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HomeMy WebLinkAboutCertificate of Insurance (3)Al%— " CERTIFICATE OF LIABILITY DATY) ice.— INSURANCE 8/31/2021 08/31 /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 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 Parker, Smith & Feek, Inc.PNONE 16201 E Indiana Ave, Suite 1000 Spokane Valley, WA 99216 CONTACT NAME: 509-789-8350 FAx 509-931-0794 I&A I&A No. Ext): A C a): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # 00 Hartford Casualty Ins. Co. 52UUNOL5120 INSURED Alta Planning +Design, Inc. INSURER B : Trumbull Insurance Company — INSURER C : Twin City Fire Ins. Co. 711 SE Grand Ave Portland, OR 97214 INSURER D: Continental Casualty Company INSURER E: INSURER F: 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 SUBR WVDPOLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DD/YYYY LIMITS A GENERAL LIABILITY 00 52UUNOL5120 09/01/2021 09/01/2022 EACH OCCURRENCE $ 1,000,000 K COMMERCIAL GENERAL LIABILITYDAMAGE CLAIMS -MADE lxl OCCUR10,090 X TO RENTED PREMISES Ea occurrence $ 1,000,000 MED EXP (Any one person) $ PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY X PEO X LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY 52UENOl..5676 09/01/202'1 09/01/022 COMBINED SINGLE LIMIT 1,000,000 Laaccidentl $ X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE - Per accident $ A UMBRELLA LIAR 1K OCCUR 52XHUOL5121 09/01/2021 09/01/2022 EACH OCCURRENCE $ 7,000,000 X EXCESS LIAR CLAIMS -MADE AGGREGATE $ 7,000,000 DED X RETENTION $ 10,000 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? ❑ N /A 52WEOL6HIT 09/01/2021 09/01/2022 K WCSTATU- OTH- o IT E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1 ,000,000 D Professional Liability MCH114135257 09/01/2021 09/01/2022 5,000,000 Each Claim/Aggregate; 10/17/2001 Knowledge Date DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Project #00-2016-391 - Los Altos, CA Pathway Inventory and Assessment. Town of Los Altos Hills, is additional insured on the general liability policy per the attached endorsements/forms. ACORD 25 (2010/05) 3 of 10 SPC ID: K v Matsu-ZU'IU AI–UKU L UKHURA IIUN. All rights reserved. The ACORD name and logo are registered marks of ACORD (CM000) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Los Altos Hills 26379 Fremont Road AUTHORIZED REPRESENTATIVE Los Altos, CA 94022 00 ACORD 25 (2010/05) 3 of 10 SPC ID: K v Matsu-ZU'IU AI–UKU L UKHURA IIUN. All rights reserved. The ACORD name and logo are registered marks of ACORD (CM000) SECTION II -WHO IS AN INSURED 1. If youare designated in the Declarations as: a. An individual, you and your spouse are insureds, but only with respect'to the conduct of a business of which you are the sole owner. b. A partnership or joint venture, you are an insured. Your members, your partners, and their spouses are also insureds, but only with respect to the conduct of .your business: c. A limited liability company; .you are an insured. Your members are also insureds, but only with respect to the, conduct of your business. Your managers are insureds, but only with respect to their duties as your managers, d. An organ ization,.other than a partnership, -joint venture or limited liability company, you are an insured. Your "executive officers" and directors are insureds, but only with respect to their duties as your officers or directors. Your stockholders are also insureds, •but only with respect to their liability asstockholders. e. A trust, you are an insured. Your trustees are also Insureds, but only with respect to their duties as trustees. 2. Each of: the following i's also an insured: a. Employees And Volunteer Workers Your "volunteer workers" only while performing duties related to the conduct of your business, or your "employees", other than either your "executive officers" (if you are an organization other than a partnership, joint venture or limited liability company) or your managers (if you are a limited liability company), but only for acts within the scope of their employment by you or while performing duties related to the conduct of your business. However, none of these "employees" or "volunteer workers" are insureds for: (1) "Bodily injury' or "personal and advertising injury': (a) To you, to your partners or members (if you are a partnership or joint venture), to your members (if you are a limited liability company), to a. co --"employee" while in the course of his or her employment or performing duties related to the conduct of your business, or to your other "volunteer workers" while performing duties related to the conduct of your business; (b) To: the spouse, child, parent, brother or sister of that co -"employee" or that "volunteer worker" as a consequence of Paragraph (1)(a) above; (c) For which there. is any obligation to share damages with or repay someone else who must pay damages because of the injury described in Paragraphs (1)(a) or (1)(1b) above; or (d) Arising out of his or her providing or failing to provide professional health care services. If you are not in the business of providing professional health care services: (a) Subparagraphs (1)(a), (1)(b) and (1)(c) above do not apply to any "employee" or "volunteer worker" providing first aid services; and (b) Subparagraph (1)(d) above does not apply to any nurse, emergency medical technician or paramedic employed by you.to provide such services. (2) "Property damage" to property: (a) Owned, occupied or used by, (b) Rented to, in the care, custody or control of, or over which physical control is being exercised for any purpose by You, any of your "employees", "volunteer workers", any partner or member (if you are a partnership or joint venture), or any member (if you are a limited liability company). b. Real Estate Manager Any person (other than your "employee" or "volunteer worker"), or any organization while acting as your real estate manager. c. Temporary Custodians Of Your Property. Any person or organization having proper temporary custody of your property if you die, but only: (1) With respect to liability arising out of the maintenance or use of that property; and (2) Until your legal representative has been appointed. d. Legal Representative If You Die Your legal representative if you die, but only with respect to duties as such. That representative will have all your rights and duties under this Coverage Part. e. Unnamed Subsidiary Any subsidiary, and subsidiary thereof, of yours which is a legally incorporated entity of which you own a financial interest of more than 50% of the voting stock on the effective date of the Coverage Part. HG 00 01 09 16 Page 11 of 21 (h) "Bodily injury" or "property damage" arising out of the sole negligence of the vendor for its own acts or omissions or those of its employees or anyone else acting on its behalf,_ However, this exclusion does not apply to: (i) The exceptions contained in Sub- paragraphs (d) or (f); or (ii) Such inspections, adjustments, tests or servicing as the -vendor has agreed to make or normally undertakes to make in the usual course of business, in connection with the distribution or sale of the products. (2) This insurance does not apply to any insured person or organization, from whom you have acquired such products, or any ingredient, part or container, entering into, accompanying or containing such products. b.. Lessors Of Equipment (1) Any person(s) or organizations) from whom you lease equipment; but only with respect to their liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your maintenance, operation or use., of equipment leased to you by such persort(s) or organization(s), (2) With respect to the insurance afforded to these additional insureds this insurance -does not apply to any "occurrence" which takes place after the equipment lease expires. c. Lessors Of Land Or Premises Any person or organization from whom you lease land or premises, but only with respect to liability arising out 'of the ownership, maintenance or use of that part of the land or premises leased to.you. With respect to the insurance afforded these additional insureds the following additional exclusions. apply: This insurancedoes not apply to:' 1. Any "occurrence" which, takes place after You cease to lease that land; or 2. Structural alterations, new construction or demolition operations performed by or on behalf of such person or organization. d. Architects, Engineers Or Surveyors Any architect, engineer, or surveyor, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf; (1) In connection with your premises; or (2) In the performance of your ongoing operations performed by you or an your behalf. With respect to the insurance afforded these additional insureds, the following additional exclusion applies: This insurance does not apply to "bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of or the failure to .render any professional services by or for you, including: 1. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports; surveys, field orders, change orders or drawings and specifications; or '2. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring,. employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of or the -failure .to -'render any professional services by�or for'you. e. Permits Issued By State Or Political Subdivisions Any state or political subdivision, but only with respect to operations performed by you or on your behalf for which the state or political subdivision has issued a permit. With respect to the insurance afforded these additional insureds, this insurance does not apply to: (1) "Bodily injury", "property damage" or "personal and. advertising injury" arising out of operations performed for the state or municipality; or (2) "Bodily injury" or "property damage" included within the "products -completed operations hazard". f. Any Other Party Any other person or organization who is not an additional insured under Paragraphs a. through e. above, but only with respect to liability for "bodily injury", "property. damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (1) In the performance of your ongoing operations; HO 00'01 09 16 Page 13 of 21 Policy: 52WEOL6HIT Term: 09/01/2021-09/01/2022 States per carrier: Twin City Fire Ins Co (NAIC 29459) AK, AL, AR, AZ, CO, FL, GA, ID, KS, KY, LA, MA, MD, MI, MN, MT, NM, NV, PA, SC, TN, UT, VA, WA Stop Gap Hartford Casualty Ins Co (NAIC 29424) Hartford Accident and Indemnity Ins Co (NAIC 22357) CT, NY Trumbull Ins Co (NAIC 27120) IL, CA Hartford Underwriters Ins Co (NAIC 30104) MO, NC, HI, TX Hartford Fire Ins Co (NAIC 19682) OR 9 of 10 SPC ID: K (CMC00) Parker, Smith & Feek, Inc. 2233 112th Avenue NE Bellevue, WA 98004 Town of Los Altos Hills 26379 Fremont Road Los Altos, CA 94022 1 0f 10 SPC ID: K (CMC00) AC",w®W CERTIFICATE OF LIABILITY INSURANCE DAT08/318/31/D/Y/220211 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(ies) must 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 Parker, Smith & Feek, Inc. 16201 E Indiana Ave, Suite 1000 Spokane Valley, WA 99216 CONTACT NAME: PHONE 509 789-8350 FAX 509-931-0794 we No Ext): AIC No): E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC # GENERAL LIABILITY INSURER A : Hartford Casualty Ins. Co. INSURED Alta Planning +Design, Inc. INSURER B: Trumbull Insurance Company INSURER C : Twin City Fire Ins. Co. 711 SE Grand Ave Portland, OR 97214 INSURER D: Continental Casualty Company INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: RFVIRION NIIMRFR• 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 _JhSRD ADDL SUBR POLICY NUMBER POLICY EFF IMMIDDNYYYI POLICY EXP (MM/DDNYYYILIMITS AUTHORIZED REPRESENTATIVE A GENERAL LIABILITY n0//� /� 52UUNOL5120 09/01/2021 09/01/2022 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IKI OCCUR DAMAGE TO RENTED 1,000,000 PREMISES Ea occurrence $ MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 2,000,000 POLICY KC PRO- X LOC $_F060'500 B AUTOMOBILE LIABILITY 52UENOL5676 09/01/2021 09/01/2022 Eaa accidentSINGLE LIMIT 1 ��� ��� K ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ AUMBRELLA LIAB K OCCUR 52XHUOL5121 09/01/2021 09/01/2022 EACH OCCURRENCE $ 7,000,000 K EXCESS LIAB CLAIMS -MADE AGGREGATE $ 7,000,000 DED X RET10,000 ENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A 52WEOL6H1T 09/01/2021 09/01/2022 X WCSTATU- OTH- Y E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 (Mandatory In NH) yes, describe under D DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Professional Liability MCH1141352575,000,000 09/01/2021 09/01/2022 Each Claim/Aggregate; 10/17/2001 Knowledge Date DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Project #00-2018-145 - Los Altos Hills CA Pathway Fee Study. Exhibit of Insurance. CERTIFICATE HOLDER CANCFI I ATION © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 3 of 6 SPC ID: Reissue 10/31 (CMC00) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Los Altos Hills AUTHORIZED REPRESENTATIVE 26379 Fremont Road Los Altos, CA 94022 n0//� /� © 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 3 of 6 SPC ID: Reissue 10/31 (CMC00) Policy: 52WEOL6HIT Term: 09/01/2021-09/01/2022 States per carrier: Twin City Fire Ins Co (NAIC 29459) AK, AL, AR, AZ, CO, FL, GA, ID, KS, KY, LA, MA, MD, MI, MN, MT, NM, NV, PA, SC, TN, UT, VA, WA Stop Gap Hartford Casualty Ins Co (NAIC 29424) Hartford Accident and Indemnity Ins Co (NAIC 22357) CT, NY Trumbull Ins Co (NAIC 27120) IL, CA Hartford Underwriters Ins Co (NAIC 30104) MO, NC, HI, TX Hartford Fire Ins Co (NAIC 19682) OR 5 of 6 SPC ID: Reissue 10/31 (CMCOO) Parker, Smith & Feek, Inc. 2233 112th Avenue NE Bellevue, WA 98004 Town of Los Altos Hills 26379 Fremont Road Los Altos, CA 94022 1 of 6 SPC ID: Reissue 10/31 (CMC00)