HomeMy WebLinkAboutWest Valley Construction Company, Inc. (2)l �Ro CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY)
1✓'� 9/28/202 1. %%
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. '
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLI
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the pollcy(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 coNTACT
NAME: CiIrIS
Woodruff -Sawyer & Co, PHONE Ext: 41
50 California Street, Floor 12 EMAIL
San Francisco CA 94111 ADDRESS: Ckel
INSURED WESTVAL-01 INSURER B: American Guarantee and Liability Insurance 26247
West Valley Construction Company, Inc.
580 McGlincy Lane INSURER C:
Campbell CA 95008 INSURER 0:
INSURER E:
INSURER F :
COVERAGES CERTIFICATE NUMBER: 1645156436 REVISION NIIMBFR:
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
I TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MMIDDIYYYY
POLICY EXP
MMIDDIYYYYI
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 111 OCCUR
Y
GL0883784701
10/1/2023
10/1/2024
EACH OCCURRENCE $2,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence $100,000
MED EXP (Any oneperson) $ 10,000
PERSONAL & ADV INJURY $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY II JECT F-1 LOC
OTHER:
GENERAL AGGREGATE $ 4,000,000
PRODUCTS - COMP/OP AGG $ 4,000,000
$
A
AU70MOBILELIA8ILRY
X
X
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
HIREDX NON -OWNED
AUTOS ONLY AUTOS ONLY
SAP883784901
10/1/2023
107172024
�'eBcld DtSINGLELIMIT $2,000;000
BODILY INJURY (Per person) $
BODILY INJURY Per accident
( ) $
PROPERTYDAMAGE $
Per accident
B
X
UMBRELLALIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
SXS423831800
10/1/2023
10/1/2024
EACH OCCURRENCE $1,000,000
AGGREGATE $ 1,000,000
DED I I RETENTION $
$
A
WORKERS
AND EMPLOYERSENSATION LIABILITY Y/N
ANYPROPRIETOR/PARTNERIEXECUTIVEN
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
/ A
WC883784301
10/1/2023
10/1/2024
I
X STATUTE ERH
E.L. EACH ACCIDENT $1,000,000
E.L. DISEASE - EA EMPLOYEE $1,000,000
I E.L. DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required)
RE: All jobs pertaining to the work performed under contract by the above named insured. The Town of Los Altos Hills is additional insured per the attached
form.
..
Town of Los Altos Hills
26379 Fremont Road
Los Altos 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
U 1988-2015 ACORD CORPORATION. All rights reserved.
ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD