COLUMBIA ELECTRIC, INC. - Laserfiche WebLink

DocuSign Envelope ID: 4BE41ABD-CDC3-4DEF-91 DE -1 EFE877592DC Al >R" CERTIFICATE OF LIABILITY INSURANCE DATE IYYYY) 5/13/2013/2024 v 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 Woodruff -Sawyer & Co. 50 California Street, Floor 12� San Francisco CA 94111 _NAME. Chris Kelley PHONE 415-402-6521 FAX No:415-989-9923 lL ADDRESS: ckell ruffsa r.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Travelers Prop Casualty Co of America 25674 UCWMW: 0329598 INSURER B: Travelers Indemnity Company Of CT 25682 INSURED COLUELE-01 Columbia Electric, Inc. 1980 Davis Street San Leandro CA 94577 INSURER c! Everest Indemnity Insurance Company 10851 INSURER D: Westchester Surplus Lines Insurance Company 10172 JJEECTT OTHER: B AUTOMOBILE LIABILITY Y Y 8102X531967TCT23 10/1/2023 10/1/2024 MBINEOSINGLELIMIT $1,000,000 nt INSURER E X ANY AUTO INSURER F L;UVhKAGt, \.ClCllf 1{rNIC I4VIt1u Gn IOIJGJI LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS INDICATED. NOTWITHSTANDING ANY REQUIREMENT. INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSl18R� POLICY EFF pOUCY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER 1111111111111) (111111111monlinm A X COMMERCIAL GENERAL LIABILITY Y Y DT22CO2X531967TCT23 10/1/2023 10/1/2024 EACH OCCURRENCE .51,000,000 GEi6RENTEb 5300,000 I CLAIMS -MADE � OCCUR PREMISES Eao curren MED EXP (Any one ) S5.000 PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 1:1 LOC PRODUCTS -COMP/OPAGG $2,000,000 JJEECTT OTHER: B AUTOMOBILE LIABILITY Y Y 8102X531967TCT23 10/1/2023 10/1/2024 MBINEOSINGLELIMIT $1,000,000 nt BODILY INJURY (Per person) $ X ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) $ AUTOS ONLY AUTOS WPERTYDAMAGE $ X HIRED X NON -OWNED Per t AUTOS ONLY AUTOS ONLY A X UMBRELLA LIAB X OCCUR CUP2X5338192326 10/1/2023 10/1/2024 EACH OCCURRENCE $5,000,000 AGGREGATE S5,000,000 X EXCESS LIAB CLAIMS -MADE s DED RETENTIONS X I USMARTIMER"' A WORKERS COMPENSATION Y UB2X4374752326G 10/1/2023 10/1/2024 E.L. EACH ACCIDENT $1, 000.000 AND EMPLOYERS' LIABILITY YIN ANYPROPRIETOR/PARTNER/EXECUTIVE E.L. DISEASE -EA EMPLOYEE $1,000,000 MN N/A (Mandatory in NH) 0 yes describe under E.L. USEASE-POLICY LIMIT $ 1,000.000 DESCRIPTION OF OPERATIONS below C I Excess Liability (2nd Layer) XC2EX00174232 10/1/2023 10H/2024 Each Occ./Aggregate $4,000,000 Each Occ/Aggregate $2,000,000 D Pollution Liability G71656974002 I 1/10/2024 10/1/2025 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is roquirad) Pleasanton Insured per the attached forms, RE: Project: Valley Avenue and Northway Road Intersection Improvements, CIP NO. 23532. City of are additional forms. Policies a 30 day notice of cancellation and a wherein coverage Is primary and non-contributory. Waivers of Subrogation apply per the attached contain 10 day notice of cancellation for non-payment of premium. ULK I I1 -11L A I t City of Pleasanton Attn: Public Works, Engineering PO Box 520 Pleasanton CA 94566-0802 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE w TIA\I A11 A-66- W 1Woo- ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD