Laserfiche WebLink
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE <br />THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN <br />ACCORDANCE WITH THE POLICY PROVISIONS. <br />INSURER(S) AFFORDING COVERAGE <br />INSURER F : <br />INSURER E : <br />INSURER D : <br />INSURER C : <br />INSURER B : <br />INSURER A : <br />NAIC # <br />NAME:CONTACT <br />(A/C, No):FAX <br />E-MAILADDRESS: <br />PRODUCER <br />(A/C, No, Ext):PHONE <br />INSURED <br />REVISION NUMBER:CERTIFICATE NUMBER:COVERAGES <br />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSURED provisions or be endorsed. <br />If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on <br />this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). <br />THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS <br />CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES <br />BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED <br />REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. <br />OTHER: <br />(Per accident) <br />(Ea accident) <br />$ <br />$ <br />N / A <br />SUBR <br />WVD <br />ADDL <br />INSD <br />THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD <br />INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS <br />CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, <br />EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. <br />$ <br />$ <br />$ <br />$PROPERTY DAMAGE <br />BODILY INJURY (Per accident) <br />BODILY INJURY (Per person) <br />COMBINED SINGLE LIMIT <br />AUTOS ONLY <br />AUTOSAUTOS ONLY <br />NON-OWNED <br />SCHEDULEDOWNED <br />ANY AUTO <br />AUTOMOBILE LIABILITY <br />Y / N <br />WORKERS COMPENSATION <br />AND EMPLOYERS' LIABILITY <br />OFFICER/MEMBER EXCLUDED? <br />(Mandatory in NH) <br />DESCRIPTION OF OPERATIONS below <br />If yes, describe under <br />ANY PROPRIETOR/PARTNER/EXECUTIVE <br />$ <br />$ <br />$ <br />E.L. DISEASE - POLICY LIMIT <br />E.L. DISEASE - EA EMPLOYEE <br />E.L. EACH ACCIDENT <br />EROTH-STATUTEPER <br />LIMITS(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)POLICY EFFPOLICY NUMBERTYPE OF INSURANCELTRINSR <br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) <br />EXCESS LIAB <br />UMBRELLA LIAB $EACH OCCURRENCE <br />$AGGREGATE <br />$ <br />OCCUR <br />CLAIMS-MADE <br />DED RETENTION $ <br />$PRODUCTS - COMP/OP AGG <br />$GENERAL AGGREGATE <br />$PERSONAL & ADV INJURY <br />$MED EXP (Any one person) <br />$EACH OCCURRENCE <br />DAMAGE TO RENTED $PREMISES (Ea occurrence) <br />COMMERCIAL GENERAL LIABILITY <br />CLAIMS-MADE OCCUR <br />GEN'L AGGREGATE LIMIT APPLIES PER: <br />POLICY PRO-JECT LOC <br />CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) <br />CANCELLATION <br />AUTHORIZED REPRESENTATIVE <br />ACORD 25 (2016/03) <br />© 1988-2015 ACORD CORPORATION. All rights reserved. <br />CERTIFICATE HOLDER <br />The ACORD name and logo are registered marks of ACORD <br />HIRED <br />AUTOS ONLY <br />4/29/2024 <br />Bolton Insurance Services LLC <br />3475 E. Foothill Blvd., Suite 100 <br />Pasadena, CA 91107 <br />(626) 799-7000 (626) 583-2117 <br />www.boltonco.com 6004772 Arch Insurance Company 11150 <br />Indian Harbor Insurance Company 36940 <br />A 1,000,00071PKG89850017/1/2023 7/1/2024 <br />100,000 <br />3 <br />5,000 <br />3 <br />1,000,000 <br />2,000,000 <br />2,000,0003 <br />A 71PKG8985001 7/1/2023 7/1/2024 1,000,000 <br />3 <br />A 71UFP8985001, $5M 1st 7/1/2023 7/1/2024 10,000,0003 <br />10,000,000BSXS005937902, $5M x $5M 7/1/2023 7/1/20243 <br />A 71WCI993500 7/1/2023 7/1/2024 3 <br />1,000,000N <br />1,000,000 <br />1,000,000 <br />Chau Tran <br />O'Grady Paving, Inc. <br />2513 Wyandotte Street <br />Mountain View CA 94043 <br />79731068 <br />3 <br />3 <br />GL & Auto Additional Insureds apply per CG20101219, CG20371219 & 00CA0115001013 attached, only if required by written contract/agreement. <br />OGP Job #24046 <br />The City of Pleasanton <br />P.O. Box 520 <br />Pleasanton CA 94566 <br />RE: OGP Job #24046 <br />GL, Auto & WC Cancellation Clauses apply per 00ML0087001110 attached. Additional Insured(s): The City of Pleasanton <br />79731068 | OGRAPAV-C1 | 23-24 GL Auto WC XS | Sara Powell | 4/29/2024 12:14:36 PM (PDT) | Page 1 of 8 <br />DocuSign Envelope ID: 481D2ACD-7F64-46CA-9ACB-AF08839CFE54