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HomeMy WebLinkAboutGladwell Governmental Services, Inc. 01.22.2024r%1 A r%r%^I A nool L%_ ^ K1"7 h r 1--'7 ' CERTIFICATE OLIABILITY INSURANCE DATE (MM/DDIYYYY) '1122/2024 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(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. It 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 HUB International Insurance Services Inc. PO Box 5345 Riverside, CA 92517 CONTACTJordan Bartleson NAME: PHONE FAX FAX 95'1 231 2565 (A/C, No, Ext): ( 951 ) (A/C, No): ( ) ADDRESS: Jordan.Bartleson@hubinternational.corn INSURERS AFFORDING COVERAGE NAIC # 10/3'112023 INSURER A : Sentinel Insurance Company, Ltd. 11000 EACH OCCURRENCE $ 11000,000 INSURED INSURER B : Hartford Accident and Indemnity Company 22357 INSURER C : Hartford Casualty Insurance Company 29424 Gladwell Governmental Services, Inc. INSURER D :United States Liability Insurance 25895 P.O. Box 62 Lake Arrowhead, CA 92352 - INSURER E: INSURER F r4r%11C0nr_Cc r r_0Tu9:lrAT1= A1111=11=0 P1=X11Q1nnl KII1ftAR1=P- 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 NSD SUBR 'W VD POLICY NUMBER POLICY EFF MM DD POLICY EXP MM DD LIMITS A X COMMERCIAL GENERAL LIABILITY _7CLAIMS-MADE [X] OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: PJLOC POLICY ® OTHER: X 72SBAIB5623 10/3'112023 10/3'1/2024 EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED "1,000,®00 PREMISES Ea occurrence $ MED EXP An� oneperson) $ 10,000 PERSONAL & ADV INJURY $ 15000,000 GENERAL AGGREGATE $ 21Q00,000 PRODUCTS - COMP/OP AGG $ 23000,000 $ AUTOMOBILE LIABILITY X ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY 72UECPT0490 10/31/2023 10/31/2024 COMBINED SINGLE LIMIT 13000,000 Ea accident $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? IN (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 72WECAV7EWT 2/1/2024 2/1/2025 XPER STATUTE �RH 11000,000 E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 11000,000 E.L. DISEASE - POLICY LIMIT $ D D Professional Liab Professional Liab SP 1020955M. SP 1020955M 10/31/2023 10/31/2023 10/3112024 10/31/2024 Per Occurrence 15000,000 Aggregate 210003000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be_attached.if more space is required) Town of Los Altos Hills is Additional Insured with regard to the General Liability policy when required by written contract per the attached endorsement form IH12001185T. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Los Altos Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Deborah Padovan, City Clerk 26379 Fremont Road Los Altos Hills, CA 94022 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) `: ::t x 'lis ., .. i .;©1988-12015 ACORD CORPORATION'. All rights reserved. The ACORD na6Ie c bd logo are"'r6d'isMered marks of ACORD POLICY NUMBER: 72 SBA IB5623 ADDITIONAL INSURED - PERSON -ORGANIZATION CITY OF SAN MARCOS AND ITS ELECTED AND APPOINTED BOARDS, OFFICERS, AGENTS AND EMPLOYEES PRIMARY NON-CONTRIBUTORY BASIS CITY CLERK DEPARTMENT 1 CIVIC CENTER DRIVE SAN MARCOS, CA 92069-2918 RE: LOC 001 BLDG 001. CITY OF SANTA ROSA. ATTENTION: CITY CLERK 100 SANTA ROSA AVE, ROOM 10 SANTA ROSA, CA 95404 CITY OF SAN GABRIEL 425 SOUTH MISSION DR. SAN GABRIEL, CA 91778 LOC 001 BLDG 001 CITY OF MERCED ATTENTION: INFORMATION TECHNOLOGY 678 18TH ST. MERCED, CA 95340 LOC 001 BLDG 001 CITY OF BEVERLY HILLS 455 N. REDFORD DR. BEVERLY HILLS, CA 92352-0062 TOWN OF LOS ALTOS HILLS 26379 FREMONT ROAD LOS ALTOS HILLS, CA 94022 CITY OF EL CAJON ATTN: KATHIE RUTLEDGE, CITY CL 200 CIVIC CENTER WAY EL CAJON, CA 92020-3916 Form IH 12 00 11 85 T SEQ. NO'_.O�C�S Print�d' Its �J!.5.�. Page 0 O l ( CONTINUED ON NEXT PAGE) •w,.. , .,;r.. _ . Process ®ata: 08 /10/22 � ��w a• . ,., .•. ._ _Ex n:ration Date: 10/31123. _.. F S". h .q ■ 70 AC"R" CERTIFICATE OF LIABILITY INSURANCE s DATE (MM/DD/YYYY) 02/01/2024 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(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 CONTACT Victoria L. Smith NAME: PHONE, (571)248-3190 FRAC No): (877)418-5422 Yergey Insurance Services, LLC E-MAIL victoria er a ins.com ADDRESS: �Y g Y 5941 Parsons Lane INSURERS AFFORDING COVERAGE NAIC # EACH OCCURRENCE $ 3,000,000 INSU RERA : ACE Fire Underwriters Insurance Company - SPI 20702 King George VA 22485-2434 INSURED INSURER B: INSURER C : PyroAnalysis LLC INSURER D: 1095 Hilltop Drive, Suite 200 INSURER E: INSURER F Redding CA 96003 COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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/DD/YYYY) POLICY EXP (MM/DD/YYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X Errros and Omissions GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY 7 PRO LOC JECT OTHER: 26379 Fremont Road SPIG289.91174006 02/01/2024 02/01/2025 EACH OCCURRENCE $ 3,000,000 DAMAGE RENTED P EM SESOEa occurrence)$ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 3,000,000 GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $ 3,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS u HIREDu NON -OWNED AUTOS ONLY X AUTOS ONLY SPIG28991174006 02/01/2024 02/01/2025 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y /N ANY PROPRIETOR/PARTNER/EXECUTIVE H OFFICER/MEMBER EXCLUDED? __ (Ma�ndatery in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A UB -008W234823 05/24/2023 05/24/2024 PER OTH- 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 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION Fax: Email: ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Peter Pirnejad ACCORDANCE WITH THE POLICY PROVISIONS. City Manager AUTHORIZED REPRESENTATIVE Town of Los Altos Hills 26379 Fremont Road Los Altos Hills CA 94022 Fax: Email: ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD M EYERI 0 OP ID: RF CERTIFICATE OF LIABILITY INSURANCE ""'",°°""" THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR 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 858-514-7123 Insurance Brokerage 1615 Murray Canyon Rd Ste 1050 San Diego, CA 92108 Shawn M. Royle CONTACT Shawn M. RoyleAhern NAME: PHONE 858-514-7123 FAX 858-571-9010 (AIC, No, Ext): (A/C, No): E -ML sroyle@acrisure.com ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC SUBR WVD INSURER A: Ascot Specialty Insurance Comp 45055 INSURED Meyers Nave, A Professional Corporation 1999 Harrison Street, 9th Fl. Oakland, CA 94612 INSURER B: INSURER C: COMMERCIAL GENERAL LIABILITY INSURER D: INSURER E: INSURER F: 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. INTR LR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF (MW/DI2ffM) POLICY EXP (MMIDDNYYY) LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F—] OCCUR EACH OCCURRENCE $ DAMAGE TO RENTED PREMISES (Ea occurrence) $ MED EXP An one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- F LOC [_1 GENERAL AGGREGATE $ JECT PRODUCTS - COMP/OP AGG $ $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT (Ea accident) $ BODILY INJURY Per person) $ ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE (Per accident) $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION$ -AGGREGATE $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS' LIABILITY Y/N STATUTE ER E.L. EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVEN/A OFFICER/MEMBER EXCLUDED? F_ (Mandatory in NH) If yes, describe under E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION RIPTION OF OPERATIONS below A Professional Liab LPPL2410000427-04 05101/2024 05/01/2025 PER CLAIM 53000,000 Claims Made AGGREGATE 51000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) DEDUCTIBLE EACH CLAIM): $100,000 DEDUCTIBLE AGGREGATE): $200,000 I %-ogm i irit.#/A i c nULUMM CANCELLATION Town of Los Altos Hills City Manager 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 At;UKU Zb (ZU16/U3) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD