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HomeMy WebLinkAboutJepsen Electric, Inc. (3)AC"/ " CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. I 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 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 Heffernan Insurance Brokers 1350 Carlback Avenue CONTACT NA: Heather Pate PA/CNNo A/C Ne; 925-934-8278 Ext: 925-295-2548 FAx Walnut Creek, CA 94596 ADDRESS: HeatherP heffins.com INSURERS AFFORDING COVERAGE NAIC # LIMITS INSURER A: Beazley Insurance Company, Inc. 37540 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE %� OCCUR INSURED JEPSELE-02 Jepsen Electric, Inc D.M. Jepsen, Inc.; DMJ Leasing, Inc. INSURER B: Middlesex Insurance Company 23434 INSURER C: Insurance Company of the West 27847 INSURER D: 295 Boeing Ct. Livermore, CA 94551 INSURER E: INSURER F : MED EXP (Any one person) $ 5,000 COVERAGES CERTIFICATE NUMBER: 74FRR3461 PI=%/ICInKi KIHK11RCD• 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 D SUBR WVD POLICY NUMBER MM/DDY� MM/DD/YYYY LIMITS B X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE %� OCCUR A0147828005 3/29/2023 3/29/2024 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY JE� D LOC GENERAL AGGREGATE $ 3,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 EMPLOYEE BENEFITS $1,000,000 OTHER: _ B AUTOMOBILE LIABILITY A0147828001 _ 3/29/2023 3/29/2024 _ Ee aoc EDtSINGLE LIMIT $ 1,000,000 ANY AUTO BODILY INJURY (Per person) $ X OWNED X SCHEDULED AUTOS ONLY AUTOS HIRED X NON -OWNED AUTOS ONLY AUTOS ONLY BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ $ B X UMBRELLA LIAB X OCCUR A0147828006 3/29/2023 3/29/2024 EACH OCCURRENCE $ 5,000,000 EXCESS LAB CLAIMS -MADE AGGREGATE $ 5,000,000 DED I X I RETENTION $ 1 $ 1 C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED? N I A WPL 5052637 04 1/1/2024 1/1/2025 X STATUTE EERH E.L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under E.L. DISEASE - POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below A POLLUTION LIABILITY ENP000315305 3/1/2023 3/29/2024 LimitlAggregate $1M/$2M DEDUCTIBLE 5,000 DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) EXCLUDED OFFICERS: Moira Jepsen & David Jepsen. Re: As Per Contract or Agreement on File with Insured. -- VNIV IiGLLF1I IVIV Town of Los Altos Hills 26379 Fremont Road Los Altos Hills, 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 REPRRESEE NT,ATITIV E ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: A0147828005 COMMERCIAL GENERAL LIABILITY CG 2154 0196 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - DESIGNATED OPERATIONS COVERED BY A CONSOLIDATED (WRAP-UP) INSURANCE PROGRAM This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Description and Location of Operation(s): (If no entry appears above, information required to complete this endorsement will be shown in the Declarations as applicable to this endorsement.) The following exclusion is added to paragraph 2., Exclusions of COVERAGE A - BODILY INJURY AND PROPERTY DAMAGE LIABILITY (Section 1 - Coverages): This insurance does not apply to "bodily injury" or "property damage" arising out of either your ongoing operations or operations included within the "products -completed operations hazard" at the location described in the Schedule of this endorsement, as a consolidated (wrap-up) insurance program has been provided by the prime contractor/project manager or owner of the construction project in which you are involved. CG 21 54 0196 A0147828 Middlesex 1 00001 0000000000 21085 0 N This exclusion applies whether or not the consolidated (wrap-up) insurance program: (1) Provides coverage identical to that provided by this Coverage Part; (2) Has limits adequate to cover all claims; or (3) Remains in effect. Copyright, Insurance Services Office, Inc., 1994 c13faW441 e-40e5-8baf-c8e8bO98efaa Page 1 of 1 COMMERCIAL EXCESS/UMBRELLA LIABILITY EU 21 5412 04 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - DESIGNATED OPERATIONS CAUSED BY CONSOLIDATED (WRAP-UP) INSURANCE PROGRAM This endorsement modifies insurance provided under the following: COMMERCIAL EXCESS/UMBRELLA LIABILITY COVERAGE PART SCHEDULE Description and location of operation(s): The following exclusion is added to Coverage U - Umbrella Liability, Paragraph C. Exclusions of Section I - Coverages: This insurance does not apply to "Bodily Injury" or "Property Damage" arising out of your ongoing operations at the location described in the schedule of this endorsement as a consolidated (wrap-up) insurance program that has been provided by the prime contractor/project manager or owner of the construction project in which you are involved. EU 21 54 12 04 A0147828 Middlesex 1 00001 0000000000 21085 0 N 6af4f1d441e2-410e-b2ef-b665d002ef This exclusion applies whether or not the consolidated (wrap-up) insurance program: 1. Provides coverage identical to that provided by this coverage part; 2. Has limits adequate to cover all claims; or 3. Remains in effect. Page 1 of 1 0 i•x COMMERCIAL GENERAL LIABILITY CG 71 22 0219 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. EXCLUSION - RESIDENTIAL CONSTRUCTION OPERATIONS - WITH EXCEPTION FOR APARTMENTS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Designated Construction Project(s): Information required to complete this Schedule, if not shown above will be shown in the Declarations. A. The following is added to Paragraph 2. Exclusions under Section I - Coverages, Coverage A - Bodily Injury and Property Damage Liability and Coverage B - Personal and Advertising Injury Liability: Residential Construction This insurance does not apply to "bodily injury", "property damage", or "personal and advertising injury" arising out of "designated work", regardless of whether such work or operations was performed by you or on your behalf. This exclusion does not apply to: 1. Designated construction project(s) shown in the Schedule above; 2. Apartments, dormitories, military base housing, assisted living centers; or 3. "Your work" which only began after a certificate of occupancy, or other similar document issued by the applicable government agency evidencing a structure's completion, was issued for the property. However, this exception does not apply to warranty work whenever undertaken. B. Definitions The following definition is added for the purposes of this endorsement: "Designated work" means "your work", prior to or subsequent to the effective date of the policy to which this endorsement is attached, on any part of any project or development comprised of: 1. New residential construction, including: single or multiple family dwellings, residential condominiums, town homes, residential timeshare units, retirement homes or other structures built for residential use; or 2. The conversion of any existing structure to a residential occupancy. CG 7122 0219 Includes copyrighted material of Insurance Services Office, Inc., Middlesex with its permission. 1 00001 0000000000 21085 0 N 805b3bf0-0795-4407-9f2e-619814762eff Page 1 of 1 3/29/2023