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Home My WebLink AboutConfluence Restoration Inc. 09.17.2025%CORD� CERTIFICATE DF LIABILITY INSURANCE DA7E(MMlgqlYl'Yy) 911712Q25 THIS CERTIFICATE F5 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND DR 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 N°ME� AMICHAEL ROMANO _ MICHAEL R.OMANO INS AGENCY PHONE 850 359-2773 AX �� ; 550 3 9-3801 E-MAIL t � ...... 23 Rockaway Beach Ave #2 ADDRESS: ,oshlua.romanoft all,corn Pacifica, CA 94044 INSURER(s) AFFORDING COVERAGE NAIC # _ INSURER A: ADMIRAL INSURANCE COMPANY 24858 INSURED INSURER B: TRUCK INSURANCE EXCHANGE _ 2.1.897 CONFLUENCE RESTORATION INC INSURER C: M 721 SEASIDE STREET INSURER D: � _ _ • _-- __-• •- SANTA CRUZ, CA 95050 INSURER E COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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, INS - _ IADDL:SUEFt - POLICY EFF POLICY EXIT -- - LIMA - LTR TYPE OF INSURANCE I INSn . WVn I POLICY NUMRFR I MMIE�DIYYYY i MMIDD TS X COMMERCIAL GENERAL LIABILITY ^ CLAIMS -MADE X. OCCUR A FGEN'L AGGREGATE LIMIT APPLIES PER: POLICY CT Ll7C :OTHER: y Y I FEI-ECC-11885-12 � I i UMBRELLA LIAR GGGiJR A EXCESS LIAS ; CLAIMS -MADE j DFD 7 ; RETENTION $ WORKERS COMPENSATION ; AND EMPLOYERS' LIABILITY ANY PROPRIETORMARTNEWEXECUTWE Y N OFFICER/MEMBER EXCLUDED? . N 1 A 1(Mlandatory in NH) If ies,describe under .E'�SCRIPTION OF OPERATIONS below i 805104-14-91 FEI-EXC-25121-07 U4 11.11 AUTOMOBILE LIABILITY ANY AUTO 110Q�jf��j� }AMAGE TO RENTED PREMISES (Ea occu"nce) ^�OWNED AUTOS ONLY � X SCHEDULED UTOS MED EXP (Any one person) -7 HIRED X AUTOS ONLY X�,,� - NUN OWNED AUTOS ONLY y Y I FEI-ECC-11885-12 � I i UMBRELLA LIAR GGGiJR A EXCESS LIAS ; CLAIMS -MADE j DFD 7 ; RETENTION $ WORKERS COMPENSATION ; AND EMPLOYERS' LIABILITY ANY PROPRIETORMARTNEWEXECUTWE Y N OFFICER/MEMBER EXCLUDED? . N 1 A 1(Mlandatory in NH) If ies,describe under .E'�SCRIPTION OF OPERATIONS below i 805104-14-91 FEI-EXC-25121-07 U4 11.11 EACH OCCURRENCE $ 110Q�jf��j� }AMAGE TO RENTED PREMISES (Ea occu"nce) $ 50 000 MED EXP (Any one person) -7 1 $ .. _ 000 1//1912024 11119/2025 ; PERSONAL & AIV INJURY $ .11.2000,000 GENERAL AGGREGATE $ 2,000,000_ PRODUCTS - COMPIOP AGG $ ' _ Z0009000 $ i Ea accidentSINGLE LIMIT $ 2,000,000 BODILY INJURY (Per person) $ j 9119P2025 9/9/2026 80DILY INJURY (Per accident) $ I I -, PROPERTY DAMAGE $ -- --- Per accident) i$ EACH OCCURRENCE $ 49000,0QP 111/9/2024 ! 1//1912025 AGGREGATE _ $ 4-000L000 $ I OE iCiTH- STATUTE ER ! E.L. EACH ACCIDENT - 4 $ -- - E.L..DISEASE - EA EMPLOYE I $ El, DISEASE POLICY LIMIT $ I DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 141, Addltlonal Remarks Schedule, may be attached If more sp4ce is required) CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED. 2003 FIORD F150 VIN: 1FTRXI8W2.3NB70160; 2015 CHEVROLET SILVERADO VIN:1G+C1KWE8X F119746; 2018 TOYOTA TUNDRA VIN: 5TFX8X5F1I8JX70836; 2018 FORD F150 V; 1 FTFW1 EG4JKF81707, 2022 GMC CANYON V: 1 GTG 6FENXN120220'6 PROJECT: MATAD E RO CREEK RESTORATION OFFSIDE MITIGATION PLANTING PROJECT AT BYRNE PRESERVE ERTIFICATE HOLDER TOWN OF Ltd$ ALTOS HILLS 28379 FREMONT ROAD LOS ALTOS HILLS CA 94022 CANCELLATI SHOULD ANY OF THE ABOVE DESCRIIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH POLICY PROVISIONS. ACORID 25 (2018103) AIfTHQRI,Z�3E`NY74�IVE ,,.�.-.�.,.. F'�W't°1. �•�'h �J .7 /,..v ��,. ..... V 198820115 ACCORD The ACORD name and largo are registered marks of ACORD All rights reserved. j I 1 i THISENDORSEMENT H N GE THE, POLICY, ISL READ IT CAREFULLY, FARMER9 E3153 INSURANCE 1 StEdition CHANGES IN` OF RECOVERY. AGAINST OTHERSTO (WAIVER OF SUBROGATION This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORI'V'1 GARAGE COVERAGE FORM TRUCKERS COVERAGE FORM With respect to courage provided by this endorsement, the Prov si ns € the �Cc era Form I un by the endorsement. Pp Y less mod�fed This endorsement change the policy effective on the inception date of the policy unless another date is indica below. ted Endorsement Effective; Countersigned By i .09/19/2025 Named Insured: CONFLUENCE RESTORATION INC (Authorized Representative) p ) SCHEDULE Larne Of Person(s) Or Organization(s): TOWN OF LOS ALTOS HILL Additional Premium is (lig no entry appears above, information required to complete this ndorsement will be shown in the Declarations as applicable to this endorsement. The Transfer Of Rights Of Recovery Against: others To Us Condition does not apply to the� erson s) or p organization(s) shown in the Schedule. We will., retain the additional premium shown above, regardless of any early termination of this endorsement or the policy. i This endorsement is part of your policy. it supersedes and controls anything to the contrary. l i all the terms of the policy. Yt g ry t s otherwise subject to E3153 -EDI 6-06 Page 1 of 1 91-3153 E31531 01 E t POLICY. NUMBER: 605041491 COMMERCIAL AUTO CA 20 48 02 99 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, DESIGNATED INSURED This endorsement modifies insurance provided under the following: BUSINESS AUTO COVERAGE FORM GARAGE COVERAGE FORM MOTOR CARRIER COVERAGE FORM TRUCKERS COVERAGE FORM With respect to coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by this endorsement. This endorsement identifies person(s) or organization(s) who are "insureds" under the Who Is An Insured Provi- sion of the Coverage Form. This endorsement does not alter coverage provided in the Coverage Form. This endorsement changes the policy effective on the inception date of the policy unless another date is indi- cated below. Endorsement Effective: 09/19/2025 Named Insured: CONFLUENCE RESTORATION INC Countersigned By: SCHEDULE Name of Person(s) or Organ ization(s): TOWN OF LOS ALTOS HILLS Authorized Representative (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to the endorsement.) Each person or organization shown in the Schedule is an "Insured" for Liability Coverage, but only to the extent that person or organization qualifies as an "Insured" under the Who Is An Insured Provision contained in Section 11 of the Coverage Form. CA 20 49 02 99 Copyright, Insurance Services Office, Inc., 1990 Page 1 of 1 0