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HomeMy WebLinkAboutMatrix Consulting Group 07.26.2024 V2INSR ADDLSUBR LTR INSR WVD DATE (MM/DD/YYYY) PRODUCER CONTACT NAME: FAXPHONE (A/C, No):(A/C, No, Ext): E-MAIL ADDRESS: INSURER A : INSURED INSURER B : INSURER C : INSURER D : INSURER E : INSURER F : POLICY NUMBER POLICY EFF POLICY EXPTYPE OF INSURANCE LIMITS(MM/DD/YYYY) (MM/DD/YYYY) COMMERCIAL GENERAL LIABILITY AUTOMOBILE LIABILITY UMBRELLA LIAB EXCESS LIAB WORKERS COMPENSATION AND EMPLOYERS' LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) AUTHORIZED REPRESENTATIVE INSURER(S) AFFORDING COVERAGE NAIC # Y / N N / A (Mandatory in NH) ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? EACH OCCURRENCE $ DAMAGE TO RENTED $PREMISES (Ea occurrence)CLAIMS-MADE OCCUR MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GENERAL AGGREGATE $GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ $ PRO- OTHER: LOCJECT COMBINED SINGLE LIMIT $(Ea accident) BODILY INJURY (Per person) $ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $AUTOS ONLY AUTOS AUTOS ONLY HIRED PROPERTY DAMAGE $AUTOS ONLY (Per accident) $ OCCUR EACH OCCURRENCE $ CLAIMS-MADE AGGREGATE $ DED RETENTION $$ PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ If yes, describe under E.L. DISEASE - POLICY LIMIT $DESCRIPTION OF OPERATIONS below POLICY NON-OWNED SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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. 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). COVERAGES CERTIFICATE NUMBER:REVISION NUMBER: CERTIFICATE HOLDER CANCELLATION © 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORDACORD 25 (2016/03) ACORDTM CERTIFICATE OF LIABILITY INSURANCE Sentinel Insurance Company Ltd. Hartford - WC Multiple Issuing Cos Swiss Re Corp Solutions America Ins Co Twin City Fire Insurance Company 7/26/2024 USI Insurance Services, LLC 2375 E. Camelback Road, Suite 250 Phoenix, AZ 85016 877 468-6516 Christine Torrance 602 666-4830 610 537-2283 christine.torrance@usi.com Matrix Consulting Group, Ltd. 1650 S. Amphlett Blvd., Ste 213 San Mateo, CA 94402-1234 11000 00914 29874 29459 A X X X X X 59SBARO0849 08/08/2024 08/08/2025 2,000,000 1,000,000 10,000 2,000,000 4,000,000 4,000,000 A X X X X 59SBARO0849 08/08/2024 08/08/2025 2,000,000 A X X X 10, 000 59SBARO0849 08/08/2024 08/08/2025 3,000,000 3,000,000 B Y X 59WECAB6S04 08/08/2024 08/08/2025 X 1,000,000 1,000,000 1,000,000 C D Cyber Liability Professional Liab C4LTK141409CYBER20 59PG029737224 10/04/2023 08/08/2024 10/04/2024 08/08/2025 $2,000,000/$5,000 ret $2,000,000/$3,000,000 $10,000 ded/ea claim General Liability, including completed operations, and Hired & Non-Owned Auto Liability include an automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder, only when there is a written contract or written agreement between the named insured and the certificate holder and with regard to work performed by or on behalf of the named insured. General Liability, Hired & Non-Owned Auto Liability and Workers Compensation provide a blanket Waiver of Subrogation in favor of the (See Attached Descriptions) Town of Los Altos Hills 26379 Fremont RD Los Altos Hills, CA 94022 1 of 2 #S45680681/M45667941 MATRICON2Client#: 1635640 VAPZP 1 of 2 #S45680681/M45667941 SAGITTA 25.3 (2016/03) DESCRIPTIONS (Continued from Page 1) same, when required by written contract. General Liability and Hired & Non-Owned Auto Liability contain a special endorsement with "Primary and Non-Contributory" wording, when required by written contract. Umbrella follows form to Business (General) Liability, Hired & Non-Owned Auto Liability and Workers Compensation. This form is subject to any/all respective policy provisions. 2 of 2 #S45680681/M45667941