COMPLIANCE INFO_2023 - Laserfiche WebLink

Home Browse Search

® DATE (MM/DDIYYYY) ACCIO2o CERTIFICATE OF LIABILITY INSURANCE 03/03/2023 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( ies) 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 CONTACT Shala Pearson NAME: TLB Insurance Services PHONE (916) 790-5863 FAx (888) 329-8842 A/C No Ext) : AIC, No CA License #0682095 E-MAIL shala-pearson@leavitt.com ADDRESS : 2358 Maritime Dr, Ste 100 INSURER(S) AFFORDING COVERAGE NAIC If Elk Grove CA 95758 INSURERA : Westchester Surplus Lines Insurance Company 10172 INSURED INSURER B : Travelers Property Casualty Company of America 25674 Walton Engineering , Inc. INSURER C : Service American Indemnity Company 39152 P. O . Box 1025 INSURER D : Travelers Property Casualty Company. 36161 INSURER E West Sacramento CA 95691 INSURER F : COVERAGES CERTIFICATE NUMBER : 23/24 Master 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. iEFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDY/YYYY MM DDIYYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 12000, 000 CLAIMS-MADE � OCCUR PREMISES Ea occurrence)DAMAGE TO 50 ,000 X Inc. Pollution Liability MED EXP (Any one person) $ 51000 A X Inc. Professional Liability G47393735001 03/06/2023 03/06/2024 PERSONAL & ADV INJURY $ 1 ,000 , 000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2 , 0003000 POLICY � PRO E] LOC PRODUCTS - COMP/OP AGG $ 23000, 000 JECT OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 11000 , 000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ B OWNED SCHEDULED 8108L785302 03/06/2023 03/06/2024 BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY X AUTOS ONLY Per accident Uninsured motorist $ 110002000 ' WlIswim 1'v "y'V "4 "" UMBRELLA LIAB 10 , 0001000 X OCCUR EACH OCCURRENCE $ A X EXCESS LIAB CLAIMS-MADE G47393747001 03/06/2023 03/06/2024 AGGREGATE $ 1010001000 DED X RETENTION $ $ WORKERS COMPENSATION X STATUTE EPERORH _ AND EMPLOYERS' LIABILITY YIN 110003000 C ANY PROPRIETOR/PARTNER/EXECUTIVE NIA SAMTWC10020100 10/01 /2022 10/01 /2023 E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1 , 000, 000 If yes, describe under 11000 , 000 DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ Inland Marine D Leased/Rented/Borrowed 6608K816207 03/06/2023 03/06/2024 Limit $3003000 Deductible $2 , 500 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101 , Additional Remarks Schedule, may be attached if more space is required ) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN To Whom it May Concern Evidence of Insurance ACCORDANCE WITH THE POLICY PROVISIONS . AUTHORIZED REPRESENTATIVE © 1988-2015 ACORD CORPORATION . All rights reserved . ACORD 25 (2016/03 ) The ACORD name and logo are registered marks of ACORD