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5/30/2024
<br />Leavitt Pacific Insurance Brokers, Inc.
<br />License #0D79674
<br />1570 The Alameda, Suite 101
<br />San Jose CA 95126
<br />Jana Hinkle
<br />(408)288-6262 (408)298-7635
<br />jana-hinkle@leavitt.com
<br />George Bianchi Construction, Inc.
<br />775-A Mabury Road
<br />San Jose CA 95133
<br />Landmark American Insurance Company 33138
<br />West American Insurance Company 44393
<br />RSUI Indemnity Company 22314
<br />Insurance Company of the West 27847
<br />Westchester Surplus Lines 10172
<br />StarStone Speciality Insurance Company 44776
<br />23-24 Master
<br />A
<br />X
<br />X
<br />X
<br />X Y LHA142223 10/4/2023 10/4/2024
<br />1,000,000
<br />50,000
<br />NONE
<br />1,000,000
<br />2,000,000
<br />2,000,000
<br />B X
<br />X
<br />X $500 Comp Ded
<br />X
<br />X $500 Coll Ded
<br />Y BAW56320903 10/4/2023 10/4/2024
<br />1,000,000
<br />Uninsured motorist combined single limit 1,000,000
<br />C X
<br />X
<br />NHA255304 (First Layer)10/4/2023 10/4/2024
<br />5,000,000
<br />5,000,000
<br />D WPL5067540 01 10/4/2023 10/4/2024
<br />X
<br />1,000,000
<br />1,000,000
<br />1,000,000
<br />E Pollution Insurance G74352029-002 11/9/2023 11/9/2024 $2,500 Deductible $1M Occ/$2M Agg
<br />F Excess Liability 85092A211ALI (2nd Layer)10/4/2023 10/4/2024 $4M Occ/$4M Agg
<br />City of Pleasanton, its officers, employees, and agents are included as Additional Insured per attached
<br />GL endorsement. GL/AUTO/WC Waiver of Subrogation applies and attached.
<br />City of Pleasanton
<br />P.O. Box 520
<br />Pleasanton, CA 94566
<br />Fred Stafford/MIDATO
<br />Y
<br />The ACORD name and logo are registered marks of ACORD
<br />CERTIFICATE HOLDER
<br />©1988-2014 ACORD CORPORATION.All rights reserved.
<br />ACORD 25 (2014/01)
<br />AUTHORIZED REPRESENTATIVE
<br />CANCELLATION
<br />DATE (MM/DD/YYYY)CERTIFICATE OF LIABILITY INSURANCE
<br />LOCJECTPRO-POLICY
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />OCCURCLAIMS-MADE
<br />COMMERCIAL GENERAL LIABILITY
<br />PREMISES (Ea occurrence)$DAMAGE TO RENTED
<br />EACH OCCURRENCE $
<br />MED EXP (Any one person)$
<br />PERSONAL &ADV INJURY $
<br />GENERAL AGGREGATE $
<br />PRODUCTS - COMP/OP AGG $
<br />$RETENTIONDED
<br />CLAIMS-MADE
<br />OCCUR
<br />$
<br />AGGREGATE $
<br />EACH OCCURRENCE $UMBRELLA LIAB
<br />EXCESS LIAB
<br />DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
<br />INSRLTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF(MM/DD/YYYY)POLICY EXP(MM/DD/YYYY)LIMITS
<br />PER
<br />STATUTE
<br />OTH-
<br />ER
<br />E.L.EACH ACCIDENT
<br />E.L. DISEASE - EA EMPLOYEE
<br />E.L. DISEASE - POLICY LIMIT
<br />$
<br />$
<br />$
<br />ANY PROPRIETOR/PARTNER/EXECUTIVE
<br />If yes,describe under
<br />DESCRIPTION OF OPERATIONS below
<br />(Mandatory in NH)
<br />OFFICER/MEMBER EXCLUDED?
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS' LIABILITY Y / N
<br />AUTOMOBILE LIABILITY
<br />ANY AUTO
<br />ALL OWNED SCHEDULED
<br />HIRED AUTOS NON-OWNED
<br />AUTOS AUTOS
<br />AUTOS
<br />COMBINED SINGLE LIMIT
<br />BODILY INJURY (Per person)
<br />BODILY INJURY (Per accident)
<br />PROPERTY DAMAGE $
<br />$
<br />$
<br />$
<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 />INSD
<br />ADDL
<br />WVD
<br />SUBR
<br />N / A
<br />$
<br />$
<br />(Ea accident)
<br />(Per accident)
<br />OTHER:
<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 />IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to
<br />the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
<br />certificate holder in lieu of such endorsement(s).
<br />COVERAGES CERTIFICATE NUMBER:REVISION NUMBER:
<br />INSURED
<br />PHONE(A/C, No, Ext):
<br />PRODUCER
<br />ADDRESS:
<br />E-MAIL
<br />FAX
<br />(A/C, No):
<br />CONTACTNAME:
<br />NAIC #
<br />INSURER A :
<br />INSURER B :
<br />INSURER C :
<br />INSURER D :
<br />INSURER E :
<br />INSURER F :
<br />INSURER(S)AFFORDING COVERAGE
<br />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 />INS025 (201401)
<br />Docusign Envelope ID: 15F8BE68-D125-405B-9ADC-3D65624EB783
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