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AC"Ra CERTIFICATE OF LIABILITY INSURANCE F
DATE(MMIDD/YYYY)
05/14/2020
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 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
Willis Towers Watson Northeast, Inc.
0/0 26 Century Blvd
P.O. Box 305191
Nashville, TN 372305191 USA
INSURED
Civiaplus
302 S 4th Street, Suite 500
Manhattan, Kt 66502
Willis Towers Watson Certificate Center
FAX (
1-677-945-7378 1-868-467-2378
cp: � (AIC, Nod:
certificatespwillis.com
A: Greet Northern Insurance Company 20303
B: Federal Insurance Company 20281
COVERAGrg (1PRTIF'ICATF N111fAYA1~1=t• W16465667 rap%1telnnl K111RA CC),
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.
...__��__.__._._a ypOL�CY LF� PgL[CY F?x�" .._...
GTR TYPE OF INSURANCE POLICY NUMBER MM/ Q/YYY M /QQIYYY LIMITS^
X
COMMERCIAL GENERAL LIABILITY
EACHOCCURRENCE
$ 2,000,000
CLAIMS -MADE (,,^j OCCUR
DAMAGE O E T U
I D3EMI ,ES(( q_ocrtarrencct}
6w...___. 2,000,000
A
MEQ EXP (Any ono porson)
$ 10,000
PERSONAL &ADVINJURY
$ 1,000,004
3602-53-12
05/17/2020
05/17/2021
AGGREGATE LIMIT APPLIES PER:
GENERAL AGCRkGATE
2,000,000
GEN'L
I
POLICY E JEtPT E LOC
PRODUCTS. COMP/OP AGO
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
, M11l da11SINGLE LIMIT
000, 000
X
ANY AUTO
BODILY INJURY (Per person)
$
H
OWNED SCHEDULED
AUTOS ONLY _ AUTOS
735887-92
45/1.7/2020
05/17/2021
BODILY INJURY (Per accident)
$
AUTOS
PROPERTYDAMAGE^'—
ONLY AUTOS ONLYY$
$
B
—
UMBRELLA LIAB X OCCUR
EACH OCCURRENCE
$ 15,000,000
AGGREGATE
_. . _ __-.- -..____u_ ..---.
5,000,000
?._ - ._..._ _._..
X
EXCESS LIAB CLAIMS -MADE
7989-49-14
05/17/2420
05/17/2021
QEQ X RE'1'GNTIC7N$ 0
$
WORKERSCOMPENSATION
!
X S
AND EMPLOYERS' LIABILITY Y / N
}R17U'rEI
E.l EACH ACCIDENT .
—
$ 1,000,000
a
ANYPROPRIETOR/PARTNER/EXECUI'IVE
OFFICER/MEMBER EXCLUDED'? �
NIA
(20) 7174-92-49
05/17/2020
05/17/2021
(Mandatory In NH)
E.L.DISEASE GA EMPLOYEE-
$ 1,000,000
II os, describe under
— —
D SCRIPTION OF OPERATIONS below
E.L. DISEASE - POLICY LIMIT
$ 1,000,000
I
DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached I1more space Is required)
The Town of Los Altos Rills
26379 Fremont Road
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.
AUTHORIZED REPRESENTATIVE
//4
cn 1988.2016 ACORD CORPORATION, All rights reserved.
ACORD 25 (2016/03) The ACORD name and Ingo are registered marks of ACORD
sit XD: 19617191 BATCH: 1680264
2oi2
WILLIS TOWERS WATSON
26 CENTURY BLVD.
6TH FL
NASHVILLE, TN 37214
1999 1 MB 0.436
'111"IIIIIII'IIJill 1JI1'11Irlll1ll�llnl�'lll'll��lll'�'nlll�l
THE TOWN OF LOS ALTOS HILLS 1999
26379 W FREMONT RD
LOS ALTOS HILLS, CA 94022-2624
1 of 2 1999