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HomeMy WebLinkAboutPC&N Construction, Inc. (5)A4C 4DREI CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/NM �..�.� 11/2/2010 TIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS RTIFICATE 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 MMID Y AJG/Winn & Company Insurance Brokers 321 Fifth Street NCONTACT AME 831-637-9241 831-630-0286 lao Na Ext): ac No P.O. Box 220 E-MAIL Hollister, CA 95023 PRODUCER License #0726293 EACH OCCURRENCE $ 1,000,000 INSURER(S) AFFORDING COVERAGE NAIC It INSURED INSURERA: Travelers Prop Cas Co of America P C & N Construction, Inc. INSURER B : Travelers Indernnity Co of Conn. 5301-F Byron Hot Springs Road Byron, CA 94514 INSURERC: INSURERD; EIF A INSURER E: INSURER F: V V v VI�I9V VV I :FK I IFIL _a 1 F NI lmmf - DC\/ILIA\I \II 1\�GCl1. 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. LLT TYPE OF INSURANCE PL I R SUBRE WVD POLICY NUMBER MMIO MMID Y LIMITS GENERAL. LWSILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE OCCUR DAMAGE RENTED $ 300,000 PREMISES We 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'LA GGREGATE LIMIT APPLIES PER: POLICYX PRO- LOC JECT,.,. r PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE X LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 BODILY INJURY (Per person) $ ALL OWNED AUTOS -,_ BODILY INJURY (Per accident) $ B SCHEDULED AUTOS 810-0022R857 04/10/2010 04/10/2011 PROPERTY DAMAGE $ (Per accident) X HIREDAUTOS X NON -OWNED AUTOS $ $ UMBRELLALIAB OCCUR EACH OCCURRENCE $ EXESS CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNER D(ECtI WE OFFICER/MEMBEREXCLUDED? (Mandatory In NH) If yes, describe under NIA DTE -UB -0849P91 -A-10 10/01/2010 10/01/2011 X OR LIT S OER_ _ 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 below DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, fl more space is required) RE: PC & N Job No. 21010; Location: MBGR at West Loyola Drive. 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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE X379 Fremont Road THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN s Altos Hills, CA 94022 ACCORDANCE WITH THE POLICY PROVISIONS. FAX: 650-941-3160 AUTHORIZED REPRESENTATIVE ry DONALD WINN / SHERI SWYGERT ACORD 25 (2009109) ©1986-2009 ACORD CORPORATION. All rights reserved. 1 ne e+vvlw 1I0III0 411U 1U9U UFO FUU15LU1rVU Ir1dnrS OF At VKL1 COMMENTS/REMARKS 4. As a condition of coverage provided to the additional insured by this endorsement: a) The additional insured must give us written notice as soon as practicable of an "occurrence" or an offense which may result in a claim. To the extent possible, such notice should include: i. How, when and where the "occurrence" or offense took place; ii. The names and addresses or any injured persons and witnesses; and iii. The nature and location of any injury or damage arising out of the "occurrence" or offense. b) If a claim is made or "suit" is brought against the additional insured, the additional insured must: i. Immediately record the specifics of the claim or "suit" and the date received; and c) The additional insured must immediately send us copies of all legal papers received in connection with the claim or "suit," cooperate with us in the investigation or settlement of the claim or defense against the "suit," and otherwise comply with all policy conditions. d) The additional insured must tender the defense and indemnity of any claim or "suit" to any provider of "other insurance" which would cover the additional insured for a loss we cover under this endorsement. However, this condition does not affect whether the insurance provided to the additional insured by this endorsement is primary to "other insurance" available to the additional insured which covers that person or organization as a named insured as described in paragraph 3 above. 5. The following definition is added to SECTION V. - Definitions: "Written contract requiring insurance" means that part of any written contract or agreement under which you are required to include a person or organization as an additional insured on this Coverage Part, provided that the "bodily injury" and "property damage" occurs and the "personal injury" is caused by an offense committed: a) After the signing and execution of the contract or agreement by you; b) While that part of the contract or agreement is in effect; and c) Before the end of the policy period. CG D2 46 08 05 0 2005 The St. Paul Travelers Companies, Inc. Page 2 of 2 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.