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HomeMy WebLinkAboutCOI_ W & J Lazero Inc DBA Alexis Trucking_7.9.25SHOULD 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 7/9/2025 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 150B018382 07/13/2025 07/13/2026 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 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