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HomeMy WebLinkAboutCertificate of Insurance 5/21/2021TOWIINC-01 MICHAF_I_A '4"coRa® CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 5/27/2021 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 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 License # OE67768 IOA Insurance Services 3875 Hogyard Road Suite 200 CONTACT Gig! Yuen NAME: PHONE FAX (MC, No, Ext): (925) 660-3514 50008 (A/c Noy. (926) 416-7869 ADDRESS: Gigi.Yuen@loausa.com Pleasanton, CA 94588 INSURER(S) AFFORDING COVERAGE NAIL # INSURER A: RLI Insurance Company 13056 PSB0005460 INSURED INSURER B:Navigators Specialty Insurance Company 36056 INSURERC: TOwill, Inc. Cunha Engineering, Inc. MED EXP (Any oneperson) $ 10,000 2300 Clayton Road, Suite 1200 LKSURER D INSURER E : Concord, CA 94520 INSURER F: CnVF_RAGF_S CFRTIFICATF_ NIIMRF_R! RFVISInN NIIMRFR- 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 LTR TYPE OF INSURANCE ADDL I D SUBR WVD POLICY NUMBER POLICY EFF DDIYYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [X] OCCUR PSB0005460 6/1/2021 6/1/2022 EACH OCCURRENCE $ 2,000,000 DAMAGE TO RENTED 1,000,000 PREMISES (Ea occurrence $ MED EXP (Any oneperson) $ 10,000 PERSONAL & ADV INJURY $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FX] JECT F] LOC GENERAL AGGREGATE $ 4,000,000 PRODUCTS - COMP/OP AGG $ 4,000,000 $ OTHER: A AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accldent $ BODILY INJURY Per erson $ AUTO PSA0002658 6/1/2021 6/112022 IxANY OWNED SCHEDULED AUTOS ONLY AUTOSS INJURY Per accident $ Pear acc den DAMAGE $ pBODILY AiJT OS ONLY LxAUTOS ONLY B UMBRELLA LIABX OCCUR EACH OCCURRENCE $ 10,000,000 X EXCESS LIAB CLAIMS -MADE SF21EXC7537721C 6/1/2021 6/1/2022 AGGREGATE $ 10,000,000 DED I RETENTION $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE DEFILER/MEMBER EXCLUDED? FY (Mandatory In NH) N /A PSW0004302 6/1/2021 6/1/2022 X STATUTE EERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 V describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 A Professional Liab. RDP0043528 6/1/2021 6/1/2022 Per Claim 5,000,000 A Professional Liab. RDP0043528 6/1/2021 6/1/2022 Aggregate 7,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Survey Support Services -Page Mill Road (Between Lupine Road and Via Feliz) The Town of Los Altos Hills, its elective and appointed officers, employees, and volunteers are Additional Insured and Primary Wording applies to General Liability and Auto Liability, as required by written contract. Waiver of Subrogation applies to General Liability, Auto Liability and Workers Compensation in favor of Certificate Holder, as required by written contract. 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 Town of Los Altos Hills 26379 Fremont Road ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD