COMPLIANCE INFO_2019 - Laserfiche WebLink

Home Browse Search

AC"R "" CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 11 / 5 / 2018 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( ies) must 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 CONTACT Shala Pearson NAME : _ TLB Insurance Services PHONE E ( 916 ) 691 - 5555 AIC No ; ( 888 ) 329 - 8842 CA License # OB82095 AIL ADDRESS: shala - pearson@leavitt . com 3000 Oak Road , Suite 210 INSURERS AFFORDING COVERAGE NAICIf Walnut Creek CA 94597 INSURERA :Admiral Insruance Company a24856 INSURED INSURERs :Travelers Casualty Co . of America 19046 Walton Engineering , Inc . INSURERC :State Compensation Insurance Fund 35076 P . O . Box 1025 INSURERD :Travelers Casualty Co . of America 19046 INSURER E : West Sacramento CA 95691 INSURER F : COVERAGES CERTIFICATE NUMBER: 18 / 19 All Policies 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 TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MM/DDIYYYY MCY EFF MLDD//YYYY LIMITS LTR1= AWOL X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 , 000 , 000 DAMAGE TO RENTED A CLAIMS-MADE1XI OCCUR PREMISES Ea occurrence $ 500000 X Incl . Pollution Liab . FEIECC1358705 3 / 6 / 2018 3 / 6 /2019 MED EXP (Any one person) $ 51000 X Incl . Professional Liab , PERSONAL BADV INJURY $ 11000 , 000 GENI AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 , 000 , 000 JECT LOC PRODUCTS $ 2 . 000 , 000 POLICY OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000 , 000 Ea accident XANY AUTO BODILY INJURY (Per person) $ B ALL OWNED SCHEDULED AUTOS AUTOS 8106X992397 3 / 6 /2018 3 / 6/2019 BODILY INJURY (Per accident) $ NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident $ $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 101000 , 000 A X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10 , 000 , 000 DED RETENTION FEIEXS1358805 3 / 6 / 2018 3 /6/2019 $ WORKERS COMPENSATION }( AND EMPLOYERS' LIABILITY AND ER YIN ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ 11000 , 000 OFFICER/MEMBEREXCLUDED? NIA C (Mandatory In NH) 9113339 10 / 1/2018 10/1/2019 E.L. DISEASE - EA EMPLOYE $ 11000 , 000 If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 11000 , 000 D Inland Marine 660BK816207 3 / 6 /2018 3 / 6 /2019 Limit $ 300 , 000 Rented , Leased or Borrowed Deductible $ 21500 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required) REC? � , ` JUN 0 3 2019 CERTIFICATE HOLDER CANCELLATION ANY OF DESCRIBED POLIC FORE LD Evidence of Insurance THEUEXPIRATIIONHDATEVTHEREOF, NOTICE WIILLLL B�DELW D IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Shala Pearson / SHPEAR © 1988 -2014 ACORD CORPORATION . All rights reserved . ACORD 25 (2014/01 ) The ACORD name and logo are registered marks of ACORD INS025 (201401 )