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HomeMy WebLinkAboutBarrett Business Services, Inc. L.C.FACQR©� CERTIFICATE OF LIABILITY INSURANCE L _- DATE (MM/DD/YYYY) 1/30/2020 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 be endorsed. If SUBROGRATION 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 Willis Towers Watson CONTACT NAME: San Jose 12980 Metcalf Ave Suite 500 PHONE (A/C, No (408) 321-9901 ' FAX (A/C, NO): (360) 828-0699 w Overland Park KS 66213 . r m ,.. v ._.....a s _.=.a.... __ n, .,. _---"t., . ,a EMAIL ADDRESS: Jerry.Sparks(c�bbsihq.com WVD INSURER(S) AFFORDING COVERAGE ' NAIC # (MM/DD/YYYY) INSURER A !ACE American Insurance Company 122667 INSURER B INSURED Barrett Business Services, Inc. L/C/F GENERAL LIABILITY BEAR ELECTRICAL SOLUTIONS, INC. INSURER C: 1341 ARCHER STREET INSURER D: SAN JOSE, CA 95131 r�ry .e INSURER E INSURER F. ? ..,�_ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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 ISSUES 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF POLICY EXP LIMITS LTR INSR WVD (MM/DD/YYYY) (MM/DD/Y" GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR DAMAGE TO RENTED PREMISES (Ea accurence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GF_N'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ POLICY -1 PROJ- n LOC ECT $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE LIMIT (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB OCCUR AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N C66386909 02/01/20 02/01/2021�/ WC STATU- TORY LIMITS OTH- ER ANY PROPRIETOR/PARTNER/ EXECUTIVEE.L. Y OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, describe under N / A X Covered states: CA EACH ACCIDENT $2,000,000 E.L. DISEASE - EA EMPLOYEE $2,000,000 E.L. DISEASE - POLICY LIMIT $2,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) In the event of any payment under this policy for a Loss for which the named insured has waived the right of recovery in a written contract entered into prior to the Loss, insurer hereby agrees to also waive our right of recovery but only with respect to such Loss. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE City of Los Altos Hills EXPIRATION DATA THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 26379 Fremont Avenue AUTHORIZED REPRESENTATIVE Los Altos Hills CA 94022 Authorized Rep a. �' ACORD 25 (2010/05) c) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD. AGENCY CUSTOMER ID: LOC: #: �41,,,..-- ADDITIONAL REMARKS SCHEDULE AGENCY NAMED INSURED: Barrett Business Services, Inc. L/C/F Lockton Affinity BEAR ELECTRICAL SOLUTIONS, INC. POLICY NUMBER 1341 ARCHER STREET SAN JOSE, CA 95131 C66386909 CARRIER ACE American Insurance Company ADDITIONAL REMARKS NAIC CODE 22667 EFFECTIVE DATE: 02/01/20 THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: Certificate of Liability (01/14) CERTIFICATE HOLDER: City of Los Altos Hills ADDRESS: 26379 Fremont Avenue Los Altos Hills CA 94022 RE: Traffic Signal Maintenance and Repair Services. Page 2 of 2 ACORD 101 (2008/01) c) 1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD.