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HomeMy WebLinkAboutInterstate Grading & Paving, Inc. 11.03.2022Policv Number: Date Entered:.1/2/2022 A�Q��� CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11/3/2022 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 INSIGHT Agency Insurance Services PIIB Affiliate P.O. BOX 5230 0 CONTACT Dooley NAME: Amy y PHOA ACNE Ext): (707) 843-5425 FAX No : (707) 843-542-6 E-MAILamy@ insightagency . net ADDRESS: X1 COMMERCIAL GENERAL LIABILITY Santa Rosa, CA 95402 INSURER(S) AFFORDING COVERAGE NAIC # INSURER A : y Travelers Indemnity Co of Connectici25682 INSURED Interstate Grading & Paving, Inc INSURER B :Travelers Prop. Casualty Co of America EACH OCCURRENCE $ 1. r 000 r000 INSURER C: Insurance Company of the West 27847 128 South Maple Avenue INSURER D: Certain Underwriters at Lloyd's, Lo don South San Francisco, CA 94080 INSURER E: INSURER F: 11/1/2023 COVERAGES CERTIFICATE NUMBER -O 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 IND SUBR WVD POLICY NUMBER POLICY EFF MM/DDNYYY POLICY EXP MM/DD/YYYY LIMITS A X1 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1. r 000 r000 CLAIMS -MADE ® OCCUR DT22CO4C34487 9- 11/1/2022 11/1/2023 AMAGE TO RENTED PREM SES Ea occurrence) $ 300,000 MED EXP (Any one person) $5,000 X r C & U TCT22 PERSONAL & ADV INJURY $ 11 0 0 0 r 0 0 0 GENERAL AGGREGATE $ 2, 0 0 0 r O O O GEN'L AGGREGATE LIMIT APPLIES PER: PRO- POLICY ® JECT LOC PRODUCTS - COMP/OP AGG $2f0001000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 000 000 Ea accident r BODILY INJURY (Per person) $ A X ANY AUTO 810OL8515122226G 11/1/2022 11/1/2023 OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE $ Per accident 13 X UMBRELLA LIAB OCCUR EACH OCCURRENCE $8,000,000 EXCESS LIAB CLAIMS -MADE CLTP7H42 0 907222 6 11/1/2022 11/1/2023 - AGGREG -- _ ATE $8,000,000 DED I XRETENTION $10 1 0 0 0 $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/E, XECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N/A T�jSA 5034996 06 11/1/2022 11/1/2023 XPER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1 f000,000 1 0 0 0 0 0 0 E.L. DISEASE - EA EMPLOYEE $ r If yes, describe under DESCRIPTION OF OPERATIONS below - 1 0 0 0 0 0 0 E.L. DISEASE - POLICY LIMIT $ r r D Pollution Liability ENP 0006952-01 1/29/2022 1/29/2023 Each Occurrence 2 r 000, 000 - Aggregate . 2,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Job: 2022 Pavement Rehabilitation and Drainage Improvement Project The Town, its officials, employees and volunteers are named as Additional Insureds CERTIFICATE HOLDER CANCELLATION Town of Los Altos Hills 26379 Fremont Rd Los Altos Hills, CA 94022 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE -THEREOF, THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE William Zimmerman �s it ����xr �zY� � y�� �� yi �} .�bA' ♦.il„x,.fii ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD