HomeMy WebLinkAboutR.J. Dailey Construction Co. 10.05.2022CERTIFICATE OF LIABILITY INSURANCE DATE (Mii9PDDIYYYY')
10/5/2022
THIS CERTIFICATE IS ISSUED AS A MATTER CP INFORMATION ONLY AND CONFERS NC 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 be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditions of the policy, certain policiesmay require an endorsement. A statement on this certificate dice's not confer rights tothe
certificate holder in: lieu of such e ndorsement(s).
PRODUCER CONT: ACT Carlyn Eaton
Leavitt Pacific Insurance Brokers, Inc. PHONE (408)288-6262 FAX (.408) 298-7635
WC, N Ext : AIC, N
License ##OD79'674 E-MAIL car -l- n-eaton@leavitt. com
ADDRESS:
1570 The Alameda, Suite 101 INSURER(S) AFFORDING COVERAGE NAIL #
San Jose CA 95126 INSURER.A: Capitol Specialty In.sul:ance Czar oratior. 10328
INSURED INSURER B : Nationwide Mutual Insurance Com2any 23787
R.J. Dailey Construction Co. INSURER C : Crum & Forster S2ecialty Insurance Com: 44520
401 First Street INSURER D : Re:dwood Fire & Casualty Insurance Comet. a 1.1673
-
INS'li!RER E : James River Insurance Cam sn 1.:2203
Los Altos CA 94022: INSURER F
COVERAGES CERTIFICATE NUMBER:22-23 Master REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSPIRED NAMED ABOVE FOR THE POLICY Y PE IOD
INDICATED. NOTWITHSTANDING ANY REC�UIREME T, TERM OR GONDITION CSF ANY CONTRACT OR OTHER D CUME.I�`f
WITH RESPECT TO WHICH THIS
CERTIFICATE MAY SE ISSUED OR MAY RERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SI..!!B.IECT 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
SUSR
POLICY NUMBER
POLICY EFF
M1' /RDIYYY
POLICY EXP
MMIDDIYYYY
LIMITS
X
COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
0
11 000 1 0'EACH
A
txLAll~rIS-I+�IADE[i] OCCUR
DAMAGE TO EI•,•JTED.
PREMISES Ea occurrence
,.
10C� 000
r
X
C'T2019023304
10/1/2022
10/1/2023
NJED EXP (Any onp person)
;5
.:...........�51000
PER: {^r{`.I.AL & ADI,' .' 4J U RY
$
1,000,000
w
GREGATE LIINIITAPPLIES PER:
G&TLA
GE11EPA,LArvGREGATE
S
2.1 000, 000
IK PRC-
21000,000
POLICY. J1=CT LCD
PRODUCTS - COIVIP><'OP AGG
8
CTI-1EE;:
t
_ MO
AUTOMOBILE LIABILITY
c"ONIBII,.•IED SII..1F_i (V11IT
t{
i CiY r"�c.�3(Ie.�et)
�5
1,000,000
B X ANY AUTO W�..
BODILY .-LIURY (Per liersn:n
i
S
ALL C7}11fI11ED SCHEDULED AUTOS
AUTOS AUTOS 10/1/2022 10/1/2023
BODILY R.-IJURY (Per ac:cicfent)
S
IIraI'1-+�I1I'•IED
I -TIRED ALJTt� � AUTOS(Per
PROPERTY DAMAGE
accident
w
�
UMBRELLA LIAR X OCCUR
EACH OC{RURREI•'�ICE �
S.. ,
51.00=0 r 001 .
C - E.XCESS LIAR
ADCCREt,:ATE
tI; -
-- — 0 010y
. 0
DEDRETEE'ITIOt`J SE0120703 10/1/2022 10/1/2023
WORKERS COMPENSATION
X PE'.RTUTE �TH-
AND EMPLOYERS' LIABILITY Y / N
AI,,JY PROPRIETORIPARTNER/EXECU T IVB$
NPA
E.L.. EACH AO�GIDE1'•JT
�. OOQ 000
1 1
Q, FFJCER0v`IEP;vtB•ER E CLiJDED?
D (Mandatory in: NH) R.JWC329935 10/1/2022 10/1/202.3
E.L.. DISEASE - EA EMPLOYEE
�
� , 00th, 000
If yes, de'sc:rilae under
D SCRIPTIOtI OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
1 OOQ 000
B Rented/Leased Equipment ACP3029889886 10/1/2022 10/'1./2023
Deductble TWO . LImIt
100, 000
E Excess Liability/Umbrella 000959433 10/1/2021 10/1/2023
Eacb Ocr.urrer,ceiAggregate
5, 000, 000
DESCRIPTION OF OPERATIONS LOCATIONS I VEHICLES (ACCORD 101, Add:Itianal Rernarks Schedule, maybe attached if more space is required)
Town of Los Altos Hills is haired as additional insured per GL endorsement.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Tern of Lias Altos .Hills THE EXPIRATION GATE THEREOF, NOTICE WILL BE DELIVERED IN
26379 Fremont Road ACCORDANCE WITH THE POLICE' PROVISIONS,
Los Altos Hills , CA 94022
AUTHORIZED REPRESENTATIVE
1005-2014 ACORD CORPORATION. All rights reserved..
ACORD 25 (2014101) The ACORD nacre and logo are registered /narks of ACORD
INS025 (201401)