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HomeMy WebLinkAboutCertificate of InsurancePALOALT-32 MPFnRn7A A�./ ®' CERTIFICATE OF LIABILITY INSURANCE DAT9/312 D/YYYY) 9/3/2021 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 NQ[JEACT Michele Costa Bozzuto & Associates Insurance Services 34 S 2nd Street Campbell, CA 95008 PH NNo, Ext 408 680'0217 FAX ): ( ) (AIC, No): nooRlEss: michelec@dbinsurance.com INSURERS AFFORDING COVERAGE NAIC # COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR INSURER A: ColonyInsurance Company 39993 INSURED INSURER B: California Automobile Insurance Company 38342 INSURER C: Redwood Fire & Casualty Insurance Company 11673 Palo Alto Concrete & Construction Inc. INSURER D :The Ohio Casualty Insurance Company 24074 P.O. Box 300 Palo Alto, CA 94302 INSURER E: Lloyd's Syndicate 2623 (Beazley Furlonge Limited) INSURER F: CAVFRAnFR rFRTIFICATF KIIIMRFR- 10C1/I0InAI All IaAMCM. 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM DDMDM POLICY EXP (MMiDDLr= LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR X 600GL002457803 7/12/2021 7/12/2022 EACH OCCURRENCE 1,000,000 DAMAGE TO RENTED 50,000 PREMISES Ea occurrence MED EXP (Any oneperson) $ 5,000 PERSONAL &ADV INJURY $ 1,000,000 AGGREGATE LIMIT APPLIES PER: POLICY X JECT [_]LOC GENERAL AGGREGATE $ 2,000,000 GEN'L PRODUCTS - COMP/OP AGG $ 2,000,000 OTHER: B AUTOMOBILE LIABILITY Ee aacid D SINGLE LIMIT $ 1,000,000 X BODILY INJURY Perperson) ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS BA040000068869 7/14/2021 7/14/2022 BODILY BODILY INJURY Per accident P.rr accident AMAGE $ A!JT OS ONLY AUOTOS So A UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,000,000 X EXCESS LIAR CLAIMS -MADE XS173537 7/12/2021 7/12/2022 AGGREGATE $ 3,000,000 DED RETENTION $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OpFILER/MEMBER EXCLUDED? (Mandatoryin NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A PAWC229374 3/8/2021 3/8/2022 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 1,®OO,OpO E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT 1,000,000 D Equipment Floater BM058153661 7/12/2021 7/12/2022 RTD/LSD 250,000 E Pollution ENP0004818-02 7/12/2021 7/12/2022 Limit 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) Re: 26379 Fremont Road, Los Altos Hills, CA 94022 Town of Los Gatos, its officers, officials, employees and volunteers are included as Additional Insured on the General Liability policy per the attached endorsement. CFRTIFICATF NAI nFR rAMrFI 1 ATInNI ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 REPRESENTATIVE %Yvwedea Pedio;a ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Policy Number: 600GL002457803 COMMERCIAL GENERAL LIABILITY CG 20 37 0413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - COMPLETED OPERATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART PRODUCTS/COMPLETED OPERATIONS LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location And Description Of Completed Operations All persons or organizations as required by written As designated in written contract with the Named Insured contract with the Named Insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury" or "property damage" caused, in whole or in part, by "your work" at the location designated and described in the Schedule of this endorsement performed for that additional insured and included in the "products -completed operations hazard". However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. B. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; 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. CG 20 37 0413 © Insurance Services Office, Inc., 2012 Page 1 of 1 Policy Number: 600GL002457803 COMMERCIAL GENERAL LIABILITY CG 20 10 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations All persons or organizations as required by written As designated in written contract with the Named contract with the Named Insured Insured Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II — Who Is An Insured is amended to B include as an additional insured the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. 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 2. 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. CG 20 10 0413 © Insurance Services Office, Inc., 2012 Page 1 of 2 C. With respect to the insurance afforded to these additional insureds, the following is added to Section III — Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; 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 10 0413 Palo Alto Concrete & Construction, Inc. PO Box 300, Palo Alto, CA 94302 Phone: (650) 321-5598 Fax: (650) 321-5688 California License No. 887796 Subcontract Construction Proposal Date: To the General Contractor: Project Location: Project Description: August 30, 2021 Town of Los Altos Hills. 26379 Fremont Rd. Los Altos Hills, CA Addition of Exterior Concrete Pad Scope of Work Provide construction management, supervision, labor, materials, equipment, and job cleanup as required to complete the following scope of work. 1. Approx. 200 SF of exterior concrete demo and repour with slopes: $6,000.00 a. Demo existing concrete and remove. b. Form, Rebar, P&F Strip and Cleanup 2. Interior Floor leveling: $9,840.00 a. Prepare floor b. Apply Ardex K13 c. Cleanup Total Amount of Bid: $14,840 OXI/1""l- Page 1 of 3 Palo Alto Concrete & Construction, Inc. PO Box 300, Palo Alto, CA 94302 Phone: (650) 321-5598 Fax: (650) 321-5688 California License No. 887796 General Terms. Conditions and Limits of Liability 1. Palo Alto Concrete & Construction, Inc. (PACC) warrants that we are licensed contractors and shall perform all work in a good and workmanship like manner. PACC maintains a Worker's Compensation Insurance Policy and a $2,000,000.00 business General Liability Policy. Upon request, PACC shall provide General Contractor (GC) with certificates or insurance. 2. GC may, at any time, by written work order, direct PACC to make changes, additions, or omissions to the contract and scope of work. The parties hereto prior to commencement of change orders shall agree upon any changes in the contract price resulting from such changes in writing. 3. Change orders, extra work orders and work quoted on a time and material basis billed out at the following rates and markup: • Foreman: $95.00 per hour • Journeyman: $85.00 per hour • Labor: $75.00 per hour • Reimbursement for cost of materials, sub -contractors, and consultants. •20% markup for overhead and profit on total labor and materials costs. 4. PACC warrants that if there are any defects in workmanship or materials as determined by OWNER from one year of completion of house construction; PACC will, at its own option, either repair or replace such defective work or materials. 5. PACC is responsible for installing and maintaining during its construction all erosion control items per erosion control plan, details and specifications. 6. GC is responsible for providing and maintaining during their construction time temporary toilet, security fencing, trees protection and erosion control. 7. GC is responsible for providing and maintaining during construction water and electrical supply. 8. GC is responsible for compliance of form -work construction dimensions and elevations prior to placement of concrete and shall notify PACC in writing prior to ordering concrete ready mix delivery. 9. Any claim or controversy arising under this agreement or the work performed hereunder will be submitted to binding arbitration under the rules of the American Arbitration Association. Notice to Owner CONTRACTORS ARE REQUIRED BY LAW TO BE LICENSED BY THE CONTRACTORS STATE LICENSE BOARD. ANY QUESTIONS CONCERNING A CONTRACTOR MAY BE REFFERED TO THE REGISTAR OF THE BOARD WHOSE ADDRESS IS: CONTRACTORS STATE LICENSE BOARD, 9835 GOETHE ROAD, SACREMENTO, CA 95827 MAILING ADDRESS: P.O. BOX 2600 SACREMENTO, CA 95826 Notice: Under the Mechanic's Lien Law (California Code of Civil Procedure Section, any contractor, subcontractor, laborer, supplier or other persons who help to improve your property but is not paid for his or her work or supplies, has a right too enforce a claim against your property. This means that, after a court hearing a court officer could sell your property and the proceeds of the sale used to satisfy the indebtedness. This can happen even if you have paid your contractor in full, if the subcontractor, laborer, or supplier remains unpaid. Page 2 of 3 Palo Alto Concrete & Construction, Inc. PO Box 300, Palo Alto, CA 94302 Phone: (650) 321-5598 Fax: (650) 321-5688 California License No. 887796 Construction Schedule • Allow 1 week for PACC substantial completion. • Construction schedule excludes time required for MPE, steel and framing sub -contractors. • Excludes delays caused by rain, owner, general contractor, sub -contractors or PACC change orders. Contract Exclusions • Structural and soils engineering fees. • New swimming pool. • Building permit fees. • Sewer ejector pumps and system. • Special inspection fees. • Joint trenches and utility trenches • Excavation of hazardous materials. • Fire pit • Dewatering for excavation. • Pavers and asphalt paving. • Surveyor and property line hubs. • Concrete apron at street. • Xypex admixture to concrete • Granite fines at street. • Wood and steel framing • Remove existing driveway apron and fill in. • Framing hardware, hold-downs and embeds. • Trench drain and slot drains. • Plumbing, mechanical, or electrical work. • Any work not in contract description. • Hardscape, landscaping, irrigation and lighting. Payment Schedule and Terms • Invoice for work completed on the V and 15' of each month. • Invoice payments are due within 10 days of invoice submittal. • If not received in 30 days a Finance Charge of 1-1/2% will be imposed. This is equal to an annual rate of 18%. Page 3 of 3