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Home My WebLink AboutCertificate of InsuranceCERTHOLDER 1-"OY P.O. BOX 8192, PLEASANTON, CA 94588 CERTIFICATE OF WORKERS' COMPENSATION INSURANCE ISSUE DATE: 04-20-2021 TOWN OF LOS ALTOS HILLS NF 26379 W FREMONT RD LOS ALTOS HILLS CA 94022-2624 GROUP: POLICY NUMBER: 9103671-2020 CERTIFICATE ID: 228 CERTIFICATE EXPIRES: 06-24-2021 06-24-2020/06-24-2021 This is to certify that we have issued a valid Workers' Compensation insurance policy in a form approved by the California Insurance Commissioner to the employer named below for the policy period indicated. This policy is not subject to cancellation by the Fund except upon 30 days advance written notice to the employer. We will also give you 30 days advance notice should this policy be cancelled prior to its normal expiration. This certificate of insurance is not an insurance policy and does not amend, extend or alter the coverage afforded by the policy listed herein. Notwithstanding any requirement, term or condition of any contract or other document with respect to which this certificate of insurance may be issued or to which it may pertain, the insurance afforded by the p/oliliicy described herein is subject to all the terms, exclusions, and conditions, of such policy. Authorized Representative President and CEO EMPLOYER'S LIABILITY LIMIT INCLUDING DEFENSE COSTS: $1,000,000 PER OCCURRENCE. ENDORSEMENT #0015 ENTITLED ADDITIONAL INSURED EMPLOYER EFFECTIVE 2021-04-20 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. NAME OF ADDITIONAL INSURED: TOWN OF LOS ALTOS HILLS ENDORSEMENT #2065 ENTITLED CERTIFICATE HOLDERS' NOTICE EFFECTIVE 06-24-2015 IS ATTACHED TO AND FORMS A PART OF THIS POLICY. ENDORSEMENT #1651 - ROBERT MCKENNEY SEC,TRES - EXCLUDED. ENDORSEMENT #1651 - ROBERTA PECKHAM PRESIDENT - EXCLUDED. EMPLOYER PECKHAM & MCKENNEY, INC. NF 300 HARDING BLVD # 203D ROSEVILLE CA 95678 M0408 (REV.7-2014) PRINTED : 04-21-2021 NF