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HomeMy WebLinkAboutCertificate of Insurance 08/2020 (2)ONELS-2 OP ID: Z1 CERTIFICATE OF LIABILITY INSURANCE DA08/10/202TE Y) CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, 0811012020 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(les) must 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 Bozzuto &Associates Insurance CONTACT NAME: Melissa Sykes a/CCNo Ext): 8O0-989-8712 kc No,: 408-429-8460 34 S. Second St Campbell,CA 95008 Jennifer Anderson a DRE SS: melissas@dbinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # 07/01/2021 INSURER A: United Specialty Insurance Com 12537 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 INSURED 0. Nelson & Son, Inc. INSURER B: State Comp Ins Fund of CA 35076 3345 Tripp Road Woodside, CA 94062 INSURER C: Ohio Casualty Insurance Co 24074 INSURER D: Evanston Insurance Company 35378 INSURER E: Scottsdale Insurance Company 41297 INSURER F : PERSONAL&ADV INJURY $ 1,000,000 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. ILTR TYPE OF INSURANCE DD U D POLICY NUMBER MM/DDNYYY MMIDDNEWY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE N OCCUR X LI00058901 07/01/2020 07/01/2021 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY[XI PRO- JECT F—] LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 C X ANY AUTO BA057403797 07/01/2020 07/01/2021 BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE $ Per accident UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000 E X EXCESS LIAB CLAIMS -MADE XLS0114051 07/01/2020 07/01/2021 AGGREGATE $ 5,000,000 DED I I RETENTION $ 1 $ 1 B WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY Y / N ANY OFFICER/MEMTREXRTNER/4ECUTIVE N/A 9135884.20 07/01/2020 07/01/2021 OTH- –XI STATUTE ER E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory In Ni If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 D Pollution ECPENV01726 07/01/2020 07/01/2021 Limit 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) The Town of Los Altos Hills, its elective and appointed officers, employees, and volunteers are included as an additional insured on General Liability policy per the attached endorsement. CERTIFICATE HOLDER CANCELLATION TOWNOF4 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Los Altos Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 26379 Fremont Road Los Altos Hills, CA 94022 AUTHORIZED PREPRESENTATIVE 1_fe� ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD