HomeMy WebLinkAboutCertificate of Insurance (2)ACQR 1 0
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD/YYYY)
10/01/2020
1 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
Eclipse Marketing & Insurance Services
P O BOX 6480
CONTACT Eclipse Marketing &Insurance Services
NAME*
A/CPHONNo. Ext : (707) 469-6776
FAX
A/C No): (707) 469-8072
EMAIL
ADDRESS support@eclipseinsurance.com
Vacaville CA 95696
INSURERS AFFORDING COVERAGE NAIC #
EACH OCCURRENCE $ 1000000
INSURER A: Philadelphia Indemnity Ins. Co.
Agency Lio#: OD60747
INSURED
INSURER B: State Compensation Insurance Fund
ALL GUARD ALARM SYSTEMS, INC.
AG SECURITY SERVICES, INC.
INSURER C:
INSURER D:
GRAND CENTRAL STATION MONITORING, INC.
INSURER E:
1306 STEALTH STREET
LIVERMORE CA 94551
INSURER F:
COVERAGES CERTIFICATE NUMBER: 120827 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 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
INSRD
SUER
WVD
POLICY NUMBER
POLICYEFF
DATE (MM/DDM)
POLICY EXP
DATE (MM/DDM')
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE❑ OCCUR
X
X Errors & Omissions
(�
PHPK2189428
10/01/20
10/01/21
EACH OCCURRENCE $ 1000000
DAMAGE TO RENTED $ 100000
PREMISES Ea occurence
MED EXP (Any one person) $ 5000
PERSONAL & ADV INJURY $ 1000000
GENT AGGREGATE LIMIT APPLIES PER:
PRO -
POLICY El JECT LOC
ROTHER:
GENERAL AGGREGATE $ 3000000
PRODUCTS-COMP/OP AGG $ 3000000
$
A
AUTOMOBILE LIABILITY
X ANY AUTO
OWNED SCHEDULED
AUTOS ONLYAUTOS
X HIRED Ix NON -OWNED
AUTOS ONLYAUTOS ONLY
PHPK2189428
10/01/20
10/01/21
COMBINED SINGLE LIMIT 1,000,000
Ea accident $
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(Per accident) $
A
X UMBRELLA LIAR X
EXCESS LIAB
OCCUR
CLAIMS -MADE
PHUB741057
10/01/20
10/01/21
EACH OCCURRENCE $ 5,000,000
AGGREGATE $ 5,000,000
DED RETENTION $
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N/A
9285321-20
10/01/20
10/01/21
X PER OTH-
STATUTE E
E.L. EACH ACCIDENT $ 1,000,000
E.L. DISEASE -EA EMPLOYEE $ 1 000 000
E.L. DISEASE -POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
CERTIFICATE HOLDER IS NAMED AS ADDITIONAL INSURED PER POLICY WORDING
RE: Project: Maintenance Yard Building 27400 Purissuma RD Los Altos Hills, CA
CERTIFICATE HOLDER CANCELLATION
Tow of Los Altos Hills
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
26379 Fremont Road
THE EXPIRATION DATE THEREOF, NOTICE
WILL BE DELIVERED IN
Altos Hills CA 94022
ROVIRIONSLos
(�
Attention:
Dianna StahlLic # OG10997 "..,
ACORD 25 (2016/03) Certificate # 120827
'r"— A P`^011
@ 1988-2015 ACORD CORPORATION. All right reserved.
--A 1^-^ --!.+-A A m 1r of Af`nt?r1
POLICY NUMBER: PHPK2189428
PI -GL -005 (07/12)
THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY.
This endorsement modifies insurance provided under the following:
COMMERCIAL GENERAL LIABILITY COVERAGE PART
SCHEDULE
Effective Date: 10/01/2015
Name of Person or Organization (Additional Insured):
Blanket where required by written contract
SECTION II — WHO IS AN INSURED is amended to include as an additional insured the person(s) or
organization(s) shown in the endorsement Schedule, but only with respect to liability for "bodily injury,"
"property damage" or "personal and advertising injury" arising out of or relating to your negligence in the
performance of "your work" for such person(s) or organization(s) that occurs on or after the effective date
shown in the endorsement Schedule.
This insurance is primary to and non-contributory with any other insurance maintained by the person or
organization (Additional Insured), except for loss resulting from the sole negligence of that person or
organization.
This condition applies even if other valid and collectible insurance is available to the Additional Insured
for a loss or "occurrence" we cover for this Additional Insured.
The Additional Insured's limits of insurance do not increase our limits of insurance, as described in
SECTION III — LIMITS OF INSURANCE.
All other terms, conditions, and exclusions under the policy are applicable to this endorsement and
remain unchanged.
Page 1 of 1
Includes copyrighted material of Insurance Services Office, Inc., with its permission.