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HomeMy WebLinkAboutCertificate of InsuranceACCORDI, CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/26/2023 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 CONTACT Carlyn Eaton Leavitt Pacific Insurance Brokers, Inc. NAME:PHONE (408)288-6262 FAx A/C IL Ext: AIC No),(40e)29e-7e35 License #OD79674 E-MAILSS: car/ ADDREarlyn-eaton@leavitt.com 1570 The Alameda, Suite 101 INSURERS AFFORDING COVERAGE NAIC # San JOSE CA 95126 INSURED INSURERA:Ca ltol Specialty Insurance. Cor Oratior 10328 INSURER B: Nationwide Mutual Insurance COT an 23787 R.J. Dailey Construction Co. 401 First Street INSURER C: Redwood Fire & Casualty Insurance Coma 11673 INSURERD;James River Insurance Company 12203 INSURER E: Los Altos CA 94022 INSURER F COVERAGES CFRTI CI! ATC An rano - -- --- - - -- THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED Mr_VIJFVN NUM6ER: ABOVE FOR THE POLICY INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER PERIOD DOCUMENT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES WITH RESPECT TO WHICH THIS DESCRIBED HEREIN EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED IS SUBJECT TO ALL THE TERMS, BY PAID CLAIMS. INSRADDL SUER POLICY EXP LTR TYPE OF INSURANCE WVD POLICY NUMBER IMM1Oc1YYFF Y YYYY X COMMERCIAL GENERAL LIABILITY LIMITS � EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE 1 J OCCUR DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 X CT2019023305 10/1/2023 10/1/2024 MED EXP (Any one person) $ 5,000 PERSONAL d ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: POLICY FX PRO F]GENERAL JECT LOC AGGREGATE $ 2,000,000 OTHER: PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 X ANY Ea accident BODILY INJURY (Per person) $ B AUTO ALL OWNED SCHEDULEED AUTOS AUTOS ACP3039889886 10/1/2023 10/1/2024 BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB XOCCUR EXCESS LIAB EACH OCCURRENCE $ 5,000,000 A X CLAIMS -MADE AGGREGATE $ 5,000,000 DED RETENTION $ CX2023022301 10/1/2023 10/1/2024 WORKERS COMPENSATION $ AND EMPLOYERS' LIABILITY X PER OTH- Y/N ANY PP.OPRIETOR/PARTNER/EXECUTIVE - STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 C OFFICER/MEMBER EXCLUDED? ❑N/A (Mandatory in NH) If yes, describe under R.TwC432613 10/1/2023 10/1/2024 E.L.-DISEASE -EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 1 000,000 B Rented/Leased Equipment ACP3039889886 10/1/202310/1/2024 D Deductible$500 - Limit 100,000 Excess Liability/Umbrella 000959434 10/1/2023 10/1/2024 Each Occurrence/Aggregate 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more is space required) Re: All California operations. Town of Los Altos Hills is named as additional insured per attached GL endorsement - forms. i CERTIFICATE HOLDER CANCELLATION 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 Stafford/CHDUEN / / © 1988-2014 ACORD CORPORATION. Ali rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD INS025 (201401)