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HomeMy WebLinkAboutCertificate of Insurance 2021LEA&BRA-01 JMCCORMI AC URL?' CERTIFICATE OF LIABILITY INSURANCE I DATE(MMIDDIYYYY) -nnr_ rnnne 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 License # OL72977CONTACT NA.M...E•...____ Legacy Risk & Insurance Services PHONE FAX 1850 Mt. Diablo Blvd., Suite 400 AIC No Ext 925 482-1000 AIC No 925 482-1001 1.........,_...............__..._( ............. )....._....--_...__............-----....__._..._........._.....--..-.-___.____,......._l_.(_.........._)._...................._. E-MAIL — ................. Walnut Creek, CA 94596 ADDREss. certificates(aD-legacvrisk.net INSURED Lea & Braze Engineering, Inc. 2495 Industrial Parkway West Hayward, CA 94545-5037 INSURER F: COVERAGES CERTIFICATE Nt1MPIFR- 01:x1Icinnl nu Iafimmo 50 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 TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP L INSD W D POLICY NUMBER MM/DDIYYYY1 (MMIDDIYYYYI LIMITS A X _._.................... COMMERCIAL GENERAL LIABILITY AUTHORIZED REPRESENTATIVE EACH OCCURRENCE 1000 , ,OOO CLAIMS -MADE X OCCUR X 6072482937 7/1/2021 7/1/2022 DAMAGE TO RENTED 100,000 PREMISES_(Ea occu..rrenc..e�__ $_._...__ _ ......................... ......... .............._.._. _. _ -- MED EXP one..parson)..__ $......__._ 15,000 ....... ..... ................ .__....- __.._....._..__......- — - PERSONAL &ADV INJURY 1,000000 $ .. GEN'L f AGGREGATE LIMIT APPLIES PER: _GENERAL_AGGREGATE______ 2 OOO,OOO POLICY I.X I Pe �_) LOC _PRODUCTS -COMP/OP AGG $ 2,000,000 ._, _.._..._.......__...-._...._ OTHER: $ B AUTOMOBILE ...._.. LIABILITY COMBINED SINGLE LIMIT (_..a -accident) ............. . 1 000 1,000,000 X ANY AUTO X 6072482940 7/1/2021 7/1/2022 JURY _$__.._............._.__ .._..._......___..._...._ OWNED SCHEDULED AUTOS ONLY AUTOS _BODILY... .....jPe[person).._.. BODILY.INJURY jPer_accident)_ _$ __.._..__._.....___..._... _$ _... HIRED NON -OWN D AUTOS ONLY __ AUTOS ONLY PROPERTY DAMAGE jeer accident) ___ _..._._._..........._ _$._..._.__.._._.._...........__.._._.___...... $ C . X UMBRELLA LIAB X OCCUR OCCURRENCE 5 OOO $ ,000 EXCESS LIAB CLAIMS -MADE 6072482968 7/1/2021 7/1/2022 _ -AGGREACH EGATE AGGREGATE... S,000,OOO DED RETENTION $ D WORKERS COMPENSATION PER OTH- X. AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE �������������� X 93011832021 7/1/2021 7/1/2022 -I STATUTE.._.......__..._ER.._.._............................_.........._......_................... $ FFICER/MEMBER EXCLUDED? Mandatory in NH) N / A _E,L.,.EACH_ACCIDENT -.1,000,000 If yes, describe under E,L. DISEASE.- EA_EMP.... LOYEE . ....P.. . $ 1 .. ,000 .. ,000 ...... .... DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ 1,000,000 E Professional Liab. PAAEP0135800 12/31/2020 12/3112021 Per Claim/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space Is required) RE: Project numbers 2211250 SU 1251 Cl Town, its officers, officials, employees, and volunteers is to be named as additional insureds per written contract; GL and Auto coverage is primary and non-contributory; 30 -day NOC applies CERTIFICATE HOLDER rANrFI I ATIOKI AGORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Los Altos Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26379 Fremont Road ACCORDANCE WITH THE POLICY PROVISIONS. Los Altos Hills, CA 94022 AUTHORIZED REPRESENTATIVE AGORD 25 (2016/03) © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD