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Home My WebLink AboutPC&N Construction, Inc. (2)'°'� "� CERTIFICATE OF LIABILITY INSURANCE °A'11/2/°D"Y'"' 11/2/2010 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER C NAME AJG/Winn & Company Insurance Brokers 321 Fifth Street PHONE (AIq No, Ext): 831-637-9241 Ac, No ;831-630-0286 E -M IL l. P.O. Box 220 Hollister, CA 95023 PRODUCER License #0726293 INSURER(S) AFFORDING COVERAGE NAfC # INSURED INSURERA: Travelers Prop Cas Co ofArnerica P C & N Construction, Inc. INSURER 8: Travelers Indemnity Co of Conn. 5301-F Byron Hot Springs Road Byron, CA 94514 INSURER C: INSURER D DAMAGE TO RENTEIT$ 300,000 -PREMISES occurrence) INSURER E : A INSURER F : COVERAGES CFRTIFICATF NUMBER! RFVISInN NI IMRFR- 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. ILTR TYPE OF INSURANCE POLICY NUMBER O -_I ICY E rvuu EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE nXOCCUR DAMAGE TO RENTEIT$ 300,000 -PREMISES occurrence) MED EXP (Any one person) $ 5,000 A CO-8574PO36 04/10/2010 04/10/2011 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $2,000,000 1 POLICY X JPROECT- LOC $ AUTOMOBILE X LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS - BODILY INJURY (Per aoddent) $ B X SCHEDULEDAUTOS HIREDAUTOS 810-0022R857 04/10/2010 04/10/2011 PROPERTY DAMAGE $ (Per accident) X NON-OWNEDAUTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS -MADE AGGREGATE $ DEDUCTIBLE $ $ RETENTION $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N OFFICER/MMBRER E CLUDED?Ung F1 NIA DTE -UB -0849P91 -A-10 10/01/2010 10/01/2011 XTO Y LI TS ETF? 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 DISEASE - POLICY LIMIT $ 1,000,000 LTI- LE.L. DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORO 101, Additional Remarks Schedule, if more space is required) RR PC & N Job No. 210101; Location: MBGR at Freemont Rd & Robleda Rd. The Town of Los Altos Hills, its elective and appointed officers, employees, and Volunteers are an additional insured as per the attached. CERTIFICATE HOLDER CANCELLATION Town of Los Altos Hills 5379 Fremont Road �s Altos Hills, CA 94022 FAX: 650-941-3160 25 (20091091 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. DONALD WINN / SHERI SWYGERT 1988-2009 The ACORD name and logo are registered marks of ACORD All rinhtc rpnprvpri COMMENTS/REMARKS Policy Number: CO-8574PO36 P C & N Construction, Inc. Issue Date: 4/10/10 COMMERCIAL GENERAL LIABILITY CG 20 37 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name of Additional Insured Person(s) or Organization(s): The Town of Los Altos Hills, its elective and appointed officers, employees, and Volunteers Location of Covered Operations: PC & N Job No. 21010; Location: MBGR at Freemont Rd & Robleda Rd Information required to complete this Schedule, if not shown above, will be shown in the Declarations. Section II - Who Is An Insured is amended to include as an additional insured the person or organization shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard." COMMENTS/REMARKS Policy Number: 810-0022R857 P C & N Construction, Inc. THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM COMMERCIAL AUTO CA 20 48 02 99 With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provision of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: Named Insured (Authorized Representative) SCHEDULE Name of Person(s) or Organization(s): The Town of Los Altos Hills, its elective and appointed officers, employees, and Volunteers (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an flinsured" for Liability Coverage, but only to the extent that person or organization qualifies as an Ilinsured" under the Who Is An Insured Provision contained in Section 11 of the Coverage Form.