HomeMy WebLinkAboutZicovich Builders, Inc (2)A� 0 CERTIFICATE ®F LIABILITY INSURANCE
FDA9/(12/2023 )
THIS CERTIFICATE IS ISSUED ASA 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 pollcy(les) 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 Ileu of such endorsement(s),
PRODUCER
C NAME: Lauri Tatum
Leavitt Pacific Insurance Brokers, Inc.
License #OD79674
PHONE (408)288-6262 FAX 400)290-7035
A1C No Ext : AIC No):
E-MAIL lauri-tatum@leavitt.com
ADDRESS:
1570 The Alameda, Suite 101
INSURER(S) AFFORDING COVERAGE NAIC #
INSURERA:Ohio Security Insurance Compal_ 24082_
San Jose CA 95126
INSURED
INSURER 13: Scottsdale Insurance Company 41297
INSURER C: Everest Premier Insurance CoLnpany 16045
Zicovich Builders, Inc.
INSURERD:
761 University Ave. Ste, C
INSURER E:
GENERAL AGGREGATE $ 2,000,000
Los Gatos CA 95032
_
INSURER F:
COVERAGES CERTIFICATE NUMBER:23-24 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.
W
INSR
LTR
TYPE OF INSURANCE
ADUL
D
S BR
V
POLICY NUMBER
POLICY—CFF
MM/DDIYYYY
POLICY EXP
MM/DD/YYYY
LIMITS
A
AUTHORIZED REPRESENTATIVE
COMMERCIAL GENERAL LIABILITY
.. OLAIMS-MADE D OCCUR -
_-.
- _-
BKS57498524
9/10/2023
9/10/2024
EACH OCCURRENCE $ 1,000,000
_
DAMAGE TO RENTED --100,-000-
PREMISES Ea occurrence) - $
MED EXP (Any one person) $ 5,000
PERSONAL & ADV INJURY $ 1,000,000
GEN'LAGGREGATE LIMIT APPLIES PER:
POLICY F_XJ jE T ❑ LOC
OTHER:Employee
..
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OPAGG $ 2,000,000
Beneflrs $ 1,000,000
A
AUTOMOBILE
X
LIABILITY
ANYAUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
HIRED AUTOS NON -OWNED
ALTOSPer
BAS57498524
9/10/2023
9/10/2024
Ea BINE srNGLE LIMIT $ 1,000,000
BODILY INJURY (Per person) $
BODILY INJURY Per accldent $
( )
PROPERTYDAMAGE $
accident
Uninsured motorist combinod single $ 1,000,000
B
X
UMBRELLA LAB -
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
XLS1226005
9/13/2023
9/13/2024
EACH OCCURRENCE $ 3,000,000
AGGREGATE $ 3,000,000
DED I I RETENTION $
$
Q
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(MandatoryinNH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N / A
7600017395231
3/10/2023
3/10/2.029
X PER OTH-
STATUTE ER
E.L. EACH ACCIDENT $ 1,000,000
-—
1 E.L. DISEASE - EA EMPLOYEE $ 1,000,000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additlonal Remarks Schedule, may be attached If more space is required)
Re: 13300 Robleda Road, Los Altos Hills, CA.
CERTIFICATE HOLDER CANCELLATION
esteta@losaltoshills.ca.gov
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of Los Altos Hills
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
26379 Fremont Road
ACCORDANCE WITH THE POLICY PROVISIONS.
Los Altos Hills, CA 94022
AUTHORIZED REPRESENTATIVE
Fred Stafford/JOROME
O 1988.2011 ACORD CORPORATION, All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
INS025 (201401)