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Home My WebLink AboutAction Road Solutions deb Action Towing COI\.r• R®® CERTIFICATE OF LIABILITY INSURANCE 3/1/2025 DATE (MMIDDIYYYY) 1/10/2025 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 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 rights to the certificate holder In lieu of such endorsement(s). PRODUCER Lockton Companies, LLC 444 W. 47th Street, Suite 900 Kansas City MO 64112-1906 (816)960-9000 NAME CT Carrie Nelson PHONE EX AX No E-MAIL cnelson@locicton,com ADDRESS: X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxJ OCCUR kcasu@lockton.com INSURi AFFORDING COVERAGE NAIC # INSURER A: National Interstate Insurance Company 32620 INSURED ACTION ROAD SOLUTIONS DBA ACTION TOWING 1553585 DBA GREAT AMERICA TOWING INSURER B; Crum & Forster Specialty Insurance Co 44520 INSURER C: Vanliner Insurance Company 21172 INSURER D : 1790 INDUSTRIAL WAY REDWOOD CITY CA 94063 INSURER E : INSURER F: - -- - - COVERAGES CERTIFICATE NUMBER: 21290042 REVISION NUMBER: XXXXXXX 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxJ OCCUR Y Y FRA 4420001-00 6/21/2024 3/1/2025 EACH OCCURRENCE $ 1000 000 DAMAGE TO RENTED PREMISES(Ea occurrence $ - 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ] JECT F—]LocPRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: A AUTOMOBILE LIABILITYy y FRA 442001-00 6/21/2024 3/1/2025 Ea accdenntSINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ XXXXXXX X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ XXXXXXX PROPERTY DAMAGE $XXXXXXX Per accident $XXXXXXX B UMBRELLA LIAB X OCCUR N N SEO-130767 6/21/2024 3/1/2025 EACH OCCURRENCE $ 2 OOO 000 AGGREGATE $ 2,000,000 X EXCESS LIAB CLAIMS -MADE RETENTION $ DEDII- $XXXXXXX C WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY YIN ANY OFFICEOPRIET ER EXCLUDED? ECUTIVE � (Mandatory In NH) N / A Y FRW 4420001-00 3/1/2024 3/1/2025 OT H- X STATUTE ER E.L. EACH ACCIDENT $- 1000 000 E.L, DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E,L. DISEASE - POLICY LIMIT $ 1 000,000 A ON -HOOK / CARGO N N FRC 4420001-00 6/21/2024 3/1/2025 $250,000 / $250,000 LIMIT A GARAGEKEEPERS FRA 442001-00 6/21/2024 3/1/2025 $150,000 LIMIT LIABILITY DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER IS ADDITIONAL INSURED ON A PRIMARY AND NON-CONTRIBUTORY BASIS, WHEN REQUIRED BY WRITTEN CONTRACT, WAIVER OF SUBROGATION APPLIES WHEN REQUIRED BY WRITTEN CONTRACT AND WHERE ALLOWED BY LAW. SUBJECT TO POLICY TERMS AND CONDITIONS, CERTIFICATE HOLDER CANCELLATION Q 1988015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 42 212900 42 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN LOS ALTOS HILLS 26379 FREMONT ROAD AUTHORIZED REPRESENTATIV LOS ALTOS HILLS CA 94022 Q 1988015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD Farm W~9 „d Request for Taxpayer Give form to the (Rev. March 2024) identification Number and Certification requester, Do not Department of iTreasury Go to wwwdrs,govlFormW9 for Instructions and the latest information, send to the IRS, Internal Revenuee Service Before you begin. For guidance related to the purpose of Form W-9, see Purpose of Form, below, entities, n is you employe, ,urnawuauon nwnue, icuv/, If you uo not „ave, a nuniue,, see nuw to gel el or TIN, later, Employer Identification number Note: If the account is in more than one name, see the Instructions for line 1. See also What Name and m M �� Number To Give the Requester for guidelines on whose number to enter. 9 2 1 1 1 1 6 6 4 Under penalties of perjury, I certify that: 1. The number shown on this form Is my correct taxpayer identification number (or I am waiting for a number to be Issued to me); and 2. 1 am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U,S, citizen or other U,S. person (defined below); and 4. The FATCA codes) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct, Certification Instructions. You must cross out Item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage Interest paid, acquisition or abandonment.of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and, generally, payments other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN, See the Instructions for Part II, later. Sign Here UlSnpersonature f �� /_140 'L. r� "�, _----- ---- - � � —- Date D J h General Instructions Section references are to the Internal Revenue Code unless otherwise noted, Future developments. For the latest Information about developments related to Form W-9 and Its Instructions, such as legislation enacted after they were published, go to wwwAs.govfFormW9, What's New Line 3a has been modified to clarify how a disregarded entity completes this line, An LLC that Is a disregarded entity should check the appropriate box for the tax classification of Its owner, Otherwise, it should check the "LLC" box and enter Its appropriate tax classification. New line 3b has been added to this form. A flow-through entity is required to complete this line to indicate that it has direct or Indirect foreign partners, owners, or beneficiaries when It provides the Form W-9 to another flow-through entity in which it has an ownership Interest. This change is Intended to provide a ilow-through entity with information regarding the status of its Indirect foreign partners, owners, or beneficiaries, so that it can satisfy any applicable reporting requirements. For example, a partnership that has any Indirect foreign partners may be required to complete Schedules K-2 and K-3. See the Partnership Instructions for Schedules K-2 and K-3 (Form 1066), Purpose of Form An individual or entity (Form W-9 requester) who is required to file an Information return with the IRS Is giving you this form because they Cat, No. 10231X Form W-9 (Rev. 3-2024) 1 Name of entity/Indlvidual, An entry is required. (For a sole proprietor or disregarded entity, enter the owner's name on line 1, and enter the business/disregarded entity's name on line 2,) ACTION ROAD SOLUTIONS, LLC 2 Business name/disregarded entity name, If different from above. ACTION TOWING, GREAT AMERICA TOWING, ELLISON'S TOWING a)monly 3a Check the appropriate box for federal tax classification of the entity/Individual whose name is entered on line 1. Check 4 Exemptions (codes apply only to one of the following seven boxes, certain entitles, not Individuals; QL o ❑Individual/sole proprietor ❑ C corporation F]S corporation ❑Partnership EJTrust/estate see instructions on page 3): d C ❑✓ LLC. Enter the tax classification (C = C corporation, S = S corporation, P = Partnership) . . . . p Exempt payee code (If any) d Note: Check the "LLC" box above and, In the entry space, enter the appropriate code (C, S, or P) for the tax 16. �i classification of the LLC, unless it is a disregarded entity. A disregarded entity should Instead check the appropriate Exemption from Foreign Account Tax o box for the tax classification of Its owner, Compliance Act (FATCA) reporting ❑ Other (see Instructions) code (if any) o. (Applies to accounts maintained 3b If on line 3a you checked "Partnership" or "Trustlestate," or checked "LLC" and entered "P" as Its tax classification, v and you are providing this form to a partnership, trust, or estate In which you have an ownership Interest, check outside the United States, �? this box if you have any foreign partners, owners, or beneficiaries, See Instructions . . , , . . . . . ❑ 5 Address (number, street, and apt, or suite no.). See Instructions, Requester's name and address (optional) 1790 INDUSTRIAL WAY 6 City, state, and ZIP code REDWOOD CITY, CA 94063 7 List account number(s) here (optional) Taxpayer identification Number (TIN) Enter your TIN in the appropriate box, The TIN provided must match the name given on line 1 to avoid social security number backup withholding. For Individuals, this is generally your social security number (SSN). However, for a resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later, For other ......,.. , ...,........ IJ.�...Itl.�...,�... .� ....1..... W M� m entities, n is you employe, ,urnawuauon nwnue, icuv/, If you uo not „ave, a nuniue,, see nuw to gel el or TIN, later, Employer Identification number Note: If the account is in more than one name, see the Instructions for line 1. See also What Name and m M �� Number To Give the Requester for guidelines on whose number to enter. 9 2 1 1 1 1 6 6 4 Under penalties of perjury, I certify that: 1. The number shown on this form Is my correct taxpayer identification number (or I am waiting for a number to be Issued to me); and 2. 1 am not subject to backup withholding because (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all Interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U,S, citizen or other U,S. person (defined below); and 4. The FATCA codes) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct, Certification Instructions. You must cross out Item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, Item 2 does not apply. For mortgage Interest paid, acquisition or abandonment.of secured property, cancellation of debt, contributions to an Individual retirement arrangement (IRA), and, generally, payments other than Interest and dividends, you are not required to sign the certification, but you must provide your correct TIN, See the Instructions for Part II, later. Sign Here UlSnpersonature f �� /_140 'L. r� "�, _----- ---- - � � —- Date D J h General Instructions Section references are to the Internal Revenue Code unless otherwise noted, Future developments. For the latest Information about developments related to Form W-9 and Its Instructions, such as legislation enacted after they were published, go to wwwAs.govfFormW9, What's New Line 3a has been modified to clarify how a disregarded entity completes this line, An LLC that Is a disregarded entity should check the appropriate box for the tax classification of Its owner, Otherwise, it should check the "LLC" box and enter Its appropriate tax classification. New line 3b has been added to this form. A flow-through entity is required to complete this line to indicate that it has direct or Indirect foreign partners, owners, or beneficiaries when It provides the Form W-9 to another flow-through entity in which it has an ownership Interest. This change is Intended to provide a ilow-through entity with information regarding the status of its Indirect foreign partners, owners, or beneficiaries, so that it can satisfy any applicable reporting requirements. For example, a partnership that has any Indirect foreign partners may be required to complete Schedules K-2 and K-3. See the Partnership Instructions for Schedules K-2 and K-3 (Form 1066), Purpose of Form An individual or entity (Form W-9 requester) who is required to file an Information return with the IRS Is giving you this form because they Cat, No. 10231X Form W-9 (Rev. 3-2024)