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HomeMy WebLinkAboutSupple Homes Inc.� �elr7 0 CERTIFICATE OF LIABILITY INSURANCE DATE (MMIDD/YYYY) 7/22/2024 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 Acrisure Partners West Coast Insurance Services, LLC 1950 W Corporate Way #1 Anaheim CA 92801 CONTACT NAME: PHONE FAX A/c No Ext): 408-350-5700 AIC No): ADDRIESS: INSURERS AFFORDING COVERAGE NAIC # 7/19/2024 INSURERA: Scottsdale Insurance Company 41297 License#: 6009644 INSURED SUPPHOM-01 Supple Homes Inc. 2087 Avy Ave INSURER B: California Automobile Insurance Company 38342 INSURER C: Insurance Company of the West 27847 INSURER D : Menlo Park CA 94025 INSURER E : PRODUCTS -COMP/OP AGG $ 2,000,000 INSURER F : B COVERAGES CERTIFICATE NUMBER: 1299236569 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 SUBR POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR X 5,000 Y BCS2001699 7/19/2024 7/19/2025 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED PREMISES Ea occurrence $100,000 MED EXP (Any one person) $ Excluded PERSONAL &ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- F LOC OTHER; GENERAL AGGREGATE $2,000,000 PRODUCTS -COMP/OP AGG $ 2,000,000 $ B AUTOMOBILE LIABILITY ANY AUTO OWNED SCHEDULED AUTOS ONLY AUTOS HIREDX NON -OWNED AUTOS ONLY AUTOS ONLY BA040000047207 7/19/2024 7/19/2025 COMBINED SINGLE LIMIT $ 1,000,000 Ea accident X BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ X PROPERTY DAMAGE $ Per accident A UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE XLS2004827 7/19/2024 7/19/2025 EACH OCCURRENCE $ 5,000,000 X AGGREGATE $ 5,000,000 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/MEMBER EXCLUDED? F—] (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WSA 5050603 05 7/19/2024 7/19/2025 X STATUTE EERH EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) RE: All California Operations / Town of Los Altos Hills is named as Additional Insured per endorsement CG20101219 CERTIFICATE HOLDER CANCELLATION ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of Los Altos Hills 26379 Fremont Road Los Altos Hills CA 94022 AUTHORIZED REPRESENTATIVE ©1988.2015 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD POLICY NUMBER:BCS2001699 COMMERCIAL GENERAL LIABILITY CG 20 10 12-19 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. IT A • • to I !; • •; •, �, This endorsement modifies insurance provided under the following: COMMERCIAL GENERAL LIABILITY COVERAGE PART SCHEDULE Name Of Additional Insured Person(s) Or Organization(s) Location(s) Of Covered Operations Any person or organization when required All Locations by written contract or agreement, executed prior to the occurrence to which this insurance applies, that such person or organization be added as an additional insured on your policy 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 the person(s) or organization(s) shown in the Schedule, but only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused, in whole or in part, by: 1. Your acts or omissions; or 2. The acts or omissions of those acting on your behalf; in the performance of your ongoing operations for the additional insured(s) at the location(s) designated above. However: 1. The insurance afforded to such additional insured only applies to the extent permitted by law; and 2. 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. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: 1. All work, including materials, parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed; or 2. That portion of "your work" out of which the injury or damage arises has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. C. 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; whichever is less. This insurance does not apply to "bodily injury" or This endorsement shall not increase the applicable "property damage" occurring after: limits of Insurance. CG 20 10 12-19 © Insurance Services Office Inc. 2018 Page 1 of 1