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Home My WebLink AboutMP Nexlevel of California, Inc. (3)Page I of 2 60 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDDNYYY) 12/10/2023 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR.NEGAt1VELY 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 ADDRI"IBNA4 INSURED, the pollay(les) must have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and condltlons of the: policy, certain policies may require an ondorserne m. A statement on this certificate does not confer rights to the certificate holder in lieu of such ondorsement($. PRODUCER Willis Towers Watson Midwest, %no. c/o 26 Century Blvd P.O. Box 305191 2�4`6�-Wi 3 1�,! Towers Watson Certificate Center EAHMNE ami 1-877-945-'7378 1-888-467-2378 , --------- - - ------- LALO, N a): All. AD ESS: certi�icatarsl�wvillis.�5r5m _ INSUSER(S) AFFORDING COVERAGE NAIC# Nashville, TN 372305191 USA INSURERA: Zurich American insurance Company 26535 INSURED bw voxieval of California, Inc.. INSURFIRD: AXIS surplus insurance Company 26620 INSURER 0: -- 500 County Road 37 East INSUAIIRO: Maple Lake, MIN 55358 INSURERS: INSURER F: $. 10,000 COVERAM CERTIFICATE NUMBER, W31615107 REVISION NUMBVR: THIS 19 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 On 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, jij§1A1[--'- - 1 1 --------------------- F LTH TYPECIFINSURANCE Hsl) In POLICYNUMSER Y) (M'ML/D,y1yWyLIMITS I X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 21000,000 r--1 CLAIMS -MADE WOCCUR -�'Contxaotusl. -W -Ra 9M 2,000,000 A Liability MED EXP(Any orio person) $. 10,000 Y GLO 8902940-04 12/31/2023 12/31/2,024 PEnSONAL&ADVINJURY $ 2,000,000 .GEN'L AGGnCOATC LIMIT APPLIES PER: GENE-nAL.AG0nEGATC $ 4,000,000 POLICY LOC PRODUCTS - COMPIOP AGG $ 4,000,000 $ AUTOMOBILE LIABILITY Q OM 0I N E6-8 NGL 1211 M IT $ 5,000,000 ANYAUTO BODILY INJURY (Per person) $ A OWNED SCHEDULES AUTOS ONLY AUTOS y BAP 8488453-04 22/31/2023 12/31/2024 BODILY INJURY (Per aceldent) $ Pp OJ�ERf -Y HIRED NON -OWNED IX AUTOS ONLY AUTOS ONLY $ UMBFIELLALIAB X OCCUR EACH OCOURRENCe $ 8,000,000 X EXCESS LIAR CLAIMS -MADE -DED P-001-000068228-06 12/31/2023 12/31/2024 AGGREGATE - -------- ------ -- $ 5,000,000 71 J-1 F,I-ETENTION III $ WORKERS COMPENSATION Sr Ar UT AND EMPLOYERS' LIABILITY YINRN qW_ACCIDENT $ 5,000,000 ANYl3FtOPHlETOR/PA(ITNERIEXCOUTIVE OFFICER/MCMBEFIEXCLUDED7 NIA WC 8902941-04 12/31/2023 12/31/2024- (Mandatory in NH) G.L. DISEASE - CA EMPLOYEE $ 5,000,000 If gs. describe Under DESCRIPTION OP9aATtONS below E.L. DISEASE � POLICY LIMIT $ 5 10001000 A Workers Compensation/ WC 8713291-04 12/31/2023 12/31 2024 E.L. Each Accident $5,000,000 Employers Liability E.L.Disease-Sa Empl $6,000,000 Per Statute M.L. Disease-Pol Lmt 05,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS /VEHICILES (ACORD 101, Additional Remarks Schedule, mnybe attached It more space Is required) Stop Gap Employers Liability for the Monopolistic States of North Dakota, Ohio, Washington and Wyoming in provided under Workers' Compensation policy, however, Statutory coverage for the Monopolistic states is not. SEE ATTACKED Town of Los Altos Hills 26379 Fremont Road 94022 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE UL, 1Ut$tI-ZU1 b AIL;UKU L;UKFUKA I 1UN. Ali rignis reservea. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD OR ID: 25105591 BATOR: 3249953 54766: 2 * of 2 1 AGENCY CUSTOMER ID: LOG #: ACC?RV ADDITIONAL REMARKS SCHEDULE Page 2 Of 2 AGENCY NAMED INSURED Willis Towers Watson Midwest, Inc. MP Noxioval of California, lnc 5.00 County Road 37 East POLICY NUMBER Maple Lake, MN 55350 See Page I CARRIER NAIC See -C ODE S s See Page I SPage I EFFECTIVE DATE: See Page I Mi �1104NFTAIR*1-41TJEW THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD PORM, FORM NUMBER:"'_ FORM TITLE: Certificate of Liability Insurance The Town of Los Altos Hills, its elective and appointed officers, employees, and volunteers are included as Additional insureds as respects to General Liability and Auto Liability as required by written contract. INSURER AFFORDING COVERAGE: Zurich American insurance Company NAIC#. 16535 POLICY NUMBER: CPP0084169-08 EFF DATE: 05/01/2023 EXP DATE: 05/01/2024 TYPE Or INSURANCE: LIMIT DESCRIPTION: LIMIT AMOUNT: Leased/Rented Equipment Any One Item/Per Oce $1,000,000 Deductible See Below ADDITIONAL REMARKS: Leased/Rented Equipment Deductible: $10,000 Per Occurrence < 0250,000 item value; $50,000 Per Occurrence > $250,000 item value; $50,000 for Theft ACORD 101 (2008/01) 0 2008 ACORD CORPORATION, All rights reserved. The ACORD name and logo are registered marks of ACORD SR ID: 25105591 BATCH: 3249953 CERT: W31615187 54766: 2 of