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HomeMy WebLinkAboutCert of Liability Insurance 8-12-16' — -1 AC40RIDOO CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD/YYYY) 01/2212016 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 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 Phone: 888 -874 -3800 Fax: 800- 921 -5506 CONSTRUCTION SPECIALTIES INSURANCE SERVICES 100 HOWE AVENUE SUITE 200 NORTH SACRAMENTO CA 95825 CONTACT Construction Specialties Insurance Services p PHONE FAX 800 -921 -5506 A _No,_Ext_. 888 -874 -3800 _ (A/C ,No): /c E -MAIL cs ADDRESS: info O isins.com — _ INSURER(S) AFFORDING COVERAGE NAIC # I EACH OCCURRENCE INSURER A : Rockhill Insurance Company Agency Lic #: OB35752 INSURED W S K & SONS, INC. INSURER B : State Compensation Insurance Fund 35076 INSURER C $ 34455 SUNLIGHT DRIVE INSURER D: YUCAIPA CA 92399 INSURER E _ ! MED. EXP (Any one person) —�— — _50,000 $ 5,000 INSURER F $ 5,000,000 COVERAGES CERTIFICATE NUMBER: 69271 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 LTR TYPE OF INSURANCE ADD'L INSR SUBR WVD POLICY NUMBER _ _ POLICY EFF POLICY EXP MM /DD MM /DD/YYYY LIMITS A GENERAL LIABILITY ENVP007766 -03 01124/16 01/24/17 I EACH OCCURRENCE $ 5,000,000 -- X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES (Ea occurence) $ CLAIMS -MADE OCCUR _ ! MED. EXP (Any one person) —�— — _50,000 $ 5,000 PERSONAL & ADV INJURY $ 5,000,000 Y -� X POLLUTION LIABILITY i X PROFESSIONAL LIABILITY GENERAL AGGREGATE $ 5,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP /OP AGG $ 5,000,000 — -- X ? POLICY � l JE C � LOC ! — j _ — - - -- _ — - $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY (Per person) $ — ALL OWNED SCHEDULED AUTOS NON -OWNED HIRED AUTOS AUTOS ( j BODILY INJURY (Per accident) $ PROPERTY DAMAGE (per accident) $ UMBRELLA LIAB J OCCUR EXCESS LIAB j CLAIMS -MADE EACH OCCURRENCE Is $ AGGREGATE $ DED ; RETENTION $ _— $ I I B WORKER COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / -� OFFICER/MEMBER EXCLUDED? (Mandatory in NH) ! 9019184 -15 04/11 /15 N/A �, ! 04/11 /16 � WC STATI OTH TORY LIMITS_ ER $ E.L. EACH ACCIDENT _ $ 1 , 000 , 000 E.L. DISEASE -EA EMPLOYEE $ > > 1 000 000 If yes, describe under DESCRIPTION OF OPERATIONS below I I E.L. DISEASE- POLICY LIMIT $ 1,000,000 I ! DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) *10 DAYS NOTICE FOR NON - PAYMENT, 30 DAYS FOR ALL OTHER PROOF OF INSURANCE ONLY CERTIFICATE HOLDER CANCELLATION ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PROOF OF INSURANCE ONLY THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attention: AUTHORIZED REPRESENTATIVE T ' i Brett Webster ACORD 25 (2010/05) ©1988 -2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD