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HomeMy WebLinkAboutCertificate of Insurance 2017L DATE(MM/DD/YYYY) CC>RI CERTIFICATE OF LIABILITY INSURANCE 06/30/17 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. ORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must have ADDITIONAL INSURED provisions or be endorsed. 10BROGATION 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 NAME: Kell M. King or Aileen Hill _ KELLY KING INSURANCE SERVICES PHONE —— FAX (A/ E,,,: (888) 540-5464 ,vC� (209) 599-7517 125 E. Main Street, Suite #2 E-MAIL — AODREss:aileen@kellykinginsuranc_e . com Ripon, CA 95366 INSURER(S) AFFORDING COVERAGE NAICN 08132 68 INSURER A : WeSCo Insurance Co. 25011 INSURED Timberline Tree Service, Inc. INSURER B : State Comp Ins. Fund 3507 6 350 Lang Road INSURER C Burlingame, CA 94010 INSURER D: INSURER E : COVERAGES CERTIFICATF Nl1MRFR• RFS/IRIr1Ni nu II\4Rr:R- 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. R LTR LT TYPE OF INSURANCE DDL INSD suBR wv0 POLICY NUMBER POLICY EFF MM/DDIYYYY POLICY EXP MM/DD/YYYY — — LIMITS MITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE CI OCCUR EACH OCCURRENCE $ 1,000,000 ­TO­RENTE7D- DAMAGE PREMISES Ea occurrence $ 100,000 MEDEXP (Any one person) $ 51000 A Y WPP110573305 7/1/17 7/1/18 X_WORKMANSHIP ERROR PERSONAL &ADV INJURY $ 1,000,000 GE_N'L AGGREGATE LIMIT APPLIES PER: X POLICY CI I LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: WKMNSHP ERROR $ 1,000,000 AUTOMOBILE LIABILITY CORDTFESEa accident INULL I $ 1,000,00 0 ANYAUTO BODILY INJURY (Per person) $ A r OWNEDSCHEDULED X AHIRED UTOS ONLY AUTOS ONLY X NON-OWNED S ONLY WPP110573305 7/1/17 7/1/18 BODILY INJURY (Per accident) $ PeOPERTaccidentDAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (MandatoryinNH) If DESCRIPTION OFoOPERATIONS below N/A 9062875-2017 7/1/17 7/1/18 ER YT - X STATUTE ER E.L. EACH ACCIDENT $ 1 '000,000 -- ——_ E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE -POLICY LIMIT $ 1,000,000 RENTED/LEASED $50,000 A EQUIPMENT FLOATER WPP110573305 7/1/17 7/1/18 DEDUCTIBLE $1,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ALL TREE WORK THE TOWN OF LOS ALTOS HILLS, ITS ELECTIVE AND APPOINTED OFFICERS, EMPLOYEES AND VOLUNTEERS ARE INCLUDED AS ADDITIONAL INSURED AS PER THE ATTACHED ENDORSEMENT FORMS. t arc I Irwry t nvLLJF-rt L:ANIaLLA I IUN TOWN OF LOS ALTOS HILLS 26379 FREMONT ROAD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN LOS ALTOS HILLS, CA 94022 ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: RICHARD CHIU AUTHORIZED REPRESENTATIVE U 'I Uuts-ZU1 o ACUKU CURNURATION. All rights reserved. ACORD25(2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: WPP110573305 COMMERCIAL GENERAL LIABILITY CG 20 38 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - AUTOMATIC STATUS FOR OTHER PARTIES WHEN REQUIRED IN WRITTEN CONSTRUCTION AGREEMENT This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured: 1. Any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy; and 2. Any other person or organization you are required to add as an additional insured under the contract or agreement described in Paragraph 1. above. Such person(s) or organization(s) is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: a. Your acts or omissions; or b. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured. However, the insurance afforded to such additional insured described above: a. Only applies to the extent permitted by law; and b. Will not be broader than that which you are required by the contract or agreement to provide for such additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for the person or organization described in Paragraph 1. above are completed. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury", "property damage" or "personal and advertising injury" arising out of the rendering of, or the failure to render, any professional architectural, engineering or surveying services, including: a. The preparing, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications; or b. Supervisory, inspection, architectural or engineering activities. This exclusion applies even if the claims against any insured allege negligence or other wrongdoing in the supervision, hiring, employment, training or monitoring of others by that insured, if the "occurrence" which caused the "bodily injury" or "property damage", or the offense which caused the "personal and advertising injury", involved the rendering of, or the failure to render, any professional architectural, engineering or surveying services. 2. "Bodily injury" or "property damage" occurring after: a. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or CG 20 38 04 13 © Insurance Services Office, Inc., 2012 Page 1 of 2 POLICY NUMBER: WPP110573305 b. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: The most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement described in Paragraph A.1.; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable Limits of Insurance shown in the Declarations. Page 2 of 2 © Insurance Services Office, Inc., 2012 CG 20 38 0413