HomeMy WebLinkAboutLewis and Tibbitts, Inc.CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN
12/22/2021
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
Woodruff -Sawyer 8 Co.
50 California Street, Floor 12
San Francisco CA 94111
CONTACT
NAME: Ran and Sharma
PHONE
A/C No Ext): 415-402-6507 A/C No). 415-989-9923
AIL
ADDRESS: rsharma@,woodruffsawyer.com
INSURERS AFFORDING COVERAGE NAIC #
INSURERA: Hartford Fire Insurance Company 19682
INSURER B : Hartford Casualty Insurance Company 29424
INSURED LEWIAND-01
Lewis and Tibbitts, Inc.
INSURER C: Travelers Prop Casualty Co of America 25674
1470 Industrial Avenue
San Jose CA 95112
INSURER D: Sentinel Insurance Company, Ltd. 11000
INSURER E:
INSURER F
CC•VFRAr.F.R !`COTICI!`ATC K11 IRA-.
- - ----- --- ---._.�� ME:VIJIUAI I4UIVI13tK:
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
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
IS SUBJECT TO ALL THE TERMS,
-NSR ADDL SUBR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY
LIMITS
A X COMMERCIAL GENERAL LIABILITY 57UEAZM1413 1/1/2022 1/1/2023
CLAIMS -MADE OCCUR
EACHOCCURRENCE $1,000,000
DAAGE Tol RETE
PREMISES occur ence $ 300,000
MED EXP (Any one person) $ 10,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'LAGGREGATELIMITAPPLIESPER:
POLICYPEC LOC
GENERAL AGGREGATE $2,000,000
PRODUCTS - COMP/OP AGG $ 2,000,000
A
AUTOMOBILELIABILITY57UEAZM1416
1/1/2022
1/1/2023
COMBINED SINGLE LIMIT $1,000,000
Ea accidentBODILY
X ANY AUTO
INJURY Per person) $
OWNED SCHEDULED
BODILY INJURY (Per accident) $
AUTOS ONLY AUTOS
y HIRED NON-OWNED
AUTOSPROPERTY
AUTOS ONLY AUTOS ONLY
DAMAGE
$
Per accident
$
B
XJ UMBRELLA LIAB
X
OCCUR
57RHAZM1556
1/1/2022
1/1/2023
EACH OCCURRENCE $ 1,000,000
4 EXCESS LAB
CLAIMS -MADE
AGGREGATE $ 1,000,000
17
DED RETENTION $
j
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
57WEAPK7544
1/1/2022
1/1/2023
$
X I PER OTH-
STATUTE I ER
Y / N
ANYPROPRIETOR/PARTNER/EXECUTIVEE.L.
OFFICER/MEMBEREXCLUDED? ❑
N/A
EACH ACCIDENT $ 1,000,000
(Mandatory in NH)
E.L. DISEASE - EA EMPLOYEE $ 1,000,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT $ 1,000,000
C
Installation Floater
QT630OT271347TIL22
1/1/2022
1/1/2023
Limit $3,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
All California Operations performed by the Named Insured for the certificate holder
!'I'ATICl/'ATC Uni rico
Town of Los Altos Hills
26379 Fremont Rd
Los Altos Hills CA 94022
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
REPRESENTATIVE
v I wv-w I U Muumu L UKI I IUN. All rights reserved.
ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD