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HomeMy WebLinkAboutCertificate of InsuranceKAIGCOR-n1 1:1 = 1r CERTIFICATE OF LIABILITY INSURANCE FDATE(M 11/312020 0 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 # 0757776 CN2ME:NTACT N HUB International Insurance Services Inc. 4695 MacArthur Court Suite 600 Newport Beach, CA 92660 P"c NE ,Ext 714 569-2700 Fax ): ( ) (A/c, Noy (714) 569-3099 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # INSURERA:Philadelphia Indemnity Insurance Company- 18058 X INSURED INSURER B: Vanta ro Specialty Insurance 44768 INSURER C: Oak River Insurance Com >l an 34630 Postmaster Services, LP INSURER D : 9716 S Virginia Street -#E -F Reno, NV 89511 INSURER E INSURER F: COVERAGES CERTIFICATF_ Nl1MRFR_ RF1/ICInK1 Al11MCiC112. 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 LTR TYPE OF INSURANCE ADDL IND SUER WVD POLICY NUMBER POLICY EFF MM DD POLICY EXP DD LIMITS A, X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCURPHPK2188602 X 9/30/2020 9/30/2021 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence $ MED EXP (Any oneperson) $ 5,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ ECT LOC GENERAL AGGREGATE $ 4,000,000 PRODUCTS. COMP/OP AGG $ 4,000,000 OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident X BODILY INJURY Perperson) ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS 5087077800 11/1/2020 11/1/2021 BODILY INJURY Per accident $ X AUTOS ONLY X AUOTOS ONt�LDY Per eCcid AMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE EXCESS LIAB CLAIMS -MADE DED RETENTION $ C WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YEN OFFICEJ2IMEMBER EXCLUDED? (Manda ory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA KAWC119674 1011/2020 1011/2021 PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,000000 E.L. DISEASE. EA EMPLOYEE 1,000,000 E.L. DISEASE -POLICY LIMIT 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 Additional Remarks Schedule, may be attached If more space Is required) The Town of Los Altos Hills, its elective and appointed officers, employees, and volunteers are Additional Insureds with regard to the General Liability policy when required by a written contract, per the attached endorsement form CG2010 04/13. Worker's compensation coverage is Evidence Only. Should the policies be cancelled before the expiration date, Hub International Insurance Services Inc. (Hub), independent of any rights which may be afforded within the policies to the certificate holder named below, will provide to such certificate holder notice of such cancellation within thirty (30) days of the cancellation date, except in the event the cancellation is due to non-payment of premium, in which case Hub will provide to such certificate holder notice of such cancellation within ten (10) days of the cancellation date. Town of Los Altos Hills 26379 Fremont Road Los Altos Hills, CA 94022 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ondoaalllv­ ACORD 25 (2016/03) 01988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: PHPK2188602 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organizations Location(s) Of Covered Operations Blanket Additional Insured as required by Various locations required by contract written contract prior to the loss Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to 1. All work, including materials, parts or equipment include as an additional insured the person(s) or furnished in connection with such work, on the organization(s) shown in the Schedule, but only project (other than service, maintenance or with respect to liability for "bodily injury", "property repairs) to be performed by or on behalf of the damage" or "personal and advertising injury" additional insured(s) at the location of the caused, in whole or in part, by: covered operations has been completed; or 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This insurance does not apply to "bodily injury" or This endorsement shall not increase the applicable "property damage" occurring after: Limits of Insurance shown in the Declarations. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1