WP0037334 - Laserfiche WebLink

Home Browse Search

ACCOR V CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYVY( CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 9/11 /2017 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(les) 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 endorsemen s . PRODUCER NA EAC LISA Rossignol Alliant Specialty Insurance Services, Inc. PNONE 559-437-3360 F4X 559-437-3385 PO Box 609015 E-MAIL ADDRESS. Irossignol@alliant.com San Diego CA 92160 INSU S AFFORDING COVERAGE NAIL N EACH OCCURRENCE $ INSURER A: Everest National Insurance Company 10120 INSURER B. INSURED Briski Well Drilling Co., Inc. INSURERC: P.O. Box 1539 DAMAGE 0 RENTED San Andreas CA 95249 INSURER D. INSURER E: INSURER F; COVERAGES CERTIFICATE NUMBER: 242351104 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 S POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MWD LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE 0 RENTED CLAIMS -MADE F OCCUR PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY ❑ JEC7PRO F7LOC PRODUCTS - COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY Ea accident $ ANY AUTO BODILY INJURY (Per person) $ NED SCHEDULED AU OS BODILY INJURY (Per accident) $ NON -OWNED DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION 7600004345151 1/1/2017 1/1/2018 X STATUT ER AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? FYI N / A - (MandatorylnNH) E.L. DISEASE - EA EMPLOYEE $1,000,000 I/ es, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be altedW If mora space Is regohsd) Proof of Insurance. CERTIFICATE HOLDER CANCELLATION © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and lotto are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE San Joaquin Environmental Health Department THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1868 East Hazelton Ave. ACCORDANCE WITH THE POLICY PROVISIONS. Stockton CA 95205 AUTHORIZED REPRESENTATIVE © 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and lotto are registered marks of ACORD