HomeMy WebLinkAboutCertificate of Insurance (2)KIFI_ARR-n1
11 IA
Aa►m CERTIFICATE OF LIABILITY INSURANCE
DATDIY12/2z12o21
s/11
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 # 0767776
CONEACT Yvonne Esquivel
HUB International Insurance Services Inc.
40 East Alamar Avenue
Santa Barbara, CA 93105
palco, No Ext : (805) 204.3244 (Alc No):(805 832-6581
)
yvonne.esquivel@hubinternational.com
INSURERS AFFORDING COVERAGE NAIC #
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE [ OCCUR
INSURERA:Colony Insurance Company 39993
INSURED
INSURER e: United States Liability Insurance 25896
INSURER C :
Kielty Arborlst Services LLC
P.O. Box 6187
San Mateo, CA 94403
INSURER D :
INSURER E
INSURER F :
COVFRAGF_R CFRTIFICATF NI IMRFR- 09:11MInnI nu inneco.
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
LT
TYPE OF INSURANCE
ADDL
❑
SUBR
WVD
POLICY NUMBER
POLICY EFF
D
POLICY EXP
MM DD
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE [ OCCUR
101GL006971704
2/14/2021
2/14/2022
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTpg ISE 00cE a ce 100,000
MED EXP (Any oneperson) $ 5,000
PERSONAL &ADV INJURY $ Excluded
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PEo F1 LOC
GENERAL AGGREGATE $ 2,0001000
PRODUCTS - COMP/OPAGG $ Excluded
$
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
E cc de
BODILY INJURY Perperson)$
ANY AUTO
OWNED SCHEDULED
AIUTOS ONLY AUTOS
BODILY INJURY Per accldenl
AUTOS ONLY ATOS ONLY
Parr. ,cld.nt AMAGE $
$.
UMBRELLA LIAB
HCLAIMS-MADE
OCCUR
EACH OCCURRENCE
AGGREGAT $
EXCESS LIAR
DED I I RETENTION $
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
AANNFICERO RIETORR/EXCLUD D7 ECUTIVE ❑'
N /A
PER MOTH-
T LITE ER
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE
(Mandatory in NH)
If yes, describe under
E,L. DISEASE - POLICY LIMIT
DESCRIPTION OF OPERATIONS below
B
Errors & Omissions
SP1558694F
211412021
2/14/2022
Each Claim 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
RE: Various arborist services throughout Los Altos Hills.
Proof of Insurance.
CERTIFICATE HOLDER CANCFI_I ATInhl
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.
Public Works Engineering
26379 Fremont Road
AUTHORIZED REPRESENTATIVE
Los Altos, CA 94022
ACORD 25 (2016/03) @ 1988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD