HomeMy WebLinkAboutR.J. Dailey Construction Co. 10.05.2022 V2ACC>R" CERTIFICATE OF LIABILITY INSURANCE DATE( MIDD YYY.)
1€3/5,72022
THIS CERTIFICATE 1S ISSUED AS A FATTER. OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRN�A7IVELY 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($), AUTHORIZED
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUB Rc�... GATION IS WAIVED, subject to
the terms and conditions of the ,policy, certain policies :n ay require an endorsement. A statement on this certificate does not confer righty to the
certificate holder in lieu of such endorsement(s).
PRODUCER
CONTACT Carlyn Eaton.
Leavitt Pacific Insuran.ceL Brokers, Inc.
RHONE (403 j 2.1 8- 62 62 FAX (408) 298-7635
A/C No E . AIC, No):
License #IOD79674
E-MAIL carlyn—e:aton@leavitt.com
ADDRESS,
INSURER(S) AFFORDING COVERAGE NAIL
N�
1570 The Alameda, Suite 101
San Jose CA 95.26
INSURERA: Capitol S ecialt Insurance Cox caratior 10328
INSURED
INSURER B: Nationwide Mutual Insurance Com2any 23787
INSURER C : Crum & Forster S26cialty Insurance Com: 44520
R. a. Dailey Construction Co.
INSURER D : Redwood Fire & Casualty insurance Com a 11673
401 First Street.
I' NSl1RER. E : James River Insurance Coo an x,2203
INSURER F:
Los Altos CA 94022
COVERAGES CERTIFICATE NUMBER.:22-23 Master
.K....�....... ,..—.-.`,,�,..
REVIS ON NUMBER:
Town of Los Altos Hills
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE: INSURED NAMED ABOVE FOR THE POLICY PERIOD
ACCORDANCE WITH THE POLICY PROVISIONS,
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF .ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TMJWHICH THIS
CERTIFICATE MAY BE. ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREN
IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
-
INSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE POLICY NUMBERILII` /DDIYYYY) (MMIDDIYYYYI
LIMITS
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE
$
11 Obf� , C}oo
A
t�LA` I ,-I IAE3E C)CCUR
DkvIAGE TO R0,-ITED
PREMISES�Fc< f�Cf";�.if'!'t''.17we-?
�
b
10 � 000
t
_
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x
(,T2019023304
10/1/2022
10/1/2023,
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+^
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5, �?�3D
.
PERSOI'•J:AL. & ADV II'•<JUR'Y
$
11000,000
GEN'L.AGGREGATE LIN11T APPLIES PER:
GE11ERAL AGGREGATE
S
21000,000
PO -
POLICY E JECT LOC
PRODUCTS - COMPtOPAGG
$
2 r OC)b, 000
OTHER:
AUTOMOBILE LIABILITY
CC)IiIBI1''• M 971E LE 1171IT
a accident)
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1k r �l b Q, U^D �
B
X ANY AUTO a
BODILY INiJURY (Per peg aon
ALL 0WI-',]ED SCHEDULED
AUTOS AUTOS
AC.:P.3029889886
10/1/2022
10/1./2023
BODILY INJURY (Per accklent)
I'-I0N-O'�`,II�••�IED
1-11REDAUTC�.S AUTOS
PROPERTY DAMAGE
'Pea accident
�
UMBRELLA LIAR
�..... OCt;:,LIR
EACH �rG':c;;UPnREI,Ic;;E
.
�
5 boa QCO
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-- - EXCESS L IA,B-- - =L J. _CL,A NIS -€'IAD
- -
- -- - -
..... ..
AGGREGATE -- - ----
....,.....� ...................
$
... ......
f 000,000 -
L}'E.D RETEIITIC�r,J' $8E0120703
10/1/2022
10/1/2023
WORKERS COMPENSATION
� PER OTH-
AND EMPLOYERS' LIABILITYY1N
STATUTE ER
ANY PP,C)PREETC)PJPARThIER/EXECi.IT NE
:}MCERItvIEk-lBER EXCLUDED? N 1 A
�R43WC3299.35
E.L. EACH A1c IDErdT
S
1 b00 bb0
?
(Mandatory In. N:H) 10/1/2022 10/1/2023
E._. DISEASE - EA EMPLOYEE EE
S
1 000 bbb
If yes; desc:r[be under
,
DESCRIPTIOr<I OF OPERATI01.4S below
E.L. DISEASE - POLICY LIMIT1
000,000
B Rented/Leased Equipment ACP3029889886 10/1/2022 10/1/2023
DeduchbleuZOO - Limit
100,000
E Excess Liability/Umbrella 000959433 10/1/2022 10/1/202.3
EactOccirrencegAggregate
51flbb, bbb
DESCRIPTION OF OPERATIONS 1 LOCATIONS.! VEH[CL:ES. (ACORD '101, Add!I#Inrlal Remarks Schedule, may be ,;i.tt� ahed if' more- space Is rewired)
Re., All California operations.
Town of Los Altos Tills is named as additional insured per attached CL endorsement.
forms.
CERTIFICATE HOLDER CANCELLATION
Q 1088-20' 4 .ACORD CORPORATION-. All rights reserved.
ACCORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
IN$025 (201401)
SHOULD ANY OF THE ABOVE DESCRIBED POL.ICIES BE CANCELLED BEFORE
Town of Los Altos Hills
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
26379 Fremont Road
ACCORDANCE WITH THE POLICY PROVISIONS,
Los Altos Hills, C.A. 94022
AUTHORIZED :REPRESENTATIVE
Q 1088-20' 4 .ACORD CORPORATION-. All rights reserved.
ACCORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
IN$025 (201401)