HomeMy WebLinkAboutCertificate of Insurance (2)mAPvTun_n1 MCDONALDJ
CERTIFICATE OF LIABILITY INSURANCE
DATDIYYYY)
9//18/218/2023
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 License # OE67768
IOA Insurance Services
3875 Hopyard Road
Suite 200
Pleasanton, CA 94588
NAME?cT Jessica McDonald
(A/C, No, Ext): (925) 918-4535 FAX No):
E-MAIL
ADDREss: Jessica. McDonald@ioausa.com
INSURERS AFFORDING COVERAGE NAIC #
INSURER A: Valley Forge Insurance Company 20508
INSURED
Mark Thomas & Company, Inc.
2833 Junction Avenue, Ste 110
San Jose, CA 95134
INSURER B: Continental Casualty Company 20443
INSURER C: Continental Insurance Company 35289
INSURER D: Lloyd's NA
INSURER E
INSURER F:
n MMr Clnn'rC AUInnDCD. RFVISInNI NHMRFR-
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.
III SIR I
LTR
A
TYPE OF INSURANCE
X COMMERCIAL GENERAL LIABILITY
ADDL
INSD
SUBR
WVD
POLICY NUMBER
POLICY EFF
MMIDD YYY
POLICY EXP
MM DD YYY
LIMITS
1,000,000
EACH OCCURRENCE $
CLAIMS -MADE �X OCCUR
X
X
7040185059
9/15/2023
9/15/2024
PREMISESOEaoccur.nce $ 1,000,000
MED EXP (Any oneperson) $ 15'000
PERSONAL & ADV INJURY $ 11000'000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY ❑X PECT PRO- ❑ LOC
J
GENERAL AGGREGATE $ 2'000'000
PRODUCTS - COMP/OP AGG 2,000,000
B
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT 1,000,000
(Es accident) $
BODILY INJURY Perperson) $
X ANY AUTO
X
X
7040183912
911512023
9115/2024
BODILY INJURY Per accident $
OWNEDSCHEDULED
AUTOS ONLY AUTOS
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
PROPERTY AMAGE
Per accident $
C
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE $ 9'000'600
AGGREGATE $
X
EXCESS LAB
X
CLAIMS -MADE
7040283234
911512023
9115/2024
RETENTION$ DED
9,000,000
A
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
ANFICER/MEM ORIPAR NEE/E ECUTIVE Y�
(Mandatory in NH)
NIA
X
7040274825
9115/2023
911512024
X PER
EERH
1,000,000
E.L. EACH ACCIDENT $
E.L. DISEASE - EA EMPLOYEE $ 1'000'666
1,000,000
E.L. DISEASE - POLICY LIMIT $
If yes, describe under
DESCRIPTION OF OPERATIONS below
D
Cyber Liability
ACS1126423
7/1/2023
711/2024
Limit 5,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
CU -20107
Re: CU -20107 - Town of Los Altos Hills - Sewer Inspection
Town of Los Altos Hills, its officers, officials, employees and volunteers are named as additional insureds.
The Workers Compensation / Employers Liability Deductible is none.
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
Town of Los Altos Hills °�
26379 Fremont Road r, 4,9_
ACORD 25 (2016/03) V 9ytSS-LU9b HI;UKU liIJKMVKHI IVIV. mn FIUI1tb 1CSC1 VCU.
The ACORD name and logo are registered marks of ACORD