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HomeMy WebLinkAboutCertificate of Insurance (4)ASR®® CERTIFICATE OF LIABILITY INSURANCE DATE(MMR2DIYYYY) 02/1812022 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 PRODUCER, AND THE CERTIFICATE HOLDER. OR IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) 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. certificate does not confer rights to the certificate holder In NAIr of c-1, o r w _ .,_. A statement on this PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O, BOX 328 OWATONNA, MN 55060 INSURER A: FEDERATED MUTUAL INSURANCE COMPANY INSURED 13935 SKYLINE LANDSCAPES, INC. 175-357-3 INSURER B: 384 4TH AVE INSURER C: REDWOOD CITY, CA 94063-3724 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 3 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREI AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AD SUBR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER POLICY EFFPOLICY EXP X COMMERCIAL GENERAL LIABILITY MMIDDIYYYVMMIDDIYYYV CLAIMS -MADE FX1 OCCUR A Y N 9841713 04/01/2022 04/01/2023 GE 'L AGGREGATE LIMIT APPLIES PER: %( POLICY 0PRO- JECT ❑ LOC OTHER: AUTOMOBILE LIABILITY X ANY AUTO SCHEDULED A OWNED AUTOS ONLY SNON-O N N 9841713 04/01/2022 04/01/2023 HIRED AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EXCESS LIAR CLAIMS -MADE AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) ADDITIONAL INSUREDS INCLUDE THE TOWN OF LOS ALTOS HILLS, ITS ELECTIVE AND APPOINTED VOLUNTEERS. REVISION NUMBER- in 12E6 NAMED ABW FOR THE POLICY PERIOD DOCUMENT WITH RESPECT TO WHICH THIS N IS SUBJECT TO ALL THE TERMS, EXCLUSIONS LIMITS EACH OCCURRENCE $1,000,000 DAMAGE ( RENTED $100,000 PREMISES Ea occurrence MED EXP (Any one person) EXCLUDED PERSONAL & ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 PRODUCTS - COMP/OP AGO $2,000,000 EAGGREOATE COMBINED SINGLE LIMIT $1,000,000 NJURY (Per person) NJURY (Per accident)TY DAMAGEentCURRENCEATESTATUTE OTH.ER ACCIDENT E.L. DISEASE - EA EMPLOYEE E.L DISEASE - POLICY LIMIT OFFICERS, EMPLOYEES AND 175-357-3 30 TOWN OF LOS ALTOS HILLS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 26379 W FREMONT RD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN LOS ALTOS HILLS, CA 94022-2624 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1966-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 9841713 COMMERCIAL GENERAL LIABILITY CG 20 12 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Town of Los Altos Hills 26379 W Fremont Rd Los Altos Hill, CA 94022-2624 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 any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforeded to such additional insured only applies to the extent permitted by law; and b. 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. Insured: Skyline Landscapes, Inc. 384 4th Ave Redwood City, CA 94063-3724 2. This insurance does not apply to: a. 'Bodily injury," "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. 'Bodily injury" or "property damage" included within the "products -completed operations hazard". 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. Project or Reference: Additional Insureds Include the Town of Los Altos Hills, its Elective and Appointed Officers, Employees and Volunteers. © Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 12 04 13 Policy Number: 9841713 Transaction Effective Date: 04/01/2022 A� ® CERTIFICATE OF LIABILITY INSURANCE DATE02/18I D 2 02/18/2022 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 terns 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 endorsements . PRODUCER - FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 CONTACT NAME: CLIENT CONTACT CENTER No E.1): 888-333-4949 FAX PAIcHONE No): 507-446-4664 ADURiCLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060. INSURER(S) AFFORDING COVERAGE NAIC # X INSURER A: FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED 175-357-3 INSURER B: SKYLINE LANDSCAPES, INC. 384 4TH AVE INSURER C: INSURER D: REDWOOD CITY, CA 94063-3724 INSURER E: MED EXP (Any one person) EXCLUDED INSURER F: 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 INSR SUBR WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDDIYYYY LIMITS THE EXPIRATION DATE THEREOF, NOTICE X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ❑X OCCUR ACCORDANCE WITH THE POLICY PROVISIONS. EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED $100,000 PREMISES Ea occurrence MED EXP (Any one person) EXCLUDED A Y N 9841713 04/01/2022 04/01/2023 PERSONAL& ADV INJURY $1,000,000 GEN'L XPOLICY AGGREGATE LIMIT APPLIES PER: PRO LOC JECT GENERAL AGGREGATE $2,000,000 PRODUCTS - COMPIOP A00 $2,000,000 OTHER: A AUTOMOBILE LIABILITY X ANY AUTO OWNED AUTOS ONLY SCHEDULED AUTOS HIRED AUTOS ONLY NON -OWNED AUTOS ONLY N N 9841713 04/01/2022 04/01/2023 COMBINED SINGLE LIMIT Ea accident,$1,000,000 BODILY INJURY (Per person) , BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident UMBRELLA LAB OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y y N ANY PROPRIETORIPARTNERIEXECUTIVE PER STATUTE OTH- ER E.L. EACH ACCIDENT OFFICERIMEMBER EXCLUDED? N I A E.L. DISEASE - EA EMPLOYEE (Mandatory in NH) If yes, describe under E.L DISEASE - POLICY LIMIT DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached it more space is required) RE: 2254 TASSO ST, PALO ALTO, CA 94301. CERTIFICATE HOLDER neural I ATIAaI 175-357-3 230 TOWN OF LOS ALTOS HILLS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 26379 W FREMONT RD THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN LOS ALTOS HILLS, CA 94022-2624 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION, All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 9841713 COMMERCIAL GENERAL LIABILITY CG 20 12 04 13 THIS ENDORSEMENT CHANGES. THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Town of Los Altos Hills 26379 W Fremont Rd Los Altos Hill, CA 94022-2624 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 any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforeded to such additional insured only applies to the extent permitted by law; and b. 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. Insured: Skyline Landscapes, Inc. 384 4th Ave Redwood City, CA 94063-3724 2. This insurance does not apply to: a. 'Bodily injury," "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. 'Bodily injury" or "property damage" included within the "products -completed operations hazard". 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. Project or Reference: Additional Insureds Include the Town of Los Altos Hills, its Elective and Appointed Officers, Employees and Volunteers. © Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 12 04 13 Policy Number: 9841713 Transaction Effective Date: 04/01/2022