HomeMy WebLinkAboutZicovich Builders Inc. 03.05.25ACC)RDr CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDD/YYYY)
F3/5/2025
TYPE OF INSURANCE
ADDLSUER
THIS CERTIFICATE IS ISSUED ASA 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,.certaln policies may require an endorsement, A statement on this certificate does not confer rights to the
certificate holder In Ileu of such endorsement(s).
PRODUCER
NAME; T Lauri Tatum
Leavitt Pacific Insurance Brokers, Inc.
PHONE (408) 2886262 FAx (400)298-7635
A/C o Ext): AIC No
License Ij079679
ADDRIESS:lauri—tatum@leavitt.com
1570 The Alameda, Suite 101
EXP"(Any one parson) - $ 5i 0.00
INSURERS AFFORDING COVERAGE NAIL #
San Jose CA 95126
INSURERA:Mesa Underwriters Specialty Insurance C 36838
INSURED
INSURER B; Ohio Security Insurance Companv 24082
Zicovich Builders, Inc.
INSURER C; Scottsdale Insurance Company 41297
761 University Ave. Ste. C
INSURER D: Everest Premier Insurance CoM2any 16045
INSURER E:
Los Gatos CA 95032
INSURER F:
%1VVGRHVC0 EaHIIHICAIF NIIMRFR-- - - oCVrcr_Kr--
THIS IS TO CERTIFYTHAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE POR 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
ADDLSUER
POLICY NUMBER
POLICY EFF
MMIDO/YYYY
POLICY EXP
MM/DD/YYYY
LIMITS
X COMMERCIAL GENERAL LIABILITY
_ _:OLAIMS;MAOF
. .CX�--:bCCUI,t..:._....
_--.:..:.
....-.__.......
_
EACH $ 1,000,000
AGOCCURRENCE
DAME TO RENTED
PREMISES Ea occurr9rical $ - 100,000
EXP"(Any one parson) - $ 5i 0.00
MP0082001008614
9/13/2024
9/13/2025MEp
PERSONAL & ADV INJURY $ 1,000,000
GEN'LAGGREGATE LIMITAPPLIES PER:
POLICY JE 0 LOC
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMPIOPAGG $ 2,000,000
Employee Benefits $ 1,000,000
OTHER:E
B
AUTOMOBILE
X
LIABILITY
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
11157498524
9/10/2029
9/10/2025
+.
COMBI ED,SIN LE LIMIT
Ea accident $ 1,000,000
BODILY INJURY (Per person) $
BODILY INJURY Per accident) $
NOWO
HIREDAUTOS_ AUTOS NED
AUTOS -
PROPERTYDAMAGEI_
Per accldent $
U lnsured`notorlsCcom6lned single $ 1, OOO, Q00
- -- _
' `
C
X
UMBRELLALIABEACH
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
OCCURRENCE $ 3,000,000
AGGREGATE $ 3,000,000
DED RETENTION $.
- $
XLS1228152
9/13/2024
9/13/2025
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED? ❑
(Mandatory In NH) -
If yes, describe under
N/A
7600017395251
3/10/2025
3/10/2026
X STA UTE EERH
E,L.EACHACCIDENT $ 11000,000
E,L, DISEASE • EA EMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS below
(ACORD 0 Ty� �e
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES 101 , Additional Remarks Schedule, may be attached If more space Is roqulred)
Re: 13300 Robleda Road, Los Altos Hills, CA.
CERTIFICATE HOLDER nnNCFI I ATIOM
esteta@losaltoshills,ca.gov
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
I Fred Stafford/GAMART
_p Oc 1988-2014ACORN CORPORATION, All rights reserved.
Mk umu Lo tAU'141U,I) The ACORD name and logo are registered marks of ACORD
INS025 (201401)