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Home My WebLink AboutCertificate of Insurance 08.04.2020Client#: 1635640 MATRICON2 A,+O• DTM CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) TYPE OF INSURANCE 8/04/2020 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 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 any rights to the certificate holder in lieu of such endorsement(s). PRODUCER USI Insurance Services, LLC 2421 West Peoria Avenue, Suite 110 Phoenix, 85029 877 468-65511 6 CONTACT Mary. AI NAME: y lana PHONE FAX A/c, No, Ext : 602-666-4812 a c, No : 610-537-2283 ADDRESS: mary.aldana@usi.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Sentinel Insurance Company Ltd. 11000 INSURED Matrix Consulting Group, Ltd 201 San Antonio Cir Ste 1 Mountain View, CA 94040--11234 INSURER B : Hartford Fire Insurance Company 19682 INSURER C: Twin City Fire Insurance Company 29459 INSURER D: Philadelphia Indemnity Insurance Co. 18058 MED EXP (Any one person) $10,000 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 CONTRACTOR 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, LTR TYPE OF INSURANCE ADDL INSR SUBR WVD POLICY NUMBER POLICY EFF MM/DD YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR 59SBAR00849 8/08/2020 08/08/2021 EACH OCCURRENCE s2,000,000 EM S PRMqGI ES� a occur ence $1,000 000 MED EXP (Any one person) $10,000 PERSONAL &ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO- X POLICY X JECT _J LOC GENERAL AGGREGATE $4,000,000 PRODUCTS - COMP/OP AGG $4,000,000 $ OTHER: A AUTOMOBILE LIABILITY 59SBARO0849 8/08/202008/08/2021 Ea III dE SSINGLE LIMIT 2,000,000 BODILY INJURY (Per person) $ ANY AUTO X OWNED SCHEDULED AUTOS ONLY AUTOS AUTOS ONLY X AUTOSNON-OWNEDONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ A X UMBRELLA LIAB X OCCUR 59SBAR00849 8/08/2020 08/08/2021 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS -MADE AGGREGATE $1 000 000 DED X RETENTION $$10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N / A 59WECAB6SO4 8/08/2020 08/08/2021 X PER OTH- STATUTE E E.L. EACH ACCIDENT $11,000,000 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 C Professional 59PGO297372 8/08/2020 08/08/2021 Aggr $3,000,000 D Emp Practice PHSD1559672 7/15/2020 07/15/2021 Aggr $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ** Workers Comp Information ** Proprietors/Partners/Executive Officers/Members Excluded: Richard P Brady, Officer Certificate holder is named as additional insured as it relates to general & auto liability & waiver of subrogation is granted as it relates to general and auto liability and workers comp in accordance with the (See Attached Descriptions) 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 (o)' MR -9n15 /lCnRn 110RPORATIf1N1 All rncnr—A ACORD 25 (2016/03) 1 of 2 The ACORD name and logo are registered marks of ACORD #S29535654/M29534915 S9KZP DESCRIPTIONS (Continued from Page 1) terms and conditions of the policies. Umbrella follows form as it relates to additional insureds. The above coverage is primary and noncontributory where required by written contract. 0AU11 I H 47.0 kzu 1 ONS) Z OT Z #S29535654/M29534915 USI INSURANCE SERVICES CERTIFICATE RETURN MAIL PROCESSING PO BOX 629035 ELDORADO HILLS CA 95762-9035 TOWN OF LOS ALTOS HILLS 26379 W FREMONT RD LOS ALTOS HILLS CA 94022-2698