Loading...
HomeMy WebLinkAboutBell Plumbing of San Mateo Inc. 1.14.25`y r' 111.�i L+ CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 01/14/2025 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 FEDERATED MUTUAL INSURANCE COMPANY HOME OFFICE: P.O. BOX 328 OWATONNA, MN 55060 NAME,. CLIENT CONTACT CENTER PHONE FAX (AIC, No, Ext); 888-333-4949 (AIC, No): 507-446-4664 ADDRIESs:CLIENTCONTACTCENTERQFEDINS,COM INSURERS AFFORDING COVERAGE NAIC 4 INSURER A:FEDERATED MUTUAL INSURANCE COMPANY 13935 INSURED BELL PLUMBING OF SAN MATEO INC 1180 SAN CARLOS AVE BOX 704 SAN CARLOS, CA 94070-2418 INSURER B: CERTAIN UNDERWRITERS AT LLOYDS LONDON 15792 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 89 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, ICbR TYPE OF INSURANCE INeR WVD POLICY NUMBER M0 IIDIYYYY AMIDDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY - - EACH OCCURRENCE - $1,000,000 CLAIMS -MADE OCCUR AMAGE TO ENTED PREMISES $100,000 Ee occurrence MED EXP (Any one person) EXCLUDED A Y N 9829156 03/17/2024 03/17/2025 PERSONAL& ADV INJURY $1,000,000 OEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY �X ,7PEDT LOC PRODUCTS & COMPIOP ACC $2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 (Ea accident) BODILY INJURY (Per Person) AUTO AOWNED JANY AUTOS ONLY AUTODULED N N 9829156 03/17/2024 03/17/2025 BODILY INJURY (Per Accident) PROPAER�dYe1 DAMAGE HIRED AUTOS ONLY AOTNDOWON, fD rvL X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $4,000,000 A EXCESS LIAB CLAIMS -MADE N N 9829157 03/17/2024 03/17/2025 AGGREGATE $4,000,000 DED I RETENTION WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN PER STATUTE I THER E.L EACH ACCIDENT ANY PROPRIETORIPARTNERI EXECUTIVE OFFICERIMEMBER EXCLUDED? L (Mandatory In NH) N/A E.L DISEASE -EA EMPLOYEE If yes, describe under DESCRIPTION OF OPERATIONS below E.L DISEASE POLICY LIMIT CONTRACTORS POLLUTION LIABILITY Y Y CPLO1016001 01/08/2025 01/08/2026 EACH LIMIT $1,000,000 BAGGREGATE $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) SEE ATTACHED PAGE CERTIFICATE HOLDER CANCELLATION F LOS ALTOS HILLS 89 1 1 FREMONT RD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED TOS HILLS, CA 94022-2624 BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE A,W-e �/�l © 1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD AGENCY CUSTOMER ID: Accw& LOC #: -' ADDITIONAL REMARKS SCHEDULE Page 1 AGENCY NAMEDINSURED FEDERATED MUTUAL INSURANCE COMPANY BELL PLUMBING OF SAN MATEO INC 1180 SAN CARLOS AVE BOX 704 SAN CARLOS, CA 94070-2418 POLICY NUMBER SEE CERTIFICATE # 89,1 CARRIER NAIC CODE EFFECTIVE DATE: SEE CERTIFICATE # 89.1 SEE CERTIFICATE # 89.1 ADDITIONAL REMARKS THIS ADDITIONAL REMARKS FORM IS A SCHEDULE TO ACORD FORM, FORM NUMBER: 25 FORM TITLE: CERTIFICATE OF LIABILITY INSURANCE THE PERMITTEE IS RESPONSIBLE FOR ALL LIABILITY FOR PERSONAL INJURY OR PROPERTY DAMAGE WHICH MAY ARISE OUT OF WORK HEREIN PERMITTED OR WHICH MAY ARISE OUT OF FAILURE ON THE PERMITTEES PART TO PERFORM HIS, HER, OR ITS OBLIGATIONS UNDER THIS PERMIT IN RESPECT TO MAINTENANCE. IN THE EVENT ANY CLAIM OR SUCH LIABILITY IS MADE AGAINST THE TOWN OF LOS ALTOS HILLS OR ANY AGENT, INDEPENDENT CONTRACTOR, OFFICER, OR EMPLOYEE OF THE TOWN, THE PERMITTEE SHALL DEFEND, INDEMNIFY, AND HOLD THEM AND EACH OF THEM HARMLESS FROM SUCH CLAIM. PURSUANT TO 7- 2.09, THIS PERMIT SHALL NOT BE EFFECTIVE FOR ANY PURPOSE UNLESS AND UNTIL THE ABOVE-NAMED RE: PERMITTEE FILES WITH THE TOWN THE FOLLOWING CERTIFICATES OF INSURANCE: PUBLIC LIABILITY IN THE AMOUNT OF S 1,000,000 AND PROPERTY DAMAGE IN THE AMOUNT OF $1,000,000, WITH THE TOWN AND ITS OFFICERS, AGENTS,INDEPENDENT CONTRACTORS, AND EMPLOYEES NAMED AS ADDITIONAL INSUREDS. THE CERTIFICATE HOLDER IS AN ADDITIONAL INSURED SUBJECT TO THE CONDITIONS OF THE ADDITIONAL INSURED - BLANKET ENDORSEMENT FOR CONTRACTORS POLLUTION LIABILITY. INSURANCE PROVIDED BY THE CONTRACTORS POLLUTION LIABILITY IS PRIMARY AND NONCONTRIBUTORY OVER OTHER INSURANCE. CONTRACTORS POLLUTION LIABILITY COVERAGE CONTAINS A WAIVER OF SUBROGATION IN FAVOR OF THE CERTIFICATE HOLDER SUBJECT TO THE CONDITIONS OF THE WAIVER OF TRANSFER OF RIGHTS OF RECOVERY AGAINST OTHERS TO US. ACORD 101 (2008/01) O 2000 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 9829156 COMMERCIAL GENERAL LIABILITY CG 20 12 12 19 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 Hill, CA 94022-2624 linformation 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 afforded 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: Bell Plumbing of San Mateo Inc 1180 San Carlos Ave Box 704 San Carlos, CA 94070-2418 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; whichever is less. This endorsement shall not increase the applicable limits of insurance. Project or Reference: Additional Insureds Also Include: the Town and its Officers, Agents, Independent Contractors, and Employees. © Insurance Services Office, Inc., 2018 Page 1 of 1 CG 20 12 12 19 Policy Number: 9829156 Transaction Effective Date: 03/17/2024 161-783-6 89 #BWNDHBS BF000-01 -0062 #XWXW0021 XXXXXXX5# TOWN OF LOS ALTOS HILLS 26379 W Fremont Rd Los Altos Hills, CA 94022-2624