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Home My WebLink AboutCertificate of InsuranceLEA&BRA-01 112ABIWc ''�.,.,"" CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) `V INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO 12/21 /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(jos) must have ADDITIONAL INSURED If SUBROGATION IS WAIVED, subject to the terms and conditions of this certificate does not confer rights to the certificate holder in lieu of provisions or be endorsed. the policy, certain policies may require an endorsement. A statement on such PRODUCER License # OL72977 endorsement(s). CON ,,MET Certificates Department Legacy Risk & Insurance Services PHONE (A/C, No, Ext): (925) 482-1000 ja/c, No):(925) 482-1001 1850 Mt. Diablo Blvd., Suite 400 Walnut Creek, CA 94596 A8 RIEss: certificates@legacyrisk.net INSURERS AFFORDING COVERAGE NAIC # MED EXP (Any oneperson) $ INSURER A: Continental Insurance Co 35289 INSURED INSURER B: American Casually Company 20427 Lea & Braze Engineering, Inc. INSURER C: Continental Casualty Co2496 20443 Industrial Parkway West Hayw Hayward,CCA 94545 Ha -5037 INSURERD:State Com Insurance Fund 35076 INSURERE:Arch Insurance Company 11150 2,000,000 INSURER F Cf)VFRAr..FC nMM 1—A rm . -- "' "` ""'•' KLVISION 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 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO WHICH THIS ALL EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THE TERMS, INSR ADOL SUBR LTR TYPE OF INSURANCE SD WVD POLICY NUMBER POLICY EFF POLICY EXP - A X COMMERCIAL GENERAL LIABILITY MMIDD/YYYYI fMM/DD1YYYY1 LIMITS CLAIMS -MADE FYI OCCUR EACH OCCURRENCE $ 1,000,000 X 6072482937 7/1/2021 7/1/2022 DAMAGE TO RENTED PREMISES Ea occurrence $ 100 00 ou MED EXP (Any oneperson) $ 15,000 PERSONAL & ADV INJURY $ 11000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ❑X PRO- ❑ POLICY LOC JECT GENERAL AGGREGATE $ 2,000,000 POTHER: PRODUCTS - COMP/OPAGG $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 X ANY AUTO—X 6072482940 7/1/2021 7/1/2022 OWNEDSCHEDULED BODILY INJURY Per person)$ AUTOS ONLY AUTOS W�E AiJT OS ONLY AUTOS BODILY INJURY Per accident $ P_7eOacc dent AMAGE $ ONLY $ EACH OCCURRENCE $ 5,000,000 C X UMBRELLA LIAB X OCCUR EXCESS LIAB CLAIMS -MADE 6072482968 7/1/2021 7/1/2022 AGGREGATE $ 5,000,000 DED RETENTION $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY $ XSTATUTE PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/M EMBER EXCLUDED? ❑ N/A X 93011832021 7/1/2021 7/1/2022 EORH ANY E. L. EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1'000 000 , If yes, describe under E DESCRIPTION OF OPERATIONS below Professional Liab. PAAEP0135801 E.L. DISEASE -POLICY LIMIT $ 1,000,000 12/31/2021 12/31/2022 Per Claim/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be 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 non-contributory; 30 -day NOC applies primary and CFRTIPI('ATF Wr)l ncm Town of Los Altos Hills 26379 Fremont Road Los Altos Hills, CA 94022 ACORD 25 /217111R/nni 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 w1 700 -Au IaoO-Au 10 AL SKU L:UKVL)KATION. All rights reserved. The ACORD name and logo are registered marks of ACORD