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HomeMy WebLinkAboutCOI_ W & J Lazaro Inc DBA Alexis TruckingSHOULD 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 11/18/2024 Navo Financial, Inc. Insurance and Financial Solutions 2045 South Court Street, Suite A Visalia CA 93277 Certificates (559) 733-5169 (888) 456-0130 certs@navofinancial.com W & J Lazaro, Inc DBA Alexis Trucking 34717 M ST BARSTOW CA 92311-4222 BURLINGTON INS CO 23620 SECURITY NATL INS CO 19879 GEMINI INS CO 10833 OMAHA NATIONAL CAS CO 32107 JAMES RIVER INS CO 12203 A ✘ ✘ ✘ Y Y 150B017936 07/13/2024 07/13/2025 2,000,000 100,000 5,000 2,000,000 2,000,000 2,000,000 B ✘ ✘ ✘ Y Y SMC181546001 11/17/2024 11/17/2025 1,000,000 C ✘ ✘ Y Y GSV500139702 11/17/2024 11/17/2025 4,000,000 4,000,000 D Y Y ONCC08642-07 10/18/2024 10/18/2025 ✘ 1,000,000 1,000,000 1,000,000 E UMBRELLA Y Y 00145927-2 11/17/2024 11/17/2025 EACH OCCURRENCE $1,000,000 AGGREGATE $1,000,000 San Bernardino Country Inc is listed with a waiver of subrogation per written contract or agreement per attached workers compensation endorsement. San Bernardino County Department of Public Works 825 East Third Street, Room 120 San Bernardino CA 92415 POLICY NUMBER: THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED CONSTRUCTION PROJECT(S) GENERAL AGGREGATE LIMIT AND GENERAL AGGREGATE FOR This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Projects: Limits: Designated Construction Project General Aggregate Limit as shown in the Commercial General Aggregate Limit General Liability Declarations, IFG-G-0002-DL General Aggregate For All Projects $ Combined A. "occurrences" under Section I - Coverage A, and Section I - Coverage C designated construction project shown in the 1. 2. sum of all damages under Coverage A, except operations hazard", and for medical expenses C a. b. Claims made or "suits" brought; or c. Persons or organizations making claims or IFG-G-0065 03 17 Page 1 of 2 All project(s) for which you are actively performing your construction operations, that have been agreed to in a written contract or written agreement provided such written contract or written agreement is fully executed prior to an "occurrence" in which coverage is sought under 3. Any payments made under Coverage A for damages or under Coverage C for medical expenses shall reduce the Designated Construction Project General Aggregate Limit for that designated construction project. Such payments shall not reduce the General Aggregate Limit shown in the Declarations nor shall they reduce any other Designated Construction Project General Aggregate Limit for any other designated construction project shown in the Schedule above. 4. The limits shown in the Declarations for Each Occurrence, Damage To Premises Rented To You and Medical Expense continue to apply. However, instead of being subject to the General Aggregate Limit shown in the Declarations, such limits will be subject to the applicable Designated Construction Project General Aggregate Limit. B.For all sums which the insured becomes legally obligated to pay as damages caused by "occurrences" under Section I - Coverage A, and Section I - Coverage C attributed only to ongoing operations at a single 1. A C 2. C. "occurrences" for all Construction Projects whether designated or not is the General Aggregate For All Construction Projects Combined Limit shown in D. "products-completed operations hazard" is provided, any payments for damages because of "bodily injury" or "property damage" included in the "products-completed operations hazard" will reduce the Products-Completed Operations Aggregate Limit, and not reduce the General Aggregate Limit nor the Designated Construction E. has been abandoned, delayed, or abandoned and then restarted, or if the authorized contracting parties deviate from plans, blueprints, designs, specifications or timetables, the project will still be deemed to be the same construction project. F. Section III Limits Of Insurance All other terms and conditions of this Policy remain unchanged. IFG-G-0065 03 17 Page 2 of 2 CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 3 POLICY NUMBER: 150B017936 COMMERCIAL GENERAL LIABILITY CG 20 10 12 19 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) Any person(s) or organization(s) for whom you are performing operations, but only if you have agreed, in a written contract or written agreement, should be added as an additional insured on your policy for that location or part thereof, provided such written contract or written agreement is fully executed prior to an "occurrence" in which coverage is sought under this policy. 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 include as an additional insured the person(s) or organization(s) shown in the Schedule, 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) at the location(s) designated 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. Page 2 of 3 © Insurance Services Office, Inc., 2018 CG 20 10 12 19 B.With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1.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 location of the covered operations has been completed; or 2.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. CG 20 10 12 19 © Insurance Services Office, Inc., 2018 Page 3 of 3 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. CG 24 04 12 19 © Insurance Services Office, Inc., 2018 Page 1 of 1 POLICY NUMBER: 150B017936 COMMERCIAL GENERAL LIABILITY CG 24 04 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE PART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS SCHEDULE Any person(s) or organization(s) that are shown in the applicable Declarations for this endorsement. Information required to complete this Schedule, if not shown above, will be shown in the Declarations. 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 against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IFG-G-0210 03 17 ISO Properties, Inc., with its permission. Page 1 of 2 AUTOMATIC ADDITIONAL INSURED – OWNERS, LESSEES OR CONTRACTORS – TRUCKING AND GARBAGE COLLECTION (TENDER OF ANY LOSS TO OTHER AVAILABLE INSURANCE) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Any person or organization with whom you have agreed, in a written contract, that such person or organization should be added as an additional insured on your policy, provided such written contract is fully executed prior to an "occurrence" in which coverage is sought under this policy. A. Section II - Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule for whom you are performing operations when you and such person(s) or organization(s) have agreed in a written contract that such person(s) or organization(s) be added as an additional insured on your policy. Such person(s) or organization(s) is an additional insured only with respect to liability 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) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. The insurance afforded to such additional insured will not be broader than that which you are required by the written contract to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. 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) has been completed; or 2. 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: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the written contract; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. POLICY NUMBER:150B017936 Page 2 of 2 ISO Properties, Inc., with its permission. IFG-G-0210 03 17 D. If other valid and collectible insurance is available to the person(s) or organization(s) shown in the Schedule for a loss we cover under Coverage A or B then the person or organization shown must also tender any loss to each such other insurance. Should such other insurance apply then this insurance is excess over any other such insurance. All other terms and conditions of this Policy remain unchanged. COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CG 20 01 04 13 Page 1 of 1 PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART The following is added to the Other Insurance Condition and supersedes any provision to the contrary: Primary And Noncontributory Insurance 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. POLICY NUMBER:150B017936 Schedule WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY 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 No. Endorsement Effective Insured Policy No. Insurance Company Countersigned By WCON04WSA (Ed.01-19) Person or Organization Job Description WAIVER OF OUR RIGHT TO RECOVER FROM OTHERS ENDORSEMENT CALIFORNIA Wehavetherighttorecoverourpaymentsfromanyoneliableforaninjurycoveredbythispolicy.Wewillnotenforceourright againstthepersonororganizationnamedintheSchedule.(Thisagreementappliesonlytotheextentthatyouperformwork underawrittencontractthatrequiresyoutoobtainthisagreementfromus.) Youmustmaintainpayrollrecordsaccuratelysegregatingtheremunerationofyouremployeeswhileengagedinthework describedintheSchedule. BlanketWaiver:Theadditionalpremiumforthisendorsementshallbe2%oftheCaliforniaworkers’compensationpremium otherwisedueonsuchremuneration. SpecificWaiver:Theadditionalpremiumforthisendorsementshallbe5%oftheCaliforniaworkers’compensationpremium otherwisedueonsuchremuneration. Omaha National Casualty Company 10/18/2024 ONCC08642-07 Blanket Waiver of Subrogation As respects to all CA jobs performed by the named insured during the policy period where by written contract a waiver of subrogation is required prior to the commencement of work. W & J Lazaro, Inc. dba Alexis Trucking POLICY NUMBER:COMMERCIAL AUTO CA990188 0514 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY WAIVER OF SUBROGATION - AUTOMATIC STATUS WHEN REQUIRED BY WRITTEN AGREEMENT WITH YOU This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM TRUCKERS COVERAGE FORM MOTOR CARRIER COVERAGE FORM This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Named Insured: Countersigned by: (Authorized Representative) For accidentor loss occurring after the Endorsement Effective Date the CONDITION entitled “TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US” does not apply to any person or organization for whom the named insured has agreed by written contract to furnish this waiver. This provision does not apply unless the contract is made prior to the accident or loss. CA990188 0514 Page 1 of 1 7 05 W & J Lazaro, Inc. Policy Number:SMC181546001 SMC181546001 Endorsement Effective:11/17/2024 POLICY NUMBER: COMMERCIAL AUTO CA990312 0514 THE ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. CA990312 0514 Page 1 of 1 BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are “insureds” under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below Endorsement Effective: Countersigned By: Named Insured: SCHEDULE Endorsement Premium A.Section II – Who Is An Insured is amended to include as an “insured”any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability arising out of your ongoing operations performed for that “insured”. A person’s or organization’s status as an “insured” under this endorsement ends when your operations for that “insured” are complete. 05 $150 11/17/2024 SMC181546001 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. Includes copyrighted material of Insurance Services Office, Inc. with its permission Page 1 of 1 PRIMARY AND NONCONTRIBUTORY – OTHER INSURANCE CONDITION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM With respect to the Other Insurance Condition in the Business Auto Coverage Form and the Other Insurance – Primary And Excess Insurance Provisions Condition in the Motor Carrier Coverage Form, the following is added: Primary and Noncontributory Insurance 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. The provisions of this endorsement supersede any provision to the contrary. SMC181546001