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HomeMy WebLinkAboutO. Nelson & Son, Inc. 07.08.2024nKIl=i cnK1_n'2 nnnGKinl`7 '' CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 7/8/2024 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 Acrisure Partners West Coast Insurance Services, LLC 1950 W Corporate Way #1 Anaheim, CA 92801 CONTACTJustin MCGaugh PHONE FAX (A/C, No, Ext): (A/C, No): ADDRESS: JMcgaugh@acrisure.com INSURERS AFFORDING COVERAGE NAIC # 7/1/2024 INSURER A : CM Vantage Specially Insurance Company 15872 EACH OCCURRENCE $ 11000,000 INSURED INSURER B : The Ohio Casualty Insurance Company 24074 INSURER C: Palomar Excess and Surplus Insurance Company 16754 O. Nelson & Son, Inc. INSURER D: State Compensation Insurance Fund of California 35076 3345 Tripp Road Woodside, CA 94062 INSURER E: Navigators Specialty Insurance Company 36056 INSURER F LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY COVERAGES CERTIFICATE NUMRER-- RFVISIC)N NIl1MRFR- 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX] OCCUR X Owner's & Contractor X CMV-PLI-0051219-01 7/1/2024 7/1/2025 EACH OCCURRENCE $ 11000,000 DAMAGE TO RENTED 100,000 PREMISES Ea occurrence)$ MED EXP (Any oneperson) $ 51000 GEN'L AGGREGATE LIMIT APPLIES PER: RO- POLICY ® JJEC I LOC OTHER: PERSONAL & ADV INJURY $ 11000,000 GENERAL AGGREGATE $ 21000'000 PRODUCTS - COMP/OP AGG $ 21000,000 $ B AUTOMOBILE X LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIRED NON -OWNED AUTOS ONLY AUTOS ONLY BA057403797 7/1/2024 7/1/2025 COMBINED SINGLE LIMIT 15000,000 Ea accident $ BODILY INJURY Perperson) $ BODILY INJURY Per accident $ PROPERTY DAMAGE Per accident $ - C X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE - - - -- - -- - - -- PES -XS -01-2355 -- - 7/1/2024 - --- - 7/1/2025 EACH OCCURRENCE--- $ - -- 21000,000 AGGREGATE $ 21000'000 DED I RETENTION $ $ D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A 9135884 7/1/2024 7/1/2025 X IPI STATUTE EORH E.L. EACH.ACCIDENT $ 1'000'000 1,000,000 E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ 11000,000 E Pollution SF24ECP000697NC 7/1/2024 7/1/2025 Limit 11000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Re: The Town of Los Altos Hills are included as an additional insured on General Liability policy per the attached endorsement. CERTIFICATE HOLDER CANCELLATION 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 Town of Los Altos Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 26379 Fremont Road Los Altos Hills, CA 94022 AUTHORIZED REPRESENTATIVE ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD