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HomeMy WebLinkAboutChrisp Company (6)�'�CERTIFICATE OF LIABILITY INSURANCE D TYPE OF INSURANCE 1ATE 0/29IDD/Y 10/29/20133 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 pol[cy(ies) must 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 LIC #0726293 1-925-299-1112 Arthur J. Gallagher & Co. Insurance Brokers of California, Inc. 3697 Mt. Diablo Boulevard, Suite 300 CONTACT Certificates Team NAME: A/CNNo Ext); 925-299-1112 IFNo): 925-953-6270 E-MAILafba area_certaBa ADDRESS: Y jg.com INSUREWS1 AFFORDINGCOVERAGE NAIC# Lafayette, CA 94549 INSURERA: OLD REPUBLIC GEN INS CORP 24139 Client Code: CHRIS -8 INSURED Chrisp Company INSURER B: INSURER C: 43650 Osgood Road INSURER D: INSURER E: Fremont, CA 94539 INSURER P: 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 MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS A GENERAL LIABILITY X AICG99131202 12/01/1 12/01/13 EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE [XI OCCUR X BI/PD: $10,000 DED/OCC DAMAGE TO RENTED PREMISES Ea occurrence $ 100,000 MED EXP (Any one person) $ 5,000 PERSONAL &ADV INJURY $ 1.000,000 GENERALAGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 2,000,000 POLICY X PRO LOC $ A AUTOMOBILE LIABILITY AICA99131202 12/01/1, 12/01/13 COMBINED SINGLE LIMIT Ea accident 1,000,000 X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident $ ( ) X X NON -OWNED AUTOS HIRED AUTOS Hx COMP/COLE DED:$1,000* PROPERTY DAMAGE Per accident $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ - $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBER EXCLUDED? ❑ N / A A1CW99131202 12/01/1 12/01/13 WCSTATU- OTH- X LI S E - EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below [SEE ATTACHED SUPPL. PAGE] DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) Chrisp Job #: 1A.3115 / RE: Sunhills Drive, Los Altos Hills, CA. ADDITIONAL INSURED(S): Town of Los Altos Hills, its elective and appointed officers, employees and volunteers. k;t_KI It-IUAI t_ MULUIZK CANCELLATION Chrisp Job #: 1A.3115 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Los Altos Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 26379 Fremont Road AUTHORIZED REPRESENTATIVE Los Altos Hills, CA 94022 USA ACORD 25 (2010/05) adilaf 36666971 ©1988-2010 ACORD CORPORATION The ACORD name and logo are registered marks of ACORD All rights reserved. POLICY NUMBER: AICG99131202 COMMERCIAL GENERAL LIABILITY CG 20 10 07 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - OWNERS, LESSEES OR CONTRACTORS - SCHEDULED PERSON OR ORGANIZATION This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s): Locations Of Covered Operations WHERE REQUIRED BY WRITTEN CONTRACT WHERE REQUIRED BY WRITTEN CONTRACT 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 the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to "bodily injury" or "property damage" occurring after: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. CG 20 10 07 04 © ISO Properties, Inc., 2004 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY, THIS ENDORSEMENT MODIFIES INSURANCE PROVIDED UNDER THE FOLLOWING: COMMERCIAL GENERAL LIABILITY COVERAGE FORM Name of Additional Insured Person(s) Location(s) of Covered Operations Or Organization(s), WHERE REQUIRED BY WRITTEN CONTRACT Information required to complete this Schedule, if not shown above, will be shown in the Declarations. The insurance provided by this endorsement is primary insurance and we will not seek contribution from any other insurance of a like kind available to the person or organization shown In the schedule above unless the other insurance is provided by a contractor other than the person or organization shown In the schedule above for the same operation and job location. If so, we will share with that other insurance by the method described in paragraph 4,c, of Section IV — Commercial General Liability Conditions, All other terms and conditions remain unchanged. Named Insured CHRISP COMPANY Polley Number Al CG99131202 Endorsement No. Policy Period 2/01/12 to 12/01/13 : Endorsement Effective Date 12/01/12 Producer's Name: ARTHUR J. GALLAGHER & CO. INSURANCE BROKERS OF CA, INC. Producer Number: LICENSE #0726293 CG EN GN 0029 09 06 Im SUPP (05104) DATE SUPPLEMENT TO CERTIFICATE OF INSURANCE 10/29/2013 NAME OF INSURED: Chrisp Company Additional Description of Operations/Remarks from Paae 1: Additional Information: GENERAL LIABILITY: * Additional Insured if required by written contract per attached Form CG2010 0704 * Coverage is Primary/Non-Contributory if required by written contract per attached CGENGN0029 0906 WORKERS- COMPENSATION: * Covered States: California, Nevada, Oregon t SUPP (05104)