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HomeMy WebLinkAboutCentral Coast Ag InsuranceCENTR07 OP ID; KDK CERTIFICATE OF LIABILITY INSURANCE DATE 10/13/2016 ) 10/13/2016 _ 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 Mackey & Mackey Insurance E -CE-1Y NAME.,_ HONE Matthew J. Clevenger Agency, Inc. License #0668959 ; _(AIC, No. Exti: 805-772-1799 IMC. No): 805-772-6906 800 Quintana Road Suite 1A E-MAIL Morro Bay, CA 93442 0 C r 17 20 1sADDREss: matt acke insurance.com Matthew J. Clevenger i INSURERS) AFFORDING COVERAGE NAIC # INSURER A: Nonprofits Insurance Alliance A VIII, INSURED Central Coast Ag Netwoik INSURER B: P.O. Box 3736 San Luis Obispo, CA 93403 INSURER C: INSURER D: INSURER E INSURER F C()Vr-RA(FS CFRTIFIrATF NIIMRPR- of=vlQlnW r,n n1Amcn. .I 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. TNSRTYPE OF INSURANCE $ POLICY EFF POLICY LTR D WVD POLICY NUMBER MMIDD/YYYY MMM LIMBS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FYI OCCUR X 201631357NP0 10/16/2016 10I16I2017 EACH OCCURRENCE $ 1,000,00a T5AMAGETO RENTED - PREMISES fEa occurrence $ 500,000 MED EXP (Any one person) $ 20,00111 X ISC-$500'000 PERSONAL &ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L F1POLICY AGGREGATE LIMIT APPLIES PER: FI PRO- ❑ JECT LOC PRODUCTS -COMP/OP AGG $ 2,000,00 $ OTHER: AUTOMOBILE LIABILITY GOMBiNEO SINGLE LIMIT $ ER acrJdenl BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Leracdde $ UMBRELLA LIAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ r $ WORKERS COMPENSATION EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N / A PE EOR STATUTE ER EL. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below — E. L. DISEASE - POLICY LIMIT 1 $ I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Certificate holder is hereby named Additional insured as respects General Liability per Form CG2011 01196 for the leased property at 0 Calle Joaquin, San Luis Obispo, CA 93401. The insurance shall be primary insurance as respects City of San Luis Obispo and shall be excess of and non-contributory with this insurance. t,.=r[ I If- tkAI r nULLPr11% UAN(;hLLAI ION SLOCIPW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN City of San Luis Obispo ACCORDANCE WITH THE POLICY PROVISIONS. City Clerk's Office AUTHORIZED REPRESENTATIVE 990 Palm Street San Luis Obispo, CA 93401 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 2016-351357 COMMERCIAL GENERAL LIABILITY CG 20 11 01 96 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - MANAGERS OR LESSORS OF PREMISES This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE 1. Designation of Premises (Part Leased to You): 2. Name of Person or Organization (Additional Insured): Any person or organization acting as a manager or lessor of a covered premises that you are required to name as an additional insured on this policy, under a written contract, lease or a reement currently in effect, or becoming effective during the term of this policy, and for which a certificate of insurance naming that person or organization as additional insured has been issued. City of San Luis Obispo 3. Additional Premium: INCLUDED (If no entry appears above, the information required to complete this endorsement will be shown in the Declara- tions as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person or organization shown in the Schedule but only with respect to liability arising out of the ownership, maintenance or use of that part of the prem- ises leased to you and shown in the Schedule and subject to the following additional exclusions: This insurance does not apply to: 1. Any "occurrence" which takes place after you cease to be a tenant in that premises. 2. Structural alterations, new construction or demolition operations performed by or on behalf of the person or organization shown in the Schedule. CG 20 11 01 96 Copyright, Insurance Services Office, Inc., 1994 Page 1 of 1 0 City Administration 990 Palm Street, San Luis Obispo GA 9340 1 -3249 805 7Bi 7114 April 8, 2016 Central Coast Ag Network, Inc dba: Central Coast Grown P.O. Box 3736 San Luis Obispo, CA 93403 Subject: Expired Insurance Certificates for Central Coast Grown Contract Dear Vendor: Our records indicate the following insurance coverage(s) will expire as of the referenced date below. According to the contract, you must maintain insurance coverage throughout the term of the contract. We would greatly appreciate your prompt attention to this matter as we have several contracts with your business. Workers Comp/Employers Liab: Expiration date: 01/13/2016 For General Liability coverage, you will need to submit a binder or certificate of insurance with the "Additional Insured Endorsement" prior to the date of expiration. If you submit a binder, you will need to send the certificate of insurance and the "Additional Insured Endorsement" once it is issued. The documents may be emailed in advance to ligoodwin.Aslocity.org and then hard copies mailed. All documents should be sent to: City of San Luis Obispo Attn: City Clerk's Office 990 Palm Street San Luis Obispo, CA 93401 If you have any questions, please phone me at (805) 781-7103. Our fax number is (805) 781-7109. Sincerely, Heather Goodwin Deputy City Clerk CENTR07 OP ID: MC CERTIFICATE OF LIABILITY INSURANCE FDATE(MMIDD/YYYY) 10/02/2015 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 NAME., Matthew J. Clevenger Mackay & Mackey Insurance PHONE , 806-772-1799 FAX No, 805-772-6906 Agency, Inc. License 90668959 EMAIL 800 Quintana Road Suite 1A ADDRESS: matt macke-insurance.com Morro Bay, CA 93442 Matthew J. Clevenger INSU S AFFORDING COVERAGE NAIC # INSURERA: Non rofits Insurance Alliance 25 o _ I' INSURED Central Coast Ag Network P.O. Box 3736 San Luis Obispo, CA 93403 B: State Compensation Ins. Fund INSURER 0: INSURER E: INSURER F, OVERAGES CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUR INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS Cep TYPE OF INSURANCE -- A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JET F1 LOC AUTOMOBILE LIABILITY A ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X NON -OWNED HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS -MADE nPn RETENTION $ NUMBER 531357NPO 11011612015110116/2016 357NPO 110/1612016110116/2016 AND EMPLOYERS' LIABILnV B ANY PROPRIETORIPARTNERrF_XECUTIVE YIN N 913793015 07113/2015 01/13/2016 OFFICERIMEMBER EXCLUDED? O NIA (Mandatary In NH) ti yes, descrlbe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is requ 'ert ficate holder is hereby named Additional insured as respects General �iabillly per Fonn CG2011 01196 for the leased properly at 0 Calle Joaquin, San Luis Obispo CA 93401. The insurance shall be primary insurance as res ects City of tan Luis Obispo and shall be excess of and non-contributory Nit this insurance. RFUICrnPJ NI IMRFR• 1 :D NAMED ABOVE FOR THE POLICY PERIOD )OCUMENT WITH RESPECT TO WHICH THIS HEREIN IS SUBJECT TO ALL THE TERMS, LIMITS EACH OCCURRENCE S 1,000,00 15MW5 TO RENTED— PREMISES Ea ocwrranco $ 500,0'0 MED EXP (Arty one person) $ 20,00 PERSONAL & ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 PRODUCTS - COMP/OP AGG S 21000200 $ CFC tiacrllNdEOt ANGLE LIMIT $ 11000100 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Peracekleni EACH OCCURRENCE S AGGREGATE S PERI H- I 3STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE -POLICY LIMIT S red) SLOCIPW SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of San Luis Obispo City Clerk's Office AUTHORIZED REPRESENTATIVE 990 Palm Street Matthew J. Clevenger San Luis Obispo, CA 93401 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD ANNUAL RATING ENOOPSEMENT NOME OFFICE v" SAN FRANCISCO IT IS AGREED THAT THE CLASSIFICATIONS AND RATES PER $100 OF REMUNERATIIiN APyAPINr, IN THE CONTINUOUS POLICY ISSUED TO THIS EMPLOYER ARE AMENOEO AS JT1Ci'IIN RC %'N HERE ARE YOUR NEW RATES FOR THE PERIOD INDICATED. IF '(OUR NAME OR AOr,rF» >►+�.�a�_ : BE COT;RECTFD OR IF INSURANCE IS NOT NEEDED FOR NEXT YEAR PLEASE TELL IMPORTANTN0THIS IS NOT A BILL CONTINUOUS POLICY 9137936-16 THi _ _ITA_V UNLESS TIME STATEMENT IS ENCLOSED � MONEY PCRIOD BEGINS STAAND ENDS AT 12.OIAM PACIFICRATING PERIOD 1-12-16 TO 1-12-1 0 CENTRAL COAST GROWN DEPOSIT PREMIUM 51,000,11 246 HIGUERA ST MINIMUM PREMIUM $1,000.0"3 SAN LUIS OBISPO, CALIF 93401 PREMIUM ADJUSTMENT PERIOD QuARTE'�'7 R 42 NAME OF EMPLOYER— CENTRAL COAST AG NETWORK INC (A NON—PROFIT CORP.) CUBE NO. PRINCIPAL WORK AND RATES EFFECTIVE FROM 01-12-16 TO 01-12-17 Ix7SR:f PREMIUM BASE BILL._l�, BASIS RATE RA7-'" 0172-1 TRUCK FARMS. 32000 15.rJ1 L. 4'= ********BUREAU NOTE INFORMATION******** FEIN 203447329 TOTAL ESTIMATED ANNUAL PREMIUM $3,977 CO[ 1lTI` H D&1Q��JSSURD AT SAN FRANCIJ&� DECEMBER 30, 2015 POLICY L PAGE 1 OP Pt AS A.M. Best's Consumer Insurance Information Center Page 1 of 1 A.M. Best's cerawow b"W o C$rAW alN Member Center: Loa In I Sion Uo Need Coverage?How Does Your Insurer Rate? e State Insurance Information Find insurers by state or coverage type. Einar n company Name 1 l Salad a S"lu Consumer Home I Terms to Know I Why a Best's Rating is Important I Contact Us Life & Retirement O Health & Disability Q Car & Home () Other Life Events Nonprofits' Insurance Alliance of CA 8 PriNINS; Pon o (a member of Nonprofits Insurance Alliance Group) A M Best#:11845 FEIN #'. 77-0203935 Address: P 0 Box 8507 Phone: 831-459-0980 Santa Cruz, CA 95061-8507 Fax: 831-459-0853 UNITED STATES Web: www-mac.ora Best's Ratings VifDefmitkr Need More information? Financial Strength Rating: APurchase AMB an insurer report, complete with Outlook: Stable rating history, market share and a list of Rot Effective Date: September 18, 2015 Affirmed P (Affirmed) ' competitive insurers For $ 9 95 View SAmoie Rpocrl Financial Size Category: Vlll ($100 Million to $250 Million) Licensing: The company is licensed in California The company operates in California as a risk pool under Section 5005 1 of the California Corporations Code Top Line(s) of Business (based upon Direct Premiums Written) 1 Other Liability (Occurrence) rg;i;} _n,;5mimn ) 2 Auto (Commercial) rv,nN om-,,,,,in, Top State(s) of Business (based upon Direct Premiums Written) 1 California Visit our NewsRoom for the latest News and Press Releases for this company and its A M Best Group Terms of Use All information provided on the A M Best website, including but not limited to text, data, ratings, reports, images, photos, graphics, and charts is owned by or licensed to A M Best Company and is protected by United States copyright laws and international treaty provisions A M Best and its licensors retain all copyright and other proprietary rights to the website content Best's Credit Ratings, obtained through any source, may not be reproduced, distributed to Third Parties, or stored in a database or retrieval system in any form for commercial purposes without the prior written permission of the A M Best Company All unauthorized use of Best's Credit Ratings or other published information is strictly prohibited By logging into Best's Member Center or accessing this site, you accept and agree to be bound by our complete Terms of Use. 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State Insurance Information Find insurers by state or coverage typo �will Entar a Company Name _ ILMsoled a 7510W v Consumer Home I Terms to Know I Why a Best's Rating is Important I Contact Us 0 Life & Retirement 0 Health & Disability 6) Car & Home C) Other Life Events State Compensation Insurance Fund of CA 19 Print this aaae AM Beat #: 04026 NAIC #: 35076 FEIN * 94-3231751 Address: 333 Bush Street Phone: 415-263-5400 6th Floor Fax: 415-263-5827 San Francisco, CA 94104 Web: www.statefundca com UNITED STATES Best's Ratings YLw_Dsttmtion This company has not been assigned a Rating by A M- Best Licensing: The company is licensed in California The company is legally authorized to operate in California and in states having reciprocal arrangements with CA Top Line(s) of Business (based upon Direct Premiums Written) ,. 1 Workers' Compensation mew Dorm.i an ) 2 Excess Workers' Compensation Mow pa9norl ) Top State(s) of Business (based upon Direct Premiums written) 1 California Visit our NewsRoom for the latest News and Press Releases for this company and its AM. 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Best I Site Map I Pnvacy Poldcv I Security I Terms of Use I Legal & jJonsrna Copyright © 2016 A M Best Company, Inc and/or its affiliates ALL RIGHTS RESERVED. http://www3 .ambest.com/consumers/CompanyProfile. aspx?BL=3 6&ambnum=004028&P... 4/27/2016 4Ivy 0 Oil is City Administration 990 Palm Street, San Luis Obispo, CA 93401-3249 805.781.7114 slocity.org April 8, 2016 Central Coast Ag Network, Inc dba: Central Coast Grown P.O. Box 3736 San Luis Obispo, CA 93403 Subject: Expired Insurance Certificates for Central Coast Grown Contract Dear Vendor: Our records indicate the following insurance coverage(s) will expire as of the referenced date below. According to the contract, you must maintain insurance coverage throughout the term of the contract. We would greatly appreciate your prompt attention to this matter as we have several contracts with your business. Workers Comp/Employers Liab: Expiration date: 01/13/2016 For General Liability coverage, you will need to submit a binder or certificate of insurance with the "Additional Insured Endorsement" prior to the date of expiration. If you submit a binder, you will need to send the certificate of insurance and the "Additional Insured Endorsement" once it is issued. The documents may be emailed in advance to hf,-,00dwin@slocity.org and then hard copies mailed. All documents should be sent to: City of San Luis Obispo Attn: City Clerk's Office 990 Palm Street San Luis Obispo, CA 93401 If you have any questions, please phone me at (805) 781-7103. Our fax number is (805) 781-7109. Sincerely, Heather Goodwin Deputy City Clerk