COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

- " 1 BZSER-1 OP ID : BB CERTIFICATE •OF LIABILITY INSURANCE 1 DAT02/26DIYYYY) 02/26!19 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 endorsement (s). PRODUCER CONTACT Phone. 916 -567.3233 NAME: McDowall a Keeney Ins Assoc Fax: 916-567-3155 PHONE ac No 865 Howe Ave, Suite 200IA/Co, Exit* Sacramento, CA 95825 EOMAIL ADDRESS: Jatte Allyn MuDowall INSURER S AFFORDING COVERAGE I NAIC aY INSURER A : Admiral Insurance Com any 124856 INSURED BZ Service Station Maintenance INSURERS : Nationwide Mutual Insurance Co 123787 Inc INSURER C : National Liability & Fire Ins 20052 P, 0. Box 933 West Sacramento, CA 95691 INSURER D' : INSURER E INSURER F : COVERAGES CERTIFICATE NUMBER: 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. tLTR TYPE OF INSURANCE POLICY NUMBER MMIDD/YYYFY MM/D nYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ _ 1 ,000000 A X COMMERCIAL GENERAL LIABILITY X X FEI'ECC-23429.02 02/15/19 02/15/20 DAMAGE TO Kt:N I PREMISES E E- ,,Dance $ 50,00 CLAIMSWADE FRI OCCUR MED, EXP (Any one person) s 5100 '.. X Cont Pollution PERSONAL & ADV INJURY $ 1 ,000,00 GENERAL AGGREGATE $ 2 ,000900 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMPIOPAGG $ 21000,00 X POLICY PRO• 7 LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Me accident) $ 1_,000,00 B X ANYAUTO X ACPBA3037670604 02/15/19 02/15/20 BODILY INJURY (Per. person) s AUTOSOWNED SCHEDULED AUTOSBODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS ROPEIident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS' LIABILITY C OFFIEIMEMBER ECUEPROPRIETOR/PARTNER/EXECUTIVE YIN N / A X V9WC921126 10!27118 .10/27119 E. L. EACH ACCIDENT $ 11000,00 (Mandatory In NH) If as, describe under EL. DISEASE - ,EAEMPLOYEE 11000,000 $ DESCRIPTION OF OPERATIONS belowE.L. DISEASE - POLICY LIMIT $ 10000,00 A Prof Liability FEI-ECC-23429-02 02/15/19 02!15/20 Aggregate 21000,00 Each 11000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required) Sysco Corporation , its Subsidiaries , Affiliates & Divisions are named as Additional insured , per written contract per attached CO 20 . 37 07 04 and Waiver of Subrogation applies per 'ECC- 320 - 0712 . Waiver of Subrogation . -for Comm Auto per AC 70 05 03 16 . Waiver of Subrogation for Workers Comp per 'WC 04 03 06 . CERTIFICATE HOLDER CANCELLATION SYSC0.5 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Sysco Corporation THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Insurance Compliance POSox 100085- CY AUTHORIZED REPRESENTATIVE Duluth, GA 30096 7ffar,6zca. ��1,� © 1988.2010 ACORD CORPORATION. All rights reserved . ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD t