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HomeMy WebLinkAboutBell Plumbing of San Mateo Inc. 01.29.2024 V2A.C.CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYY) 01/29/2024 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 PHONE A CNNo, Ext): 888-333-4949 FAX c, No): 507-446-4664 E-MAIL CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURERS AFFORDING COVERAGE NAIC # 03/17/2025 INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 PEAaMAGE TO RENTED PREMISES $100,000 occurranc INSURED 161-783-6 INSURER B: BELL PLUMBING OF SAN MATEO INC 1180 SAN CARLOS AVE BOX 704 _ INSURER C: INSURER D: SAN CARLOS, CA 94070-2418 INSURER E: AUTOMOBILE LIABILITY X ANYAUTO OWNED AUTOS ONLY SCHEDULED HIRED AUTOS ONLY NON -OWNED AUTOS ONLY INSURER F: N COVERAGES CERTIFICATE NUMBER: 69 REVISION NUMBER: 0 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 TYPE OF INSURANCE ADD L SUER POLICY NUMBER POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FX OCCUR Y N 9829156 03/17/2024 03/17/2025 EACH OCCURRENCE $1,000,000 PEAaMAGE TO RENTED PREMISES $100,000 occurranc MED EXP (Any one person) EXCLUDED PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ["JF ECT F-1 LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS & COMPlOP AGO $2,000,000 A AUTOMOBILE LIABILITY X ANYAUTO OWNED AUTOS ONLY SCHEDULED HIRED AUTOS ONLY NON -OWNED AUTOS ONLY N N 9829156 03/17/2024 03/17/2025 COEaMBINED accident SINGLE LIMIT $110001 000 BODILY INJURY (Per Person) BODILY INJURY (Per Accident) ROPERTY DAMAGE A X UMBRELLA LIAB EXCESS LIAR X OCCUR CLAIMS -MADE N N 9829157 03/17/2024 03/17/2025 EACH OCCURRENCE $4,000,000 AGGREGATE $4,000,000 DED I RETENTION FWORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERI EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER STATUTETHER E.L EACH ACCIDENT E.L DISEASE -EA EMPLOYEE E.L DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) SEE ATTACHED PAIGE CERTIFICATE HOLDER CANCELLATION 161-783-6 TOWN OF LOS ALTOS HILLS 26379 W FREMONT RD LOS ALTOS H I LLS, CA 94022-2624 89 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 ® 1988-201.5 ACORD CORPORATION. All rights reserved. ACORD 25 (20161031) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: 161-783-6 LOC #: ADDITIONAL REMARKS SCHEDULE Page 1 of 1 AGENCY NAMED INSURED FEDERATED MUTUAL INSURANCE COMPANY BELL PLUMBING OF SAN MATEO INC 1180 SAN CARLOS AVE BOX 704 SAN CARLOS, CA 94070-2418 .POLICY NUMBER SEE CERTIFICATE # 89.0 CARRIER NAIL CODE EFFECTIVE DATE: SEE CERTIFICATE # 89.0 SEE CERTIFICATE # 89.0 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 — FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE THE PERMITTEE IS RESPONSIBLE FOR ALL LIABILITY FOR PERSONAL INJURY OR PROPERTY DAMAGE WHICH MAY ARISE OUT OF WORK HEREIN PERMITTED OR WHICH MAY ARISE OUT OF FAILURE ON THE PERMITTEES PART TO PERFORM HIS, HER, OR ITS OBLIGATIONS UNDER THIS PERMIT IN RESPECT TO MAINTENANCE. IN THE EVENT ANY CLAIM OR SUCH LIABILITY IS MADE AGAINST THE TOWN OF LOS ALTOS HILLS OR ANY AGENTj INDEPENDENT CONTRACTOR, OFFICER, OR EMPLOYEE OF THE TOWN, THE PERMITTEE SHALL DEFEND, INDEMNIFY, AND HOLD THEM AND EACH OF THEM HARMLESS FROM SUCH CLAIM. PURSUANT TO 7- 2.09, THIS PERMIT SHALL NOT BE EFFECTIVE FOR ANY PURPOSE UNLESS AND UNTIL THE ABOVE-NAMED RE: PERMITTEE FILES WITH THE TOWN THE FOLLOWING CERTIFICATES OF INSURANCE: PUBLIC LIABILITY IN THE AMOUNT OF C 1,000,000 AND PROPERTY DAMAGE IN THE AMOUNT OF $11000;000j WITH THE TOWN AND ITS OFFICERS) AGENTS, INDEPENDENT CONTRACTORS) AND EMPLOYEES NAMED AS ADDITIONAL INSUREDS. ACORD 101 (2008101) © 2008 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: Q82B1S8 COMMERCIAL GENERAL LIABILITY CG 20 121219 ADDITIO--NAL INSURED = STATE OR GOVER-NMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION = PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART State. Or Governmental Agency Or Subdivision Or Political Subdivision: Town ofLos Altos Hills 26379VVFremont Rd Los Altos Hill, CA 94022-2624 linformation required to complete this Schedule, if not shown above, will be shown in the Declarations. I Section 11 - Who Is An Insured is amended to include as an oddibcmo| insured any state or governmental agency or subdivision or political subdivision shown in the 8chedu|o, subject tothe following provisions: 1. This insurance applies only with respect to operations performed byyou orwnyour behalf for which the state orgovernmental agency or subdivision or political subdivision has issued a-permitoreauthorizetion.-���- However: a. The insurance afforded to such additional insured only applies to the extent permitted bylaw; and b- If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded tosuch additional insured will not bebroader than that which you are required by the contract or agreement to provide for such additional insured. Insured: Bell Plumbing of San Mateo Inc 1180 San Carlos Ave Box 704 San Carlos, CA94O7O-2418 2. This insurance does not apply to: a. "Bodily injury," "property damage"' or "'personal and advertising injury" arising mut of operations performed for the federal gowernment, state or municipality; or b. "Bodily injury" or "property damage" included within the "prod uotm-mornp|eted operations hazard". B. With afforded to these additional insureds, the following is added to Section III _Limits Of Insurance: U coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf ufthe additional insured is the amount ofinsurance: 1. Required by the contract or agreement; or 2. Available under the applicable limits of insurance; whichever ieless. This endorsement aho|| not increase the applicable limits of insurance. ~ Project or Reference: Additional Insureds Also Include: the Town and its Officers, Agents, Independent Contractors, and Employees. @ Insurance Services Office, Inc., 2018 Page 1mf 1 CG 20 12 12 19 Policy Number: Q829156 Transaction Effective Date: 03M7/2024 161-783-8 89 #BWN D H BS Buono -02 - 0056 #XWX 0021 XXXXXXX 5# TOWN OF LOS ALTOS HILLS 26379 W Fremont Rd Los Altos Hills, CA 94022-2624