Loading...
HomeMy WebLinkAboutNo Fault Asphalt Inc 04.03.2024�F CERTIFICATE OF LIABILITY INSURANCE DATE (M YYY) 1 04/03/2024 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 FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 NAME CT CLIENT CONTACT CENTER AICNNo, Ext). 888-333-4949 FAX c, No): 507-446-4664 A DRIESS: CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURERS AFFORDING COVERAGE NAIC # INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 160-392-7 INSURER B: NO FAULT ASPHALT INC PO BOX 50877 INSURER C: INSURER D: PALO ALTO, CA 94303-0672 INSURER E: INSURER F: DAMAGE TO RENTED PREMISES Ilia occurrence) $100,000 COVERAGES CERTIFICATE NUMBER: 74 REVISION NUMBER: 0 IS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. OTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE SUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF CH POLICIES. LIMITS SHOWN MAY HAVE BEEN -REDUCED BY PAID CLAIMS. kN TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP Ippiyyyxi LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $1,000,000 CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES Ilia occurrence) $100,000 MED EXP (Any one person) EXCLUDED A Y N 9912362 01/22/2024 01/22/2025 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 PRODUCTS & COMP/OP AGO $2,000,000 X POLICY OFC LOC OTHER: AUTOMOBILE LIABILITY . G SINGLE LIMIT aacctdeennt $1> DOD> 000 (Eacci BODILY INJURY (Per Person) X ANYAUTO BODILY INJURY (Per Accident) A OWNED AUTOS ONLY SCHEDULED- - AUTOS N N 9912362 01/22/2024 01/22/2025 DAMAGE HIRED AUTOS ONLY NON-OWNEDPROPERTY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER STATUTE THER E.L EACH ACCIDENT ANY PROPRIETOR/PARTNERI EXECUTIVE OFFICERIMEMBER EXCLUDED? L (Mandatory in NH) NIA E.L DISEASE -EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT RIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 10.1, Additional Remarks Schedule, may be attached if more space is required) r POLICY COVERAGE AS OF 01./22/2024 ADDITIONAL INSUREDS ALSO INCLUDES TOWN OF LOS ALTOS HILLS' ELECTED AND APPOINTED OFFICERS., EMPLOYEES, AND VOLUNTEERS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. CERTIFICATE HOLDER CANCELLATION 160-392-7 TOWN OF LOS ALTOS HILLS 26379 W FREMONT RD LOS ALTOS HILLS, CA 94022-2624 74 0 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 © 198E-201.5 ACORD CORPORATION. All rights reserved. ACORD 25 (2015103) The ACORD name and logo are registered marks of ACORD Additional Insured Copy POLICY NUMBER: Q812382 COMMERCIAL GENERAL LIABILITY CG 20 12 12 19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED �STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION m PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision OrPolitical Subdivision: Town ofLos Altos Hills 26379 VVFremont Rd Los Altos Hills, CAB4O22-2824 linformation required to complete this Schedule, if not shown above, will be shown in the Declarations. I A. SectionD!-Who Is An Insured iaamended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the 8ohedu|e, subject to the following provisions: 1. This insurance oppUoe only with noupeot to operations performed byyou oronyour behalf for which the state orgovernmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforded to such additional insured only applies to the extent permitted bylaw; and. b. If ouvenego provided to the additional insured is required by o contract or agreement, the insurance afforded tosuch additional insured will not bebroader than that which you are required by the contract oragreement to provide for such additional insured. Insured: NoFouKAsphaK/no POBox 5O877 Palo Alto, CA843O3-O872 2. This insurance does not apply to: au "Bodily injury," "property damage" or "personal and advertising injury" arising out ofoperations performed for the federal govornrnont, state or municipality; or b' "Bodily injury" or "property damage" included within the "prod ucts-oomnp|eted operations hazard". B. With respect to the insurance afforded to these additiona| inauneds, the following is added to Section III-LYmmitmOf Insurance: If coverage provided to the additional insured is required by e contract oragreement, the most we will pay on behalf ofthe additional insured is the amount ofinsurance: 1' Required bythe contract oragreement; or 2. Available under the applicable limits of insurance; whichever ioless. This endorsement shall not increase the applicable limits of insurance. Project or Reference: Additional insureds also includes Town ofLos Altos Hills' elected and appointed officers. employees, and volunteers subject tothe terms and conditions of the policy. @ Insurance Services Office, Inc., 2018 Page 1of 1 CG 20 12 12 19 Policy Number: BB12382 Transaction Effective Date: O1/22/2O24