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Home My WebLink AboutConfluence Restoration Inc. 09.17.2025 V210ACOR0 CERTIFICATE OF LIABILITY DATE (MM/00�Y W) 9/17/2025 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($), AUTHORIZED REPRESENTATIVE OR PRODUCER$ AND THE CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the' policy(les) 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 rl hts to the certificate holder in lieu of such endorsement(s). PRODUCER ACT NA(ti E: MICHAEL ROMANO _ MICHAEL ROMANO INS AGENCY PHONEQ- N X650 359-2773 _ FAX �a); (550)359-380" 235 Rockaway Beach Ave #2 A alEss: loshual,romanodgmall,porn R. Pacifica, CA 94044 . INSURER(S) AFFORDING COVERAGE � _ ' NAIC # _ _ INSURrR A: ADMIRAL RAL IIwISURANCE COMPANY 24856 INSURED INSURIER B: TRUCK INSURANCE EXCHANGE 21667 CONFLUENCE RESTORATION INC INSURER C : _ T- 721 SEASIDE STREET INSURER D: SANTA CRUZ, DA 95080 INSURER E :— CN5URER F: 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, iNSR IADDL;§U- R - POLICY EFF POLICY EXI' - -- T ` --- LT TYPE OF INSURANCE POLICY NUMBER � MMIDDIYYYY , MM/DD LIMITS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 000 OOp CLAIMS -MADE OCCUR 1- DAMAGE T J RENTED - -�„� -- �--� { PREMISES Ea Occurrence s 50,000 MED EXP (Any one person) $ - 000 A �_ _J _ Y Y I FEI-ECC-11385-12 1111912024 1111912025 PERSONAL & ADV INJURY $ '� OpO 000 �FGEN'L AGGREGATE LIMIT APPLIES ICER; � � GENERAL AGGREGATE -.$ --~2,00010�Q POLICY ?� C7fiO- LOC - JECT I PRODUCTS - COMPIOP AGG $ 2,000,000 OTHER; I t I $ �4t�Tt,1NlgI ILE LIABILITY { j i MBINED INGLE LIMIT $ accident) 2,000,000 000000 ANY AUTO I � ! BODILY INJURY (Per person) $ OWNEAUTOS (7IwLY +'� AUTOSULED Y 60504-14-91 i +91'191202 1 91912028 (Per accident) $ , BODILY INJURY P HIRED � X NON -OWNED PROPERTY DAMAGE - -- --- AUTOS -ONLY � AUTOS ONLY i � ; , Per accident) -- $ UMBRELLA (.IAB ' OCCUR EACH OCCURRENCE _ 41000,010 _ A EXCESS LIAS 1 CLAIMS -MADE FEI-EXC-25121-07 11119/2024 ! 1111912028 AGGREGATE � � 4��10Q 000 L7EC� RETENTION $ � $ WORKERS COMPENSATIONE'ER , ; • OT'H- I AND EMPLOYERS' LIABILITYYIN ' STATUTE ER ANY PROPRIETORIPARTNERfEXECUTIVE I -II OFFICER/MEMBER EXCLUDED? � . NIA � � E.L. EACF# ACCIDENT $-•- _._ - 1 --• - -- (Mandatory in NHS E.L. DISEASE - EA EMPLOYEF $ if yes, describe under I- _. . DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ j i • { ° I 1 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES -'(ACORD 101, Addltlonal remarks Schedule, may be attached If more space is required) CERTIFICATE HOLDER IS NAMED ADDITIONAL INSURED. 2003 FORD F150 VIN: 1FTRX18W23141370160; 2016 CHEVROLET SILVERADO VIN:1GC1KWE8XOF119746; 2018 TOYOTA TUNDRA VIN: 5TFXBX51F18JX70836; 2018 FORD F150 V: 1 FTFW1 EG4JKF81707, 2022 GMC CANYON V: 1 GTG6FENXN1202206 PROJECT: MATADERO CREEK RESTORATION OFFSIDE MITIGATION PLANTING PROJECT AT BYRNE PRESERVE ERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF LOS ALTOS HILLS THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 28379 FREMONT ROAD ACCORDANCE WITH IHE.POLICY PROVISIONS. LOS .ALTOS HILLS, CA 94022 AUTHaRIz Ivy .5 -- 0H^W M 0 1988--2015 ACCORD O All rights reserved. ACCIRID 25 (2016/03) The ACORD name and logo are registered marks of ACORD THIS ENDORSEMENT CHANGES TME POLICY. PLEASE READ IT CAREFULLY. FARM E R� E3153 INSURANCE I st Edition CHANGES IN TRANSFER OF RIGHTS OF RECOVERYAGAINSTOTHERS TO US (WAIVER OF SUBROGATION) This endorsement modifies insurance provided under the following: BUSINESSAUTO COVERAGE FORM GARAGE COVERAGE FORM TRUCKERS COVERAGE �ORM With respectto coverage provided by this endorsement, the provisions of the Coverage Form apply unless modified by the endorsement. This endorsement changes the policy effective on the inception date of the policy unless another date is indicated below. Endorsement Effective: Countersigned By: 09/19/2025 Named Insured: CONFLUENCE RESTORATION INC (Authorized Representative) SCHEDULE Marne Of Person(s) or Organ hation(s): TOWN OF LOS ALTOS HILLS Additional Premium $ (if no entry appears above, information required to completethis endorsementwill beshown in the Declarations as applicable to this endorsement.) The Transfer Of Rights Of Recovery Against Others To Us Condition does not apply to the person(s) or 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. This endorsement is part of your policy. It supersedes and controls anything to the contrary. It is otherwise subject to a I I the terms of the policy. E3153 -EDI 6-06 Page I of 1 91-3153 E3153101 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: Countersigned By: 09/19/2025 Named Insured: CONFLUENCE RESTORATION INC 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 48 92 99 Copyright, Insurance Services Office, Inc., 1998 Page 1 of 1 13