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HomeMy WebLinkAboutNo Fault Asphalt Inc.-- CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DDNYYV) 10/27/2023 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 teens 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 endorseinent(s). PRODUCER FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 NAME cT CLIENT CONTACT CENTER A/CNNo. Ext); 888-333-4949 (A/C, No): 507-446-4664 ADDRESS: E-MAIL CLIENTCONTACTCENTER FEDINS.COM OWATONNA, MN 55060 INSURERS AFFORDING COVERAGE NAIC# 01/22/2023 INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 EACH OCCURRENCE $1,000,000 INSURED 160-392-7 INSURER B: NO FAULT ASPHALT INC PO BOX 50877 INSURER C: INSURER D: PALO ALTO, CA 94303-0672 INSURER E: INSURER F: AUTOMOBILE LIABILITY JANYAUTO ONLYSCHEDULED UTS HIRED AUTOS ONLY NON-OWNED COVERAGES CERTIFICATE NUMBER: 74 REVISION NUMBER: 1 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, I PTS.R TYPE OF INSURANCE ADDL SUER POLICY NUMBER PO ICY EFFPOCKX YI LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS•MADE ❑X OCCUR Y N 9912362 01/22/2023 01/22/2024 EACH OCCURRENCE $1,000,000 AMAGETaccurreO ENTED PREMISES $100,000 MED EXP (Any one person) EXCLUDED PERSONAL& ADV INJURY $1,000,000 GEN1 AGGREGATE LIMIT APPLIES PER: JPOLICY �ECOT � LOC OTHER: GENERAL AGGREGATE $2,000,000 PRODUCTS &COMP/OP AGO $2,000,000 AOWNEDAUTOS AUTOMOBILE LIABILITY JANYAUTO ONLYSCHEDULED UTS HIRED AUTOS ONLY NON-OWNED N N 9912362 01/22/2023 01/22/2024 CEa acOM TdeJ SINGLE LIMIT $1,000,000 clldeD BODILY INJURY (Per Person) BODILY INJURY (Par Accident) ROPERTY DAMAGE UMBRELLA LIAR OCCUR EXCESS LIAR CLAIMS -MADE DED I RETENTION EACH OCCURRENCE AGGREGATE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNERI EXECUTIVE OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A - PER STATUTE OTHER E.L EACH ACCIDENT EL DISEASE EA EMPLOYEE E.L DISEASE • POLICY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space Is required) ADDITIONAL INSUREDS ALSO INCLUDES TOWN OF LOS ALTOS HILLS' ELECTED AND APPOINTED OFFICERS, EMPLOYEES, AND VOLUNTEERS SUBJECT TO THE TERMS AND CONDITIONS OF THE POLICY. CERTIFICATE HOLDER CANCELLATION 160-392-7 TOWN OF LOS ALTOS HILLS 26379 W FREMONT RD LOS ALTOS HILLS, CA 94022-2624 741 1 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 , I G © 19BO.2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 9912362 COMMERCIAL GENERAL LIABILITY CG 20 12 04 13 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - STATE OR GOVERNMENTAL AGENCY OR SUBDIVISION OR POLITICAL SUBDIVISION - PERMITS OR AUTHORIZATIONS This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE State Or Governmental Agency Or Subdivision Or Political Subdivision: Town of Los Altos Hills 26379 W Fremont Rd Los Altos Hills, CA 94022-2624 Information required to complete this Schedule, if not shown above, will be shown in the Declarations. A. Section II - Who Is An Insured is amended to include as an additional insured any state or governmental agency or subdivision or political subdivision shown in the Schedule, subject to the following provisions: 1. This insurance applies only with respect to operations performed by you or on your behalf for which the state or governmental agency or subdivision or political subdivision has issued a permit or authorization. However: a. The insurance afforeded to such additional insured only applies to the extent permitted by law; and b. If coverage provided to the additional insured is required by a contract or agreement, the insurance afforded to such additional insured will not be broader than that which you are required by the contract or agreement to provide for such additional insured. Insured: No Fault Asphalt Inc PO Box 50877 Palo Alto, CA 94303-0672 2. This insurance does not apply to: a. "Bodily injury," "property damage" or "personal and advertising injury" arising out of operations performed for the federal government, state or municipality; or b. "Bodily injury" or "property damage" included within the "products -completed operations hazard". B. With respect to the insurance afforded to these additional insureds, the following is added to Section III - Limits Of Insurance: If coverage provided to the additional insured is required by a contract or agreement, the most we will pay on behalf of the additional insured is the amount of insurance: 1. Required by the contract or agreement; or 2. Available under the applicable Limits of Insurance shown in the Declarations; whichever is less. This endorsement shall not increase the applicable limits of Insurance shown in the Declarations. Project or Reference: Additional insureds also includes Town of Los Altos Hills' elected and appointed officers, employees, and volunteers subject to the terms and conditions of the policy. © Insurance Services Office, Inc., 2012 Page 1 of 1 CG 20 12 0413 Policy Number: 9912362 Transaction Effective Date: 10/27/2023