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HomeMy WebLinkAboutCertificate of Insurance (2)I VAIYT_4 nn M. Pc CERTIFICATE OF LIABILITY INSURANCE DATE 110/04/20412/Y1 10021 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 pollcy(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 endorsements). PRODUCER 408.526-1112 Professional Ins. Assoc Shepherd & Assoc Ins. Services 1100 Industrial Road #3 00r ACT Chris Shepherd NAAE. PHONE408-526-1112 FAx 408-526-1777 A/C, No, Ext); AIC No): EMAIL. chr s shep er-Insurance.com San Carlos, CA 94070 Christopher Shepherd INSURERS FORDING COVERAGE NAIC INSURERA:ValleY Forge Ins Co. 20508 DAMAGE TO RENTED a $ 1,000,000 INSURED LYNX Technologies, Inc 1380 41st Ave. Ste 402 Capitola, CA 96010 INSURERS: INSURER C INSURER D : INSURER E : PRODUCTS - COMP/OP AGG 4,000,000 INSURER F : A cnvca nr_cc r•co-r, c,r n-rc nn mem=o. n n ­i en �.rr.r..._ 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. INSRI TR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY EXP 09/15/2022 LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_X] OCCUR X 7012936799 09/15/2021 2 000 EACH OCCURRENCE , ,000 DAMAGE TO RENTED a $ 1,000,000 MED EXP (Any one erson 10,000 PERSONAL &ADV INJURY 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ jpeT F__1 LOG N OTHER: GENERAL AGGREGATE 4,000,000 PRODUCTS - COMP/OP AGG 4,000,000 A AUTOMOBILE IxANY LIABILITY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS D AUTOS ONLY X AUTOS ON�Y 7012936799 09/15/2021 09/15/2022 COMBIN ,SINGLE LIMIT 1,000,000 BODILY I JUR Per Person) BODILYINJURY Per acoideni BODILY Po�aCclden �AMAOE UMBRELLA LIAR EXCESS LIAR OCCUR CLAIMS -MADE EACH OCCURRENCE AGGREGATE DED RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OF FICE�tIMF�MI EXCLUDED? ( andaory n ) If es describe under D 0 0 ,EB6TIOUS below N/A IPER OTH- I STATUTE E.L. EACH ACCIDENT E.L. DISEASE - EA EMPLOYEE DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Town of Los Altos Hills, Its officers, officials, employees, agents, contrators and volunteers are added as additional insureds per attached endorsement. Town of Los Altos Hills 26379 Fremont Rd. 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 ACORL) 26 (2015103) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 7012936799 COMMERCIAL GENERAL LIABILI`T'Y CG 20 10 10 93 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE I . Name of Person or Organization (Additional Insured): Town of Los Altos Hills, its officers, officials, employees, agents, contractors and volunteers 2. Additional Premium incl. (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) WHO IS AN INSURED (Section II) is amended to include as an insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability arising out of your ongoing operations performed for that insured. CG 20 10 10 93 Copyright, Insurance Services Office, Inc., 1993 AC"R" CERTIFICATE OF LIABILITY INSURANCE �,, „✓ DATE(MMIDDIYWY) 04/26/2022 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 CONTACT NAME: Automatic Data Processing Insurance Agency, Inc. Automatic Data Processing Insurance Agency, Inc. A/co"N Ext, 1-800-524-7024 AIC No): E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # 1 Adp Boulevard Roseland NJ 07068 INSURERA: Sequoia Insurance Company 22985 INSURED Lynx Technologies Inc INSURER B: INSURER C : GENERAL AGGREGATE $ INSURER D: 1350 41st Avenue Ste 202 INSURER E: AUTOMOBILE Capitola CA 95010 INSURER F: COVERAGES CERTIFICATE NUMBER: 2428387 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 ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DD/YYW LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1:1 OCCUR EACH OCCURRENCE $ PREMISES Ea occurrence $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRC ❑ JECT LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COMBINED SINGE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITYY / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? FNN (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA N QWC1209475 05/16/2022 05/16/2023 PER OT - STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of Los Altos Hills ACCORDANCE WITH THE POLICY PROVISIONS. 26379 Fremont Rd AUTHORIZED REPRESENTATIVE Los Altos Hills CA 94022 ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD