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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 />5/30/2024
<br />Acrisure Partners West Coast Insurance Services, LLC
<br />3155 Olsen Dr., suite 400
<br />San Jose CA 95117
<br />Lorenza Acosta
<br />408-418-2740 408-418-2721
<br />Lacosta@acrisure.com
<br />License#: 6009644 Trumbull Insurance Company 27120
<br />1231 Sentinel Insurance Company, Ltd 11000DPI, Inc.; DeFreitas Pipeline, Inc.;
<br />DeFreitas Equipment, LLC
<br />5942 Las Positas Road
<br />Livermore CA 94551
<br />Hartford Fire Insurance Company 19682
<br />Hartford Casualty Insurance Company 29424
<br />Nautilus Insurance Company 17370
<br />Travelers Property Casualty Company of America 25674
<br />853607188
<br />C X 1,000,000
<br />X 300,000
<br />10,000
<br />1,000,000
<br />2,000,000
<br />X
<br />X DED $5,000
<br />Y Y 57UEABD5259 4/1/2024 4/1/2025
<br />2,000,000
<br />A 1,000,000
<br />X
<br />X X
<br />X $1,000 Comp X $1,000 Coll
<br />57UEABC4276 4/1/2024 4/1/2025
<br />D X X 9,000,00057HHABE25394/1/2024 4/1/2025
<br />9,000,000
<br />X 10,000
<br />B X
<br />Y
<br />Y 57WEAAR1NHF 4/1/2024 4/1/2025
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />E
<br />F
<br />Poll/Prof. Liab. (Ded $5,000)
<br />Contractors Equip (Ded $2,500)
<br />Installation Floater (Ded $2,500)
<br />CPP2040010-11
<br />QT-660-2L183120-TIL-24
<br />4/1/2024
<br />4/1/2024
<br />4/1/2025
<br />4/1/2025
<br />Each Claim/Aggregate
<br />Leased/Rented Equip
<br />Any Job Site
<br />$5,000,000
<br />$250,000
<br />$250,000
<br />RE: DPI job #24-312 | COP job #PWD-24-601 | Underground Infrastructure Repair Services | Pleasanton, CA.
<br />City of Pleasanton, its officers, officials, employees and agents are added as additional insureds as required by written contract for General Liability, per
<br />attached. General Liability evidenced herein is Primary & Non-Contributory to other insurance available to the additional insureds as required by written
<br />contract, per attached. Waivers of Subrogation for General Liability and Workers Compensation are granted in favor of the additional insureds as required by
<br />written contract, per attached. Excess Liability/Umbrella is following form for general liability, auto liability and employers’ liability as referenced above. Thirty
<br />(30) Day Notice of Cancellation to Others is provided in accordance with the policies provisions including 10 day notice for non-payment of premium.
<br />City of Pleasanton
<br />PO BOX 250
<br />Pleasanton CA 94566
<br />DocuSign Envelope ID: 71BFD87E-DBA4-46D8-A55A-4DA92041C7D6
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