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Home My WebLink AboutCertificate of Insurance (2)RLACWAT-n1 HFISHER CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 9/22/2023 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 # OE02096 DiBuduo & DeFendis Insurance Brokers, LLC 1560 Cummins Drive, Suite A Modesto, CA 95358-6406 CONTACT NAME: PHONE 209 578-0183 FAX 209 578-1841 (A/C, No, Ext): ( ) (A/c, No):(209) ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERANalley Forge Insurance Co 20508 INSURED INSURER B: National Fire Insurance of Hartford 20478 INSURER C: Lloyds of London 15792 Black Water Consulting Engineers, Inc. INSURER D: 602 Lyell Drive Modesto, CA 95356 INSURER E INSURER F: 1/1/2023 COVFRAr.FS CERTIFICATE NUMBER-- 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 INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 21000,000 CLAIMS -MADE X OCCUR X X 86045289343 1/1/2023 1/1/2024 DAMAGE TO RENTED 1,00®,®OO PREMISES Ea occurrence $ MED EXP (Any oneperson) $ 10,000 PERSONAL & ADV INJURY $ 2'0001000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY FI PRO- F LOC JECT GENERAL AGGREGATE $ 41000,000 PRODUCTS - COMP/OP AGG $ 41000,000 $ OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 11000,000 Ea accident $ BODILY INJURY Perperson) $ X ANY AUTO X 6076293974 1/1/2023 1/1/2024 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS PROPERTY DAMAGE Per accident $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 3,0001000 AGGREGATE $ 31000,000 EXCESS LIAB CLAIMS -MADE B7018700970 1/1/2023 1/1/2024 DED X T RETENTION $ 10X0 $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N / A STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT $ If yes, describe under DESCRIPTION OF OPERATIONS below C Professional Liabili AE233286 1/1/2023 1/1/2024 Ea Claim 21000,000 C Professional Liabili AE233286 1/1/2023 1/1/2024 Aggregate 21000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Blackwater Consulting Engineers, Town of Los Altos Hills, Sewer Bypass Hydraulic Evaluation, dated September 20, 2023 The Town of Los Altos Hills, its elective and appointed officers, employees, and volunteers are added as Additional Insureds, as respects General Liability and Auto Liability, per attached company forms SB14668C 10-19 and SCA23500d 10 2011. Waiver of Subrogation, in favor of The Town of Los Altos Hills, its elective and appointed officers, employees, and volunteers applies, as respects General Liability, per attached company form SB146968C 10-19. Primary wording applies, as respects General Liability and Auto Liability, per attached company forms CNA80103XX 09-14 and SCA23500d 10 2011. Notice of Cancellation endorsements apply, as respects General Liability, Auto Liability, Escess Liability and Professional Liability per attached company forms SB147082E 04-14, IL001711-98 & IL0270 07-209 IL0017 11-90 & IL0270 09-12, and PUA2018EA attached r'_1=RTIlz1r.ATF 1-101 ni=p CANCELLATION ACORD 25 (2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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. Contracts 26379 Fremont Road AUTHORIZED REPRESENTATIVE AZZF25 I Los Altos Hills, CA 94022 I ACORD 25 (2016/03) O 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD