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HomeMy WebLinkAboutJoe A Gonsolves and Sons Inc. 02.26.20242/26/2024 5:36:57 PM PST (GMT -8) FROM: 18004979996 -TO: 16509413160 Page: 2 of 3 CERTIFICATE OF LIABILITY INSURANCE DATE (MIM/DD/YYYY) . 2/26/2024 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 McGee & Thielen Insurance Brokers, Inc. 3840 Rosin Court- Suite 245 Sacramento, CA 95834 CONTACT NAME: PHONE FAX A/c No Ext): 916-646-1919 IWC, No): 916-646-0995 ADDRESS: INSURER(S) AFFORDING COVERAGE NAIL # 6/17/2023 INSURERA : Travelers Indemnity Company of CT 25682 www.mcgeethielen.com 0633187 INSURED Joe A Gonsalves and Sons Inc. INSURERS: Hartford Accident and Indemnity Company 22357 PERSONAL & ADV INJURY $ Excluded 925 L Street INSURER C : INSURERD : Suite 250 Sacramento CA 95814 INSURERE : INSURERF : 16609794P909 -TCT -23 r_nVr-RArl=A r r—RT1F1r. ®T1= N1 IRnFZF1?- '7Q.01 n,iar, Pr_V1_q1nAI K11 IMR1=R_ 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/DDNYYYJ LIMITS A ✓ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F_/1OCCUR GEN'LAGGREGATE LIMIT APPLIES PER: POLICY FPRO-a LOC JE CT OTHER: ✓ 16609794P909 -TCT -23 6/17/2023 6/17/2024 EACH OCCURRENCE $2,000,000 DAMAGE To RER= PREMISES Ea occurrence)$100,000 MED EXP (Any one person) s5,000 PERSONAL & ADV INJURY $ Excluded GENERAL AGGREGATE $4,000,000 PRODUCTS-COMP/OPAGG $4,000,000 $ A AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED KION -OWNED AUTOS ONLY ✓ AUTOS ONLY 16609794P909 -TCT -23 6/17/2023 6/17/2024 Ea aBINEDtSINGLE LIMIT $1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ - - -- -- UMBRELLA LIAB -EXCESS-LIAB--- -- - — - OCCUR -CLAIMS =MADE- - ---- ------ — - ---- - - - - - ---------- _ ___ _ EACH OCCURRENCE $ AGGRE�A-TE-- ----_ - ---$- - ------ - _ - --- DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEM BER EXCLUDED? (Mandatory in NH) Iryes, describe under DESCRIPTION OF OPERATIONS below N / A 57WECZ15671 4/1/2024 4/1 /2025f SPER TATUTE EORH E.L. EACH ACCIDENT $12000,000 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) Town of Los Altos Hills is named as addtional insured with respects to general liability per the attached endorsement form CG D1 05. CERTIFICATE HOLDER CANCELLATION Town of Los Altos Hills 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 Charlotte Brown © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD 78810195 1 'K24/25 Master GL/AL/WC I CharLotte Brown 1 2/26/2024 9:33:19 AM (PST) I Page 1 of 2 2/26/2024 5-36:57 PM PST (GMT -8) FROM: 18004979996 -TO: 16509413160 16609794P909 -TCT -23 Page- 3 of 3 COMMERCIAL GENERAL LIABILITY THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, W;e 01ANKET ADDITIONAL INSURED w -w OWNERS, LESSEES OR CONTRACTORS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PROVISIONS: 1. WHO IS AN INSURED (SECTION 11) is amended to include as an insured any person or organiza- tion (called hereafter "additional insured'') whom you have agreed in a written contract, executed prior to loss, to name as additional insured, but only with respect to liability arising out of "your work" or your ongoing operations for that addi- tional insured performed by you or for you. 2. With respect to the insurance afforded to Addi- tional Insureds the following conditions apply: a. Limits of Insurance — The following limits of liability apply: 1. The limits which you agreed to provide; or 2. The limits shown on the declarations, in a written contract for this insurance to apply on a primary or contributory basis.. 3. This insurance does not apply: a. on any basis to any person or organization for whom you have purchased an Owners and Contractors Protective policy, b. to "bodily injury," "property damage," 'per- sonal injury," or "advertising injury" arising out of the rendering of or the failure to render any professional services by or for you, in- cluding: 1. The preparing, approving or failing to prepare -or approve maps, drawings, opinions, reports, surveys, change or- ders, designs or specifications; and whichever is less. 2. Supervisory, inspection or engineering b. This insurance is excess over any valid and services. collectible insuranceunless you have agreed - CG D1 05 04 94 Copyright, The Travelers Indemnity Company, 1994, Includes Copyrighted Material from Insurance Services Office, Inc,, 78810195 1 w24/25 Master GL/AL/WC I Charlotte Brown 1 2/26/2024 9:33:19 AM (PST) I Page 2 of 2 Page *1 of 1 2/26/2024 5:36:57 PM PST (GMT -8) FROM: 18004979996 -TO: 16509413160 Fro t'1'1: McGee & Thielen Insurance Brokers, Inc. '- 3840 Rosin Court, Suite 245 Sacramento, CA 95834 916-646-1919 0633187 www.mcgeethielen.com Page: 1 of 3 FAX DOCUMENT Certificate of Insurance Delivery by ecertsonline TM From: Charlotte Brown .:..........:.:.....: To: Subject: Attn : Deborah Pa dova n Town of Los Altos Hills Date: A.26379 Fremont Road Los Altos Hills CA 94022 Delivery Via: No. of Pages: Cert No. 78810195 - Certificate of Liability: Joe A Gonsalves and Sons Inc. - 2/26/2024 FAX 16509413160 3 THIS MESSAGE IS INTENDED FORTH USE OF THE INDIVIDUAL OR ENTITY TO WHICH IT IS ADDRESSED AND MAY CONTAIN INFORMATION THAT IS PRIVILEGED, CONFIDENTIAL AND EXEMPT FROM DISCLOSURE UNDER APPLICABLE LAW. IF THE READER OF THE MESSAGE IS NOT THE INTENDED RECIPIENT, OR THE EMPLOYEE OR AGENT RESPONSIBLE FOR DELIVERING THE MESSAGE TO THE INTENDED RECIPIENT, YOU ARE HEREBY NOTIFIED THAT ANY DISSEMINATION, DISTRIBUTION OR COPYING OF THIS COMMUNICATION IS STRICTLY PROHIBITED. IF YOU HAVE RECEIVED THIS COMMUNICATION IN ERROR, PLEASE NOTIFY US IMEDIATELY BYTELEPHONE, AND RETURN THE ORIGINAL MESSAGE TO US AT THE ABOVE ADDRESS VIA REGULAR POSTAL SERVICE. Certificate of Insurance Delivered by ecertsonlineT"" Insurance Visions, Inc. All rights reserved.