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HomeMy WebLinkAboutCertificate of Insurance1 0 A C40 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDIYYYY) TYPE OF INSURANCE 9/30/2021 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 ABD Insurance & Financial Services, Inc. 1435 N McDowell Blvd Ste 320 Petaluma, CA 94954 NAME CT Cert Request PHONENo, 650-488-8565 FAX No E-MAIL ADDRESS: Tech CertReg uest theabdteam.com INSURERS AFFORDING COVERAGE NAIC # EACH OCCURRENCE $2000000 INSURERA: Travelers Property Casualty Co of Amer 25674 WWWTheABDteam.com INSURED Whitlock & Weinberger Transportation, Inc. dba: W -Trans INSURER B: National Union Fire Ins Co Pittsburgh PA 19445 INSURERC: Hartford Casualty Insurance Company 29424 INSURER D: Admiral Insurance Company 24856 490 Mendocino Ave. Suite 201 INSURER E: Santa Rosa, CA 95401 INSURER F: LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COVERAGES CERTIFICATE NUMBER: 64319479 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. INSR LTR TYPE OF INSURANCE ADDLSUBR _POLICY NUMBER MMIDD/YPOLICY YYY MM/DD�YY LIMITS A / COMMERCIAL GENERAL LIABILITY CLAIMS -MADE I✓ OCCUR 6806KO30786 1/31/2021 1/31/2022 EACH OCCURRENCE $2000000 AMAGE TO RENTED PREMISES Ea occurrence $1,000,000 MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $2,000,000 GEN'L AGGREGATE LIMITAPPLIES PER: POLICY ✓❑ jE� LOC OTIIER: GENERAL AGGREGATE $4,000,000 PRODUCTS - COMP/OPAGG $4000,000 $ A AUTOMOBILE LIABILITY ANYAUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BA3R944163 1/31/2021 1/31/2022 OMBIdDtSINGLE LIMIT $1000000 , BODILY INJURY (Per person) $ id BODILY INJURY (Per accent $ ) PROPERTY DAMAGE $ Per accident B 7 UMBRELLALIAB EXCESS LIAB �/ OCCUR CLAIMS -MADE EBU042761663 1/31/2021 1/31/2022 EACH OCCURRENCE $4000,000 AGGREGATE $4.000,000 DED I I RETENTION$ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANYPROPRIETOR/PARTNER/EXECUTIVEElE.L. OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If as, describe under DESCRIPTION OF OPERATIONS below N/A 57WECAK3TCF 1/31/2021 1/31/2022 `/ STATUTE PRH EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1 00 000 E.L. DISEASE - POLICY LIMIT $1 000 000 D Professional Liability E0000053416-01 1/31/2021 2 7 $5M per claim/$5M agg. $25K del per claim DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) W -Trans project #LAH003 — Crosswalk Study It is agreed that The Town of Los Altos Hills, its elective and appointed officers, employees and volunteers are named as additional insureds with regard to general liability per attached endorsement form. 30 days notice of cancellation applies to the general liability per attached form. macre I Iri%,A I c MUL L)r-M liANIaLL.A I IUN 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 Rod Sockolov U 1988-ZU16 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD 64319479 1 21/22 CL AU XS WC Prof Cyber I Vickie Fogleman 1 9/30/2021 4:51:31 PM (PDT) I Page 1 of 4 6806KO30786 9/30/2021 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART 1. The following is added to SECTION II — WHO IS AN INSURED: Any person or organization that you agree in a "written contract requiring insurance" to include as an additional insured on this Coverage Part, but: a. Only with respect to liability for "bodily injury", "property damage" or "personal injury'; and b. If, and only to the extent that, the injury or damage is caused by acts or omissions of you or your subcontractor in the performance of "your work" to which the "written contract requiring insurance" applies, or in connection with premises owned by or rented to you. The person or organization does not qualify as an additional insured: e. With respect to the independent acts or omissions of such person or organization; or d. For "bodily injury", "property damage" or "personal injury" for which such person or organization has assumed liability in a contract or agreement. The insurance provided to such additional insured is limited as follows: e. This insurance does not apply on any basis to any person or organization for which coverage as an additional insured specifically is added by another endorsement to this Coverage Part. f. This insurance does not apply to the rendering of or failure to render any "professional services". g. In the event that the Limits of Insurance of the Coverage Part shown in the Declarations exceed the limits of liability required by the "written contract requiring insurance", the insurance provided to the additional insured shall be limited to the limits of liability required by that "written contract requiring insurance". This endorsement does not increase the limits of insurance described in Section III — Limits Of Insurance. h. This insurance does not apply to "bodily injury" or "property damage" caused by "your work" and included in the "products - completed operations hazard" unless the "written contract requiring insurance" specifically requires you to provide such coverage for that additional insured, and then the insurance provided to the additional insured applies only to such "bodily injury" or "property damage" that occurs before the end of the period of time for which the "written contract requiring insurance" requires you to provide such coverage or the end of the policy period, whichever is earlier. 2. The following is added to Paragraph 4.a. of SECTION IV — COMMERCIAL GENERAL LIABILITY CONDITIONS: The insurance provided to the additional insured is excess over any valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured for a loss we cover. However, if you specifically agree in the "written contract requiring insurance" that this insurance provided to the additional insured under this Coverage Part must apply on a primary basis or a primary and non-contributory basis, this insurance is primary to other insurance available to the additional insured which covers that person or organizations as a named insured for such loss, and we will not share with the other insurance, provided that: (1) The "bodily injury" or "property damage" for which coverage is sought occurs; and (2) The "personal injury" for which coverage is sought arises out of an offense committed; after you have signed that "written contract requiring insurance". But this insurance provided to the additional insured still is excess over valid and collectible other insurance, whether primary, excess, contingent or on any other basis, that is available to the additional insured when that person or organization is an additional insured under any other insurance. CG D3 81 09 15 O 2015 The Travelers Indemnity Company. All rights reserved. Includes the copyrighted material of Insurance Services office, Inc., with its permission 64319479 1 21/22 GL AD X9 WC Prof Cyber I Vickie Fogleman 1 9/30/2021 4;51:31 PM (PDT) I Page 2 of 4 Page 1 of 2 POLICY NUMBER: 6806KO30786 ISSUE DATE: 9/30/2021 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: ALL COVERAGE PARTS INCLUDED IN THIS POLICY CANCELLATION: SCHEDULE Number of Days Notice: 30 WHEN WE DO NOT RENEW (Nonrenewal): Number of Days Notice: PERSON OR ORGANIZATION: ANY PERSON OR ORGANIZATION TO WHOM YOU HAVE AGREED IN A WRITTEN CONTRACT THAT NOTICE OF CANCELLATION OR NONRENEWAL OF THIS POLICY WILL BE GIVEN, BUT ONLY IF: 1. YOU SEND US A WRITTEN REQUEST TO PROVIDE SUCH NOTICE, INCLUDING THE NAME AND ADDRESS OF SUCH PERSON OR ORGANIZATION, AFTER THE FIRST NAMED INSURED RECEIVES NOTICE FROM US OF THE CANCELLATION OR NONRENEWAL OF THIS POLICY; AND 2. WE RECEIVE SUCH WRITTEN REQUEST AT LEAST 14 DAYS BEFORE THE BEGINNING OF THE APPLICABLE NUMBER OF DAYS SHOWN IN THIS SCHEDULE. ADDRESS: THE ADDRESS FOR THAT PERSON OR ORGANIZ- ATION INCLUDED IN SUCH WRITTEN REQUEST FROM YOU TO US. PROVISIONS A. If we cancel this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for Cancellation in the Schedule above, we will mail notice of cancellation to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for Cancellation in such Schedule before the effective date of cancellation, 30 B. If we do not renew this policy for any legally permitted reason other than nonpayment of premium, and a number of days is shown for When We Do Not Renew (Nonrenewal) in the Schedule above, we will mail notice of nonrenewal to the person or organization shown in such Schedule. We will mail such notice to the address shown in the Schedule above at least the number of days shown for When We Do Not Renew (Nonrenewal) in such Schedule before the effective date of nonrenewal. IL T4 00 05 19 © 2019 The Travelers Indemnity Company. All rights reserved. 64319479 1 21/22 GL AD XS WC Prof Cyber I Vickie Fogleman 1 9/30/2021 4:51:31 PM (PDT) I Page 4 of 4 Page 1 of 1