County of San Bernardino-Road and Materials Agreement for Pavement Coatings,Co. County of San Bernardino/County Flood Control District and its officers,employees,agents and volunteers is included as Additional Insured as respects Liability arising out of work performed by the Named Insured.The insurance provided shall be primary and any other insurance maintained by the Additional Insured is excess and non-contributory.Waiver of Subrogation applies as required by contract. 30 days’notice of cancellation will be provided to Certificate Holder,except 10 days’notice for cancellation for non-payment of premium. County of San Bernardino/County Flood Control District and its officers,employees,agents and volunteers Department of Public Works 825 East Third Street Room 120 San Bernardino CA 92415-0835 4. Other Insurance A B a. b. of: of 5. 4. (iv) of c. of a. Primary Insurance ance is primary except when arag b. li ry ffect ry w wit ll y od c. wh ap d. b. Excess Insurance (1) This u : (a) h an et ry ti : (i)That F xten v Buil w B damage"; (iii) en en (iv) 4. ag d. (v) 5. d. (b) et ry (2) w A B en w (3) h : (a) u of (b) ­ (4) ill ,I , w s w fi ly D rat g CG T1000219 © 2017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office, Inc. with its permission. ag 15 of 21 c. Method Of Sharing of of of of d. Primary And Non-Contributory Insurance If Required By Written Contract il ic ve m we will share with that sace, ovi : (1) The "jry""perty " ic ve oc; (2) T "veg jry"fo ic ve t y ff om; eq of ra ag 5. Premium Audit a. W fo Cve ac wi b. n ve rt ad m will m m fo s n fo y will t of n y 6. Representations y y a. T om ; b. t ad t ; W ve y y ff wi 7. Separation Of Insureds of y n vera rt t : a. ac b. 8. Transfer Of Rights Of Recovery Against Others To Us ve ad veag t m eq " 9. When We Do Not Renew ve t of of SECTION V-- DEFINITIONS 1. "ad y of of his definition: a. l ri of ; b. egar eb y eb bo oo rv fo rp ti rs rt vert 16 21 02017 The Travelers Indemnity Company. All rights reserved. Includes copyrighted material of Insurance Services Office Inc with its permission CG T1 000219