COMPLIANCE INFO_2021 - Laserfiche WebLink

Home Browse Search

CERTIFICATE OF LIABILITY INSURANCE DATE (M A� i 03/044//22021021 Y) � 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 CONTACT Shale Pearson NAME: TLB Insurance Services PAHicNo Ext): (916) 790-5863 n/c No): (888) 329-8842 CA License #OB82095 E-MAIL shala-pearson@leavitt.com ADDRESS: 2358 Maritime Dr, Ste 100 INSURER(S) AFFORDING COVERAGE NAIC # Elk Grove CA 95758 INSURERA : Admiral Insurance Company 24856 INSURED INSURER B : Travelers Property Casualty Company of America 25674 Walton Engineering, Inc. INSURER C : State Compensation Insurance Fund 35076 P.O. Box 1025 INSURER D : Travelers Property Casualty Company, 36161 INSURER E : West Sacramento CA 95691 INSURER F : COVERAGES CERTIFICATE NUMBER: 21 /22 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 CONTRACTOR 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 POLICY EFF POLICY EXP LIMITS LTR INSD WVO POLICY NUMBER MM/DD/YYYY MMIDD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 , 0001000 DAMAGE TO RENTED 50 , 000 CLAIMS-MADE OCCUR PREMISES Ea occurrence) $ '.. X Inc. Pollution Liability MED EXP (Any oneperson) $ 51000 A X Inc. Professional Liability FEIECC1358708 03/06/2021 03/06/2022 PERSONAL & ADV INJURY $ 12000, 000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE $ 2, 0001000 POLICY � JECT PRO ❑ LOC PRODUCTS - COMP/OPAGG $ 2, 000, 000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1 , 0001000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ ., B OWNED SCHEDULED 8108L785302 03/06/202103/06/2022 BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS X HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident Uninsured motorist $ 1 ,000, 000 UMBRELLA LIAB 10, 000,000 X OCCUR EACH OCCURRENCE $ A X EXCESS LIAB CLAIMS-MADE FEIEXS1358808 03/06/2021 03/06/2022 AGGREGATE $ 10, 000,000 DED I X1 RETENTION $ 0 1 $ WORKERS COMPENSATIONX STATUTE ETH AND EMPLOYERS' LIABILITY YIN 110001000 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACHACCIDENT $ C OFFICER/MEMBEREXCLUDED? N / A 9113339 10/01 /2020 10/01 /2021 (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 03/06/2021 03/06/2022 Limit $300,000 Deductible $2 , 500 DESCRIPTION OF OPERATIONS / LOCATIONS / 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 © 19884015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD i I i