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Home My WebLink AboutCity Rise LLC COI 06.25.250 F LIABILITY INSURANCE DATE (MMIDONYVY) 6/25/2025 CERTIFICATE DOES NOT AFFIRMATIVELY OR NIiATIVELY NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES REPRESENTATIVE OR PRODt10ER, AND THE CERTIFICATE HOLDER. CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(% AUTHORIZED endorsement.IMPORTANT: if tits certlflnate holder Is an ADDITIONAL INSURED, the pallcy(Iss) moat have ACiDI'TIONAL INSURED provisions sir be r�ndoreed, If SUBROGATION IS WAIVED., sulaJeot to the terms and conditions of the pcllcy, certain policies may require an A Statement on this certificate does 11ot confer rights to the Gertlflf;Ate holder In Ileo of such sndorsalnent s . AssuredPartn6rs of California Insurance Servioes, LLC �PAMEPHON' Cc�rtlfioato Team 426 River Park Drive, Suite 226 10-993-2700 FA 3 Sacramento CA 95815 _11. ... I INSURED City Rise, LLC 686 E. Lookeford Street Lodi CA 95240 Ins. " 14 0,1 101 frju ....... REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE A13OVE FOR THE POLICY —PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TI -418 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. ....... . ............ . TR TYPEOPINSURANCE JIWR Y_ V y POLICYNUMBER M Y X COMMERCIAL GENERAL LIA131UTY Y Nwqwm LIMITS M IMS DE Y CFIGL00327261 6/2612026 6/26/2026 EACHOCCUnR F v-1 OCCUR 7CLAIMS -MADE D $1,000,000 olj OCCUR j DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks 80hadule, may be attached If more apace Is requIrod) Mel, Liability - Carrier: At Bay Specialty Insurance Company . NIAC 9: 19607 - Policy #AB -0604677.05 - Effective: 6/2612025 - 6/25/2026. Limit of Liability - $ 000,000 - Retention - $25, 00 RE Encroachment Permit ALIto Liability Additional Insured applies per terms and conditions of the attached endoreement(s). Primary Wording for Auto Liability applies per terms and conditions of the attached endorsement. Auto Liability Waiver of Subrogation applies per terms and conditions of the attached endorsement. General Liability Additional Insured applies per terms and conditions of the attached en orsement(s). Primary Wording for General Liability applies per terms and conditions of the attached endorsement. General Liability Waiver of Subrogation applies per terms and conditions of the attached endorsement. . Town of Los Altos Hills 26379 Fremont Road Los Altos Hills CA 94022 ACORD 26 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0 1988.2015 A0 The ACORD name and logo are registered marks of ACORD All rights reserved. 140: 2 _MMD —Ex P SAIiL2�60 _PERSONAL & ADV INJURY �_ AG�IENrRAL LRLt:4ffC___ "' PRODUOTS - COMt/OP AGO $ 1,000,000 >b2 OQO 004 2 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY EW i D i Pt .r 1:1 LOO _L,000,00O__ A AUTOMOBILE. LIABILITY ANY AUTO Y Y CF4CA01650251 _R _ 5/2026 R51262 1� IN,?D IINUL—e—LIM-71— &W -9i 'QiIL___ $2,000,000 OWNED SCHEDULED AUTOS ONLYJ RE AUTO$ HIRED NON -OWNED To ONLY AUTOS ONLY AUTOS ONLY BODILY INJURY File, BODILY INJURY Mer accident) :;P11_0PE'7 YDAMAUff— $ D UMBREL ALIAB �X ] _ CUR OCCUR EXCESS LIAR NAIMS MADE SXS0069226 6/2512025 �COMP00111610111)ad $$5,0001$6,000 0/25/2026 _R�CH OCCURIIENCE $3,000,000 DED RETENTION $ _�%�REqATI ...... WORKERS COMPENSATION— AND EMPLOYERS, LIABILITY Y/N ANYPROPMETOR/PART NEWEXECUTIVE OFFICERIMEMUCREXOLUDED? [__j (Mandatory In NI -1) If you. dewribe undor DE CRIPTION,OF OPERATIONS j2_010—W N/A E L. DISEASE - EA EMPLC�YEC,_yr S E A Profauslonal Liabillty UIPM011tFloater SIqlainess AL1110 E000003473010 YM2291465901015 CF4CA01650251 E.L. DISEASE - POLICY LIMIT 131 61261202 6126)202 U 6123/2020 1 :-;aoh Doc / Aggregato ��l Catastrophe UIT11t I'llyalcal Dainag e 0000001100 1000000 1106000-0 �2,7 (�07,141 AVV 'V DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks 80hadule, may be attached If more apace Is requIrod) Mel, Liability - Carrier: At Bay Specialty Insurance Company . NIAC 9: 19607 - Policy #AB -0604677.05 - Effective: 6/2612025 - 6/25/2026. Limit of Liability - $ 000,000 - Retention - $25, 00 RE Encroachment Permit ALIto Liability Additional Insured applies per terms and conditions of the attached endoreement(s). Primary Wording for Auto Liability applies per terms and conditions of the attached endorsement. Auto Liability Waiver of Subrogation applies per terms and conditions of the attached endorsement. General Liability Additional Insured applies per terms and conditions of the attached en orsement(s). Primary Wording for General Liability applies per terms and conditions of the attached endorsement. General Liability Waiver of Subrogation applies per terms and conditions of the attached endorsement. . Town of Los Altos Hills 26379 Fremont Road Los Altos Hills CA 94022 ACORD 26 (2016/03) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 0 1988.2015 A0 The ACORD name and logo are registered marks of ACORD All rights reserved. 140: 2 CF4CA01650261 COMMERCIAL AUTO ECA 02 616 0121 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. PRIMARY AND NONCONTRIBUTORY - OTHER INSURANCE CONDITION - BLANKET This endorsement modifies insurance Provided under the following: MOTOR CARRIER COVERAGE FORM Paragraph 9. of the Other Insurance General Conditlon is replaced by the following: g. Regardless Of the provisions of Paragraph a., b., C., d. and e, above Coverage is primary end we will not seek , this Coverage Form's Liability contribution from any other insurance for any liability assumed under, an, "Insured contract" that requires liability to be assumed on a primary noncontributory basis. Additionally, only the coverage and limit Of Insurance requirements of the "Insured contract" shallapply, and in no event shall those requirements exceed the coverage and limits of insurance provided under this policy. All other terms and conditlonsof this policy apply, ECA 02 516 0121 Copyright, Everest Reinsurance Company, 2021 Includes copyrighted material of Insurance Services Office, Inc., Page I of I used with Its permission 140: 3 * of 10 COMMERCIAL CG 24 0412 19 THIS ENDORSEMENT CHANGES POLICY. PLEASE WAIVER OF O RECOVERY y.O.. .:.. (WAIVERAGAINST OTHERS TO US SUBROGATION) This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE DART ELECTRONIC DATA LIABILITY COVERAGE PART LIQUOR LIABILITY COVERAGE PART POLLUTION LIABILITY COVERAGE FART DESIGNATED SITES POLLUTION LIABILITY LIMITED COVERAGE PART DESIGNATED SITES PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART RAILROAD PROTECTIVE LIABILITY COVERAGE PART UNDERGROUND STORAGE TANK POLICY DESIGNATED TANKS Name Of Person(s) Or Organization(s). ALL PERSONS OR ORGANIZATIONS AS REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED, THE WRITTEN CONTRACT MUST BE SIGNED PRIOR TO THE DATE OF THE "BODILY INJURY", "PROPERTY DAMAGE", OR "PERSONAL AND ADVERTISING INJURY". to The following is added to Paragraph 8. Transfer Of Rights Of Recovery Against Others To Us of Section IV — Conditions: We waive any right of recovery against the person(s) or organization(s) shown in the Schedule above because of payments we make under this Coverage Part. Such waiver by us applies only to the extent that the insured has waived its right of recovery against such person(s) or organization(s) prior to loss. This endorsement applies only to the person(s) or organization(s) shown in the Schedule above. wi CG 24 041218 Q Insurance Services Office, Inc., 201 Page 1 of 1 INSURED COPY 140: 4 ' POLICY NUMBER: OF4GA01650251 COMMERCIAL AUTO CA 20 48 10 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. A A' This endorsement modifies Insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM 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 organizatlon(s) who are "insureds" for Covered Autos Liability Coverage 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 Polley effective on the Inception date of the policy unless another date is indicated below, Narned Insured: City Rise, LLC Endorsernent Effective note: 06/25/2025 Narne Of Person(s) Or Organization(s): ALL PERSONS OR ORGANIZATIONS AS aSQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. THE WRITTEN CONTRACT MUST BE SIGNED PRIOR TO THE DATE OF THE "ACCIDENT". Each person or organization shown in the Schedule Is an "insured" for Covered Autos Liability Coverage, but only to the extent that person or organization qualifies as an "Insured" under the Who Is An Insured provision contained In Paragraph Al. of Section 11 — Covered Autos Liability Coverage in the Business Auto and Motor Carrier Coverage Forms and Paragraph 0.2. of Section I — Covered Autos Coverages of the Auto Dealers Coverage Form. CA 20 48 10 13 *Insurance Services Office, Inc., 2011 Page I of I INSURM Copy 140: 5 ' of 10 POLICY NUMBER: CF1 GL00327251 COMMERCIAL GENERAL LIABILITY CG 20 37 OSI 13 THIS ENDORSEMENT CHANGESPLEASE w.,M IT CAREFULLY. ADDITIONAL INSURED - OWNERS,, LESSEES OR CONTRACTORS IAR COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART Marne Of Additional Insured Person(s) Or Or anizatlon s P R SON OR ORGANI'ZA�'� QN Fc Location And 13escri tlon Of Com feted Operations ' ENTERED INT'0 A WRI'T'TEN ANY LOCATION FOR WHIUH THE NAMED INSURED' a MORN WAS 'RACT' WI 'I1 TRE NAMED PERFORMED FOR SUCH PERSON (a) INSURED REQUIRING SUCH OR ORGANIZATION (B) FOR ANY PERSON (a) OR ORGANIZATION (S) COMPLETED OPERATIONS. TO BE INCLUDED AS AN ADDITIONAL INSURED. �In—f—onm�atlonMcquired to Com lete this Schedule, if not shown above will be shown in the Declarations, A. Section II – Who Is An Insured is amended to Include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" Caused, in whole or In part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and Included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If Coverage provided to the additional insured is required by a Contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. CG 20 37 0413 G Insurance Services Office, Inc., 2012 Page 1 of 2 INSURED COPY 140: B. With respect to the insurance afforded to these additional Insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured Is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2.Avellable under the applicable Limits of Insurance shown in the Declarations; whichever is less, This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 @Insurance Services Office, Inc,, 2012 INSURED COPY CG 20 37 0413 0 140: 7 ' of 10 CF4CA01650251 COMMERCIAL AUTO ECA 24 603 02 14 WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US This endorsement modifies insurance provided under the following: AUTO DEALERS COVERAGE FORM BUSINESS AUTO COVERAGE FORM MOTOR CARRIER COVERAGE FORM SCHEDULE Name of Person or Organization: ALL PERSONS OR ORGANIZATIONS AS REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. THE WRITTEN CONTRACT MUST BE SIGNED PRIOR TO THE DATE OF THE "ACCIDENT". (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US Condition is arnended by the addition of the following: We waive any right of recovery we may have against the person or organization shown in the Schedule above because of payments we make for an "accident" or "loss", provided that you are required under a written agree- ment to waive your rights of recovery. The written agreement must be made prior to the date of the "accident" or "loss". This waiver applies only to the person or organization shown in the Schedule above, ECA 24 603 02 14 Copyright, Everest Reinsurance Company, 2014 Page I of 1 0 Includes copyrighted material of Insurance Services Office, Inc., used with its permission. 140: 0 POLICY NUMBER: CF1 GL00327251 COMMERCIAL GENERAL LIABILITY CO 20 10 04 13 This endorsement modifies insurance provided Linder the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART Name Of Additional Insured Porson(s) Or OK9anization(s) Location(s) Of Covered Operations Any person or organization that entered into a written contract with the Named Insured requiring such person(s) or organization(s) to be named as an Additional Insured with respect to liability arising out of the premises shown on the Designation of Premises Schedule. A. Section 11 — Who Is An Insured is amended to include as an additional insured the person(s) or organ ization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf, in the performance of your ongoing operations for the additional Insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional Insured Is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for Such additional insured. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 0413 @ Insurance Services Office, Inc., 2012 Page I of 2 INSURED COPY 140: 9 C. With respect to the Insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown In the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 @ Insurance Services Office, Inc., 2012 CG 20 10 0413 INSURED COPY 140: 10