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Home My WebLink AboutG. Bartolotto & Company 07.25.2023�y ��py'-''�"� ..�-f CERTIFICATE OF LIABILITY INSURANCE DATE (MM /DD 07/25/2023 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 NAME GT CLIENT CONTACT CENTER (AIC, Ext): 888-333-4949 FAX No): 507-446-4664 a DRIESS: CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURERS AFFORDING COVERAGE NAIC # 08/21/2024 INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 DAMAGE TO RENTED PREMISES $100,000 INSURED 402-811-4 INSURER B: G. BORTOLOTTO & COMPANY 582 BRAGATO RD INSURER C: —� INSURER D: SAN CARLOS, CA 94070-6227 INSURER E: Y INSURER F: 9356459 COVERAGES CERTIFICATE NUMBER: 80 REVISION NUMBER: 0 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF YYXI POLTRLICY EXP (MM LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: POLICY liECT" PRLOC OTHER: Y N 9356459 08/21/2023 08/21/2024 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES $100,000 MED EXP (Any one person) EXCLUDED PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS & COMPIOP AGO $2,000,000 A AUTOMOBILE LIABILITY X ANYAUTO OWNED AUTOS ONLY SCHEDULED HIRED AUTOS ONLY NON -OWNED AUTOS ONLY Y N 9356459 08/21/2023 08/21/2024 COMBINED SINGLE LIMIT $110001000 Ea accident BODILY INJURY (Per Person) BODILY INJURY (Per Accident) PROPERTY DAMAGE A X UMBRELLA LIAR EXCESS LIAB X OCCUR CLAIMS -MADE N N 9356460 08/21/2023 08/21/2024 EACH OCCURRENCE $8,000,000 AGGREGATE $8,000,000 DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERI EXECUTIVE OFFICERIMEMBER EXCLUDED? L (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N1A PER STATUTE THER T E.L EACH ACCIDENT E.L DISEASE -EA EMPLOYEE E.L DISEASE POLICY LIMIT DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION 402-811-4 TOWN OF LOS ALTOS HILLS 26379 W FREMONT RD LOS ALTOS HILLS, CA 94022-2624 8110 1 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 h - Q 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 402-811-4 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY G. BORTOLOTTO & COMPANY 582 BRAGATO RD SAN CARLOS, CA 94070-6227 _ POLICY NUMBER SEE CERTIFICATE ## 80.0 CARRIER NAIC CODE EFFECTIVE DATE: SEE CERTIFICATE # 80.0 SEE CERTIFICATE # 80.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE G BORTQLOTTO ,JOB 019-803 RE: 2019 PAVEMENT REHABILITATION AND DRAINAGE IMPROVEMENT PROJECT ADDITIONAL INSURED INCLUDES: TOWN OF LOS ALTOS HILLS, ITS OFFICERS, OFFICIALS, EMPLOYEES AND VOLUNTEERS THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS WHEN REQUIRED IN CONSTRUCTION AGREEMENT WITH YOU ENDORSEMENT FOR 'GENERAL LIABILITY. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED BY CONTRACT ENDORSEMENT FOR BUSINESS AUTO LIABILITY. INSURANCE PROVIDED BY THE GENERAL LIABILITY COVERAGE IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. INSURANCE PROVIDED BY THE BUSINESS AUTO LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. GENERAL LIABILITY COVERAGE CONTAINS CG 25 03 DESIGNATED CONSTRUCTION GENERAL AGGREGATE LIMIT ENDORSEMENT APPLICABLE TO EACH CONSTRUCTION PROJECT AS REQUIRED BY WRITTEN CONTRACT OR WRITTEN AGREEMENT. COMMERCIAL UMBRELLA FOLLOWS FORM ACCORDING TO THE TERMS, CONDITIONS, AND ENDORSEMENTS FOUND IN THE COMMERCIAL UMBRELLA POLICY. FOR REASONS OTHER THAN NON-PAYMENT OF PREMIUM, 30 DAYS NOTICE WILL BE PROVIDED TO THE CERTIFICATE HOLDER IN THE EVENT THAT THE ISSUING COMPANY CANCELS THE POLICY BEFORE THE EXPIRATION DATE OF THE POLICY. ACORD 101 (2008/01) 4 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD