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HomeMy WebLinkAboutCounty of Fresno General Liability.pdf A� CERTIFICATE OF LIABILITY INSURANCE DATE06/22022/2022 ) 6R 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 endorsements . PRODUCER CONTACT FEDERATED MUTUAL INSURANCE COMPANY NAME: CLIENT CONTACT CENTER HOME OFFICE: P.O. BOX 328 A/OCNNo Ext:888-333-4949 Aic No:507-446-4664 OWATONNA, MN 55060 ADDRESS:CLIENTCONTACTCENTER FEDINS.COM INSURERS)AFFORDING COVERAGE NAIC N INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 037-103-9 INSURER B: SILVAS OIL COMPANY INC, PENCE PETROLEUM CO INC INSURER C: PO BOX 1048 — FRESNO,CA 93714-1048 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 122 REVISION NUMBER:0 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD/YYYY MM/DD/YYYV LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS-MADE X OCCUR DAMAGE TO RENTED $100,000 PREMISES 1 a I r nce MED EXP(Anyone person) EXCLUDED A Y N 9370720 08/01/2022 08/01/2023 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 X POLICY PRO- JECT LOC PRODUCTS•COMPIOP AGG S2,000,000 JECT OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 X ANY AUTO IEaOCCdeno BODILY INJURY(Per person) AOWNED AUTOS ONLY SCHEDULED — AUTOS N N 9370720 08/01/2022 08/01/2023 BODILY INJURY(Per accident) HIRED AUTOS ONLY NON-OWNED PROPERTY DAMAGE AUTOS ONLY Per ac i no X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $10,000,000 A EXCESS LIAB CLAIMS-MADE N N 9370721 08/01/2022 08/01/2023 AGGREGATE $10,000,000 DIED RETENTION WORKERS COMPENSATION PER STATUTE OTH- AND EMPLOYERS'LIABILITY ER Y/N ANY PROPRIETORIPARTNEWEXECUTIVE E.L.EACH ACCIDENT OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE It yes,describe under DESCRIPTION OF OPERATIONS below E.L DISEASE•POLICY LIMIT I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION 037-103-9 122 0 COUNTY OF FRESNO SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PO BOX 1912 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ,ESNO,CA 93718-1912 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4" (0 1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 037-103-9 ACOR�� `--� ADDITIONAL REMARKS SCHEDULE page 1 of 1 AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY SILVAS OIL COMPANY INC, PENCE PETROLEUM CO INC POLICY NUMBER PO BOX 1048 SEE CERTIFICATE#122.0 FRESNO,CA 93714-1048 CARRIER NAIC CODE SEE CERTIFICATE # 122.0 EFFECTIVE DATE:SEE CERTIFICATE##122.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE CERTIFICATEHOLDER IS AN ADDITIONAL INSURED FOR GENERAL LIABILITY. ADDITIONAL INSURED ALSO INCLUDES: COUNTY OF FRESNO, ITS OFFICERS, AGENTS, AND EMPLOYEES INSURANCE PROVIDED BY THE GENERAL LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. ACORD 101 (2008/01) 0 2008 ACORD CORPORATION.All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER:9370720 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 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) Or Organizations: Location(s) Of Covered Operations County of Fresno Any Coverage Provided by This Endorsement 4525 E Hamilton Ave Applies Only to the Delivery of Fuel and Fresno, CA 93702-4599 Products for the Certholder. Additional Insured Also Includes County of Fresno, its Officers, Agents, and Employees. 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 B. With respect to the insurance afforded to these include as an additional insured the person(s) or additional insureds, the following additional organization(s) shown in the Schedule, but only exclusions apply: with respect to liability for "bodily injury", This insurance does not apply to "bodily injury" or "property damage" or "personal and advertising "property damage"occurring after: injury" caused, in whole or in part, by: 1. Your acts or omissions; or 1. All work, including materials, parts or equipment furnished in connection with such 2. The acts or omissions of those acting on your work, on the project (other than service, behalf; maintenance or repairs) to be performed by or in the performance of your ongoing operations for on behalf of the additional insured(s) at the the additional insured(s) at the location(s) location of the covered operations has been designated above. completed; or However: 2. That portion of "your work' out of which the 1. The insurance afforded to such additional injury or damage arises has been put to its insured only applies to the extent permitted by intended use by any person or organization law; and other than another contractor or subcontractor engaged in performing operations for a 2. If coverage provided to the additional insured principal as a part of the same project. 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. © Insurance Services Office, Inc., 2012 Page 1 of 2 CG 20 10 04 13 Policy Number:9370720 Transaction Effective Date: 08/01/2022 C. With respect to the insurance afforded to these 2. Available under the applicable Limits of additional insureds, the following is added to Insurance shown in the Declarations; Section III - Limits Of Insurance: whichever is less. If coverage provided to the additional insured is This endorsement shall not increase the required by a contract or agreement, the most we applicable Limits of Insurance shown in the will pay on behalf of the additional insured is the Declarations. amount of insurance: 1. Required by the contract or agreement; or Insured: Silvas Oil Company Inc PO Box 1048 Fresno, CA 93714-1048 Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 10 04 13 Policy Number:9370720 Transaction Effective Date: 08/01/2022 COMMERCIAL GENERAL LIABILITY CG 20 01 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. 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 (2) You have agreed in writing in a contract Condition and supersedes any provision to the or agreement that this insurance would be contrary: primary and would not seek contribution Primary And Noncontributory Insurance from any other insurance available to the This insurance is primary to and will not seek additional insured. 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 © Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 01 04 13 Policy Number: 9370720 Transaction Effective Date: 08/01/2022