HomeMy WebLinkAboutCertificate of Insurance 2018ACia,RV CERTIFICATE OF LIABILITY INSURANCE
DA7E(MM/DDnYYY)
OF INSURANCE
D4/26/2018,
THIS CERTIFICATE IS I$SUEa. AO A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE MOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFEORDEI) BY THE POLICIES
BELOW, THIS CERTIFIOATE OI' IN$URANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT! If the certificate holder Is an ADDITIONAL INSURED, the, policy(tes) must have ADDITIONAL. INSURED provisions or ba' endorsed.
if SUB1166ATION IS'WAIVEI7, subject to the terms and conditions of the policy; certain policies may require an endorsement, A stelementon
this Certificate does not confoe rights to theCertificate 6' older lieu of such endorsements .
PRODUCER CAONTA Laurie C Crawford
5tateArM AleeneAltouseAgency o"E , 831-420-1555 x." 831460.1120
_
1215 Mission Street EMAIL A DR . Laurie;C.Crawford.F77W@slatefarmmeom
Santa Cruz, CA 95080 INSURER(S)AFFORDING';COWERAdE NIC N.
INSURE A; State Form General Insurance Comptury . 25151.
INSURED INSURER 8<; State Farm MIAUai Automobile insurance Company 25178
Kelleher, Patrick DBA Lynx Technologies Inc, INSURER C
1350 41stAVenue'Ste 202 INSURER D
Capitola CA 95010 INSURER E
�A
INSURER F t I
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY`THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE TNSURED 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,_LIMITSSHOWN'MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INERTYPE
OF INSURANCE
ADDL
Town of Los Altos Hills, Its Officers, Officials, Employees,
POLI Y M8E
POLICY EFF
P EXP
LIMITS.
FA
Los Altos Hills, CA 940222f,,,a
COMMERCIAL:011NERALLIABILITY
CLAIMS -MADE EDOCCUR
X
97-QE4200.7
05/16/2016
05/16/2019
EACH OCCURRENCE 1,210001000
PR MI ES Ea rrence b 3Qp,0Q0
MED EXP (Any oneperson) s 0,000
PERSONAL B ADV INJURY s
OENI.AOGREGATELIMITAPPLIES PER: �
POLICY F-1 PRO- LOC:
OTHER:'
GENERAL AGGREGATE S 4,000,OQ4
PRODUCTS • COMPIOP AGG $
$
6
AUTOMOBILE. LIABILITY
ANY AUTO
OWNED scHEryULEG
AUTOS ONLY $CHEO
HIRED r+ON«OMEU
AUTOS ONLY AUTOS"ONLY'
X
288-009-1229.05
05129/2018
11/297;2019
E aepSNG MT S;
BODILY INJURY (Per penorij $ 1 QaQ QOii'
BODILY INJURY (Pat eceidefit) S 1,000,000
ERT DAMA E 1,bQ0,00,0
UMBRELLA UAB
EXCESS L(Ae
HWIMS.'MADE
OCCUR
EACH OCCURRENCE
AGGREGATE S
DED RETENTIONS
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOWPARTNERIEXECUTIVE YIN
OFFICER/MEMBER EXCLUDED?
(Mandstory In NH)
If as, desca be under
DESCRIPTION OF OPERATIONS below
NIA.
T T ERH
E.L. EACH ACCIDENT $
91, DISEASE • EA EMPLOYEE i
III; DISEASE • POLICY LIMIT s
DESCRIPTION OF OPERATIONS I LOCATIONS IVEHICLES (ACORO 101. Add(tlonal Ronurks Schedula, may bs ottaohad It mora apace Is required)
liMR71mPATFS wnl_r)ER CANCELLATION
®1988201 S ACORD CORPORATION, All rights reserved.
ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORIA
1001488 132849,12 0310-2018
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRAA71QN DAT9 THEREOF, NOTICE WILL BE DELIVERED IN
Town of Los Altos Hills, Its Officers, Officials, Employees,
ACCORDANCE WITH THE POLICY PROVISIONS,
Agents, Contractors & Volunteers
AUTHORIZED REPRESENTATIVE
� 4�ee
26379 Fremont Road
Los Altos Hills, CA 940222f,,,a
�',�� ik> u'r�,
®1988201 S ACORD CORPORATION, All rights reserved.
ACORD 26 (2016103) The ACORD name and logo are registered marks of ACORIA
1001488 132849,12 0310-2018