6623 EVERGREEN WAY 2024-10-11 - Laserfiche WebLink

712/21/2023 (MM/DD/YYYY) ® CERTIFICATE OF LIABILITY INSURANCE 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 Bolton Insurance Services LLC PHONE FAX 3475 E. Foothill Blvd., Suite 100 A/c No Ext: 626 799-7000 A/C No: 626 583-2117 Pasadena, CA 91107 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# www.boltonco.com 6004772 INSURER A: Navigators Specialty Insurance Company 36056 INSURED INSURER B: California Automobile Insurance Company 38342 Phoenix Construction and Management, Inc. INSURERC: RSUI Indemnity Company 22314 515 S. Flower Street, Suite 1270 Los Angeles CA 90071 INSURERD: Insurance Company of the West 27847 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 77849170 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 EFF POLICY EXP D LIMITS LTR IN WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A `/ COMMERCIAL GENERAL LIABILITY LA24CGLZ03JL81C 1/1/2024 1/1/2025 EACH OCCURRENCE $1,000,000 CLAIMS-MADE 7 OCCUR PREM SES Ea occurrDence $50,000 MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $2,000,000 POLICY ✓� PE� LOC PRODUCTS-COMP/OPAGG $2,000,000 OTHER: $ B AUTOMOBILE LIABILITY BA040000063556 12/23/2023 12/23/2024 Ea BINEDt SINGLE LIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS ONLY AUTOS HIRED NON-OWNED PROPERTY DAMAGE $ AUTOS ONLY AUTOS ONLY Per accident C UMBRELLA LIAB / OCCUR NHA105402 1/1/2024 1/1/2025 EACH OCCURRENCE $10,000,000 / EXCESS LIAB CLAIMS-MADE AGGREGATE $10,000,000 DIED RETENTION$ $ D WORKERS COMPENSATION WVE504461106 1/1/2024 1/1/2025 �/ SPER TATUTE ERH AND EMPLOYERS'LIABILITY Y/N OF ICER/MEMBEREXC UDED?ECUTIVE I N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below 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) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Department of Labor and Industries THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Contractor Registration ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 44450 Olympia WA 98504-4450 AUTHORIZED REPRESENTATIVE Denise Olivares ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD 77849170 1 PHOECON-Cl 1 24-25 GL, Auto, Excess, WC I Nancy Cadwallader 1 12/21/2023 10:09:24 AM (PST) I Page 1 of 1