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HomeMy WebLinkAboutR.J. Dailey Construction Co. (2)ACC)RV� CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 10/5/2022 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 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: Carlyn Eaton Leavitt Pacific Insurance Brokers, Inc. License #OD79674 PHCNEo t, (408)288-6262 AIG No): (408)298-7635 EMAIL carlyn-eaton@leavitt.com ADDRESS: y 1570 The Alameda, Suite 101 INSURERS AFFORDING COVERAGE NAIC # San Jose CA 95126 INSURER A: Capitol Specialty Insurance Corporatior 10328 _- - INSURED INSURER B: Nationwide Mutual Insurance Company 23787 INSURERC:Crum & Forster Specialty Insurance Com 44520 R.J. Dailey Construction Co, INSURER D: Redwood Fire &_Casualty Insurance Compa 11673 401 First Street INSURER E: James River Insixrance Company 12203 INSURER F: Los Altos CA 94022 COVERAGES CERTIFICATE NUMBER:22-23 Master 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 MAYBE 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 POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MM/DDlYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 A CLAIMS -MADE X OCCUR DAMAGE TO RENT -D PREMISES Ea occurrence _S 100/000 MED EXP (Arty one person) ,.._..-.......................................__....._........_............. ;i 5,000 ............................................................................ . ..................___..._.___..._.__............_.,... .,......._..._.................................. ... X r:tT2019023304 10/1/2022 10/1/2023 PERSONAL & ADV INJURY $ 1,000,000 GEN'LAGGREG��--A---�T�-E��� LIMIT APPLIES PER. GENERAL AGC RELATE 2,000,000 - _ _.y POLICY L��__I PET LOC PRODUCTS - COMPICIPAGG 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED Sit LIMIT _(Ea accident ._,..._.._..____...... $ 1,000,000 X ANYAUTO BODILY INJURY (Per person) S B ALL OWNED .....e_ SCHEDULED- AUTOS AUTOS ACP3029989888 10/1/2022 10/1/2023 BODILY INJURY (Per accident) NOMI -OWNED PROPERTY DAMAGE S HIREDAUTOS AUTOS Pei accident ............ UMBRELLA LIAB X ..-__ OCCUR EACH OCCURRENCE .... ..........._....... ................. .......,....._............... ........ S 5,000,000 ....................... ......................... .......................... C X EXCESS LIAB CLAIMS -MADE AGGREGATE S 5,000,000 DED RETEHTIOH.i SE0120703 10/1/2022 10/1/2023 WORKERS COMPENSATION X FER 6TH - AND EMPLOYERS' LIABILITY Y / N _ STATUTE J___.1ER E.L EACH ACCIDEP-IT 3 1,000,000 ANY P(ManROPRIETORIPARTHER/EXECUTIVE P"'"'"I D OFFICERIMEMBER EXCLUDED? u OFFIC tarylnNH) NIA R.TWC32993.5 10/1/2022 10/1/2023 _ E.L DISEASE, EA EMPLOYEE _ S 1,000,000 It yes. describe under DESCRIPTION OF OPERATIONS below El. DISEASE -POLICY LIMIT S 11000,000 B Rented/Leased Equipment ACP3029889886 10/1/2022 10/1/2023 Deduchble9600 - Limit 100,000 E Excess Liability/Umbrella 000959433 10/1/2022 10/1/2023 Each OccurrencelAggregate, 5,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additinnal Remarks Schedule, may ba annahed 8 mare space Is required) Re: All California operations. Town of Los Altos Hills is named as additional insured per attached GL endorsement forms. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2014/01) INS025 (201401) (- 1988-2014 ACORD CORPORATION, All rights r©served. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Los Altos Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26379 Fremont Road ACCORDANCE WITH THE POLICY PROVISIONS, Los Altos Hills, CA 94022 AUTHORIZED REPRESENTATIVE Fred ACORD 25 (2014/01) INS025 (201401) (- 1988-2014 ACORD CORPORATION, All rights r©served. The ACORD name and logo are registered marks of ACORD