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HomeMy WebLinkAboutGladwell Governmental Services Inc 11.01.24GLADGOV-01 scoN7Al_P7 Aik-,,,,.✓ _ LY CERTIFICATE OF LIABILITY INSURANCE DAT DIYYYY) TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ^ OCCUR 11/1/2 /1!2024 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the polioy(ies) must have ADDITIONAL INSURED provisions or be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License # 0757776 CONMAMT CT ,Jordan Bartleson HUB International Insurance Services Inc.; PO Box 5345 Riverside, CA 92517 PHONE ) F,vAc,No:(�S1) 231-2565 AIC, No, Ext): (951 779.8575 ADDEMAIL RES: Jordan.Bartieson@hubinternational.com INSURERS AFFORDING COVERAGE NAIC # IN$VRER A: Hartford Underwriters Insurance Company 30104 INSURED INSURER B: Hartford Accident and Indemnity Company 22357 INSURER C: Hartford Casualty Insurance Company 29424 Gladwell Governmental Services, Inc. P.O. Box 62 Lake Arrowhead, CA 92352 INSURER D: United States Liability Insurance 25895 INSURER E: INSURER F COVERAGES CERTIFIQATE KII Immr-ox '— mr-VIJIVIV NUMCSCK: 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 A TYPE OF INSURANCE X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ^ OCCUR ADDL INSD �( SUBR WVD POLICY NUMBER 72$BABF4UK2 POLICY EFF MM/DDIYYYY 10/31/2024 PXP MM DDM/DDN 10/31/2025 LIMITS EACH OCCURRENCE 2,000,000 PREM SESOEE noanrenca $ 2,0009000 MED EXP (Any oneperson) 101000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY � JECT LOC GENERAL 4,000,000 $ PRODUCTS - CO PLOPGATE 4,000,000 PRODUCTS-COMPIOPAGG , 9000 $ EE IIIN�olED SINGLE LIMIT $ 1,000,000 B OTHER: AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS yy p M OS ONLY 2U ONt�LY 72UECPT0490 10/31/2024 10/31/2025 BODILY INJURY Per erson $ BODILY INJURY Per accident Pe0P.E @n DAMAGE $ C D D UMBRELLA LIABOCCUR EXCESS LIAR T CLAIMS -MADE N / A 72WECBK4F2G SP 1020955N SP 1020955N 10131/2024 10/31/2024 10/31/2024 10/31/2025E.L. 10/31/2025 10/31/2025 EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y / N (0 Fa CER/MEMBER EXCLUDED? (Mandatory bn N) If yes, describe under DESCRIPTION OF OPERATIONS below Professional Llab. Professional Liab. $ STATUTE fiRH EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYE $ 1,000,000 1 040,000 E.L. DISEASE - POLICY LIMIT $ } Per Occurrence 1,000,000 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attaohed if more space is required) Town of Los Altos Hills is Additional Insured with regard to the General Liability policy when required qy written contract per the attached endorsement form SL3042 10/18. Town of Los Altos Hills Attn: Deborah Padovan, City Clerk 26379 Fremont Road Los Altos Hills, CA 94022 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 tau VIVOJ ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INSURED: Gladwell Governmental Services, Inc, POLICY NUMBER: 72SBABF4UK2 EFFECTIVE DATES: 10/31/2024 to 10/31/2025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THE `"- HARTFORD low This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply. A. The following is added to Section C. WHO IS AN INSURED: Designated Person Or Organization a. The person(s) or organization(s) shown in the Declarations as Additional Insured — Designated Person Or Organization is also an additional insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (1) In the performance of your ongoing operations; or (2) In connection with your premises owned by or rented to you. b. If coverage provided to these additional insureds is required by a written contract or written agreement, or when required by a written permit issued by a state or governmental agency or subdivision or political subdivision, the insurance afforded to these additional insureds will not be broader than that which you are required by the contract, agreement, or permit to provide for these additional insureds. c. The insurance afforded to these additional insureds only applies to the extent permitted by law. B. With respect to the insurance afforded such additional insured(s) by this endorsement, the following additional exclusion is added to Section B. EXCLUSIONS: This insurance does not apply to "bodily injury" or "property damage" included within the "products -completed operations hazard". Form SL 30 42 10 18 ©2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) Page 1 of 1 GLADGOV-01 SGONZAL �...- CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/1/2024 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($), 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 conditionsthe policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of ouch uch endorsement(s). PRODUCER License 0757776 �CONTACT Jgrdan BartlesonHUB International Insurance Services Inc. PO Box 5345 Ext : (951) 779-8575 FAXRiverside, CA 92517 (A//C, No : (951) 231-2565A0FRR• Jordan.Bartlesonno hrthinfnrn.fi. '. ,....... INSURED Gladwell Governmental Services, Inc. P.O. Box 62 Lake Arrowhead, CA 92352 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HA INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFOR EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE R .TR TYPE OF INSURANCE SD WVD POLICY NUMBER A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR X 72SBABF4UK2 E: R: vc nccly lti,�Utu'1-O THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT GEN'L AGGREGATE LIMIT APPLIES PER: TO ALL THE TERMS, BEEN REDUCED BY PAID CLAIMS. PO MMIDIDYEYY MM:' POLICY JDCT EACH OCCURRENCE $ 2,000,000 LOC 10/31/2024 10/31/2025 DREM SESOEa oo ur encs $ 2,000,000 OTHER: MED EXP An one orson 10,000 B AUTOMOBILE LIABILITY PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 X ANY AUTO 72UECPT0490 PRODUCTS. COMP/OP AGO $ 4,000,000 OWNED SCHEDULED AURTOS ONLY AUTOppS�/ COMBINED SINGLE LIMIT $ Ee accident $ 1,000,000 AUTOS ONLY AUOTOS ONLY 10/31/2025 BODILY INJURY Per Person BODILY INJURY Per accident $ UMBRELLA LIAR OCCUR EXCESS LIAB CLAIMS -MADE DED RETENTION $ EACH OCCURRENCE $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 10/31/2024 10/31/2025 ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICER/MEMBER EXCLUDED? N / A 72WECBK4F2G (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 Per Occurrence If yes, describe under DESCRIPTION OF OPERATIONS below 10/31/2024 10/31/2025 D Professional Liab. 1,000,000 SP 1020955N D Professional Liab. pmay be attached if mors space Is required) olicy when required py written contract per the attached endorsement form 1-1- . -- SP 1020955N IESCRIPTION own OF OPERATIONS / LOCATIONS / VEHICLES of Los Altos Hills is Additional Insured (ACORD 101, Additional Remarks Schedule L304210/18, with regard to the General Liability E: R: vc nccly lti,�Utu'1-O THE INSURED NAMED ABOVE FOR THE POLICY PERIOD OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS DED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, BEEN REDUCED BY PAID CLAIMS. PO MMIDIDYEYY MM:' LIMITS EACH OCCURRENCE $ 2,000,000 10/31/2024 10/31/2025 DREM SESOEa oo ur encs $ 2,000,000 MED EXP An one orson 10,000 PERSONAL & ADV INJURY $ 2,000,000 GENERAL AGGREGATE $ 4,000,000 PRODUCTS. COMP/OP AGO $ 4,000,000 COMBINED SINGLE LIMIT $ Ee accident $ 1,000,000 10/31/2024 10/31/2025 BODILY INJURY Per Person BODILY INJURY Per accident $ ROPERTYDAMAGE Per accident $ EACH OCCURRENCE $ AGGREGATE $ 10/31/2024 10/31/2025 X STATUTE ER" E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 Per Occurrence 10/31/2024 10/31/2025 1,000,000 10/31/2024 10/31/2025 Aggregate 2,000,000 pmay be attached if mors space Is required) olicy when required py written contract per the attached endorsement form 1-1- . -- SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Las Altos Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Attn: Deborah Padovan, City Clerk ACCORDANCE WITH THE POLICY PROVISIONS. 26379 Fremont Road Los Altos Hills, CA 94022 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD INSURED: Gladwell Governmental Services, Inc. POLICY NUMBER: 72SBABF4UK2 EFFECTIVE DATES: 10/31/2024 to 10/31/2025 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. THR '`l HARTFORD This endorsement modifies insurance provided under the following: BUSINESS LIABILITY COVERAGE FORM Except as otherwise stated in this endorsement, the terms and conditions of the Policy apply. A. The following is added to Section C. WHO IS AN INSURED: Designated Person Or Organization a. The person(s) or organization(s) shown in the Declarations as Additional Insured — Designated Person Or Organization is also an additional insured, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by your acts or omissions or the acts or omissions of those acting on your behalf: (1) In the performance of your ongoing operations; or (2) In connection with your premises owned by or rented to you. b. If coverage provided to these additional insureds is required by a written contract or written agreement, or when required by a written permit issued by a state or governmental agency or subdivision or political subdivision, the insurance afforded to these additional insureds will not be broader than that which you are required by the contract, agreement, or permit to provide for these additional insureds. c. The insurance afforded to these additional insureds only applies to the extent permitted by law. B. With respect to the insurance afforded such additional insured(s) by this endorsement, the following additional exclusion is added to Section B. EXCLUSIONS: This insurance does not apply to "bodily injury" or "property damage" included within the "products -completed operations hazard". Form SL 30 42 10 18 O 2018, The Hartford (May include copyrighted material of Insurance Services Office, Inc., with its permission) Page 1 of 1