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HomeMy WebLinkAboutCertificate of Insurance 2/9/2021 (2)ACOR,1 0 �, CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) F2/9/2021 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 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 endorsement(s). PRODUCER Dealey, Renton & Associates License # 0020739 P. O. Box 12675 CONANTACT Nancy Ferrick PHONE FAX c Ext): 510-465-3090 A/c No): ADDRESS: nferrick@dealeyrenton.com Oakland CA 94604-2675 INSURERS AFFORDING COVERAGE NAIC# INSURERA: USSpecialty Insurance Company 29599 Y INSURED CSWSTUBERI CSW/Stuber-Stroeh Engineering Group Inc. 45 Leveroni Court INSURERS: Sentinel Insurance Company 11000 INSURER C; Twin City Fire Insurance Company 29459 INSURER D: Hartford Accident and Indemnity Company 22357 Novato CA 94949 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 1151871299 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. ILTR TYPE OF INSURANCE IVSD WVD POLICY NUMBER MM/DDY� POLICY EXP LIMITS B X COMMERCIAL GENERAL LIABILITY Y Y 57SBWD05183 9/1/2020 9/1/2021 EACH OCCURRENCE $2,000,000 CLAIMS -MADE � OCCUR DAMAGETORENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ] JE� 0 LOC GENERAL AGGREGATE $4,000,000 PRODUCTS - COMP/OP AGG $4,000,000 $ OTHER: D AUTOMOBILE LIABILITY Y Y 57UEGPC4887 9/1/2020 9/1/2021 COMBINED SINGLE LIMIT $1,000,000 Ea accident BODILYINJURY(Perperson) $ AUTO IxANY OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ Per accident B X UMBRELLA LIAB X OCCUR Y Y 57SBWD05183 9/1/2020 9/1/2021 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N Y 57WEGZR3304 9/1/2020 9/1/2021 X STATUTE ORH E.L. EACH ACCIDENT $ 1,000,000 ANYPROPRIETOR/PARTNER/EXECUTIVE — FN OFFICER/MEMBER EXCLUDED? N /A E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $1,000,000 A Professional Liability USS2030665 3/31/2020 3/31/2021 $2,000,000 per Claim $4,000,000 Annual Aggregate DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: CSW Project No. 2110011. The Town of Los Altos Hills, its elective and appointed officers, employees, and volunteers are named as Additional Insureds as respects General and Auto Liability as required per written contract or agreement. General Liability insurance is Primary/Non-Contributory per policy form wording. Insurance coverage includes Waiver of Subrogation per the attached endorsement(s). 30 Days Notice of Cancellation. CERTIFICATE HOLDER CANCELLATION 30 Days Notice of Cancellation ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Los Altos Hills 26379 Fremont Road Los Altos Hills, CA 94022 AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD