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BLD-2024-1673_SignedPermit.pdf(5) ERTIFICATE OF LIABILITY INSURANCE DATE IMM,DONYYY) 02/07/2024 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 ri _ hts to the certificate holder in lieu of such endorsement West Hills CA 91307 eNTAC7 Ron Levy' P-ONE 'A C No Fon (818) 208-3008 EMAIL ADDRESS: I xins.corn � � INSURER A : IN SU R.ER. IS) AFFORDING COVERAGE FAA DE''r'ELODERS SURETY AND IDEMNITY CO' N..IC S INSURED LEMON REMODELING AND SERVICES INC 437 West San Carlos St ar -Lose CA 95110 INSURERB: STATE COMPENSATION INSURANCE FUND INSURER c : CERTAIN UNDERWRITER AT LLOYD'S LONDON _ 5C7e 1C'92L INSURER D : 1$URER E INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO C.ERT.FY THAT THE POLICIES INDICATED. NOTWITHSTANDING ANY REQUIREMENT. CERTIFICATE MAY BE ISSUED OR MAY EXCLUSIONS AND CONDITIONS OF SUCH OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. POLICIES. UMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN3R TYPE Of INSURANCE ADDL MUD SUER WW2 POLICY NUMBER POLICY EFF POLICY EXP p1Y'Y IDOYYY) LIMITS A X COMMERCIAL OENERAL LIABILITY BIS00037955-03 01/10/2024 • 01/1012025 EACH OCCURRENCE ; 1.000.000 C—NIAC-V X 3CCJR DGE TO RENTED PREMISES 3E3 Ea occurrence S 100.000 MED EXP 'Any one per -son ; 5,000 PER3OP4 L a ADv wuar s 1.000.000 GENERAL AGGREGATE i 2,000.000 GEM -AGGREGATE LAST APPLES PER: X POLICY PRO- ❑ LOC PRODUCTS • C.OMPIOP .43s S 2.000.000 OTHER: S AUTOMOGILF LABLJ Y • = OMBINED SINGLE LIMIT E3 3CCcerxl . ANY AUTO BODILY INJURY leer e : n OWNED AUTOS ONLY SCHEDULED AUTOS BODILY INJURY leer 3C[der- HIRED AUTOS ONLY MON-OWNED AUTOS ONLY PROPERTY DAMAGE !Per accident'% ' UMBRELLA L►AB OCCUR EACH OCCURRENCE . EXCESS LIAR CLAI1d34AADE AGGREGATE DED THE ELATION li B WORKERS COMPENSATION AND EMPLOYERS' UABLrrY Y / N 9255090-23 013 17i2023 011' 17J2024 X STATUTE ERp+ Ca E.L. EACH ACC -DEYT f 1,000.000 ANY FROPRETORP.4R OFFICEME�IBER EXCLUDED? RI N N / A E.L. DI3EA3E - EA -.Svc L. _ rEE S 1.000.000 Mandatory In NH) Ir ye: dercMDe un Oer D£3CRPTION Oc OPEFtAnON : trees' E.L. DISEASE • POLICY -atrr f 1,000.000 C Commercial Inland Marine (Hazard Insurance) IMEB13962 11/3012023 11/30/2024 Miscellaneous Tool: $10,000 DESCRIPTION OF OPERATIONS LOCATIONS VEHICLES IACORD 101, Additional Pemarkc 3ohee Ie. may be atCaohed 't more cc.-:+ Lc reculredl The City of Cupertino, it's City Council, officers, officials, employees,agents, servants and volunteers and all public agencies from whom permits will be obtained and their officers, officials, employees,agents, servants and volunteers are hereby declared to be additional insureds under the terms of this policy. CERTIFICATE HOLDER CANCELLATION City of Cupertino 10300 Torre Ave Cupertino, CA 95014 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 REPRESENTATTVE _) ACORD 25 (2016;03) ® 1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD ID00370413 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. BLANKET ADDITIONAL INSURED This endorsement modifies insurance provided under the following COMMERCIAL GENERAL LIABILITY COVERAGE PART A. Section II — Who Is An Insured is amended to include as an additional insured any person or organization for whom you are performing operations when you and such person or organization have agreed in writing in a contract or agreement that such person or organization be added as an additional insured on your policy. Such person or organization is an additional insured only with respect to liability for "bodily injury", "property damage" or "personal and advertising injury" caused by and to the extent of your negligence in the performance of your ongoing operations for the additional insured. A person's or organization's status as an additional insured under this endorsement ends when your operations for that additional insured are completed. The City of Cupertino, it's City Council. officers. officials. employees.agents, servants and volunteers and all public agencies from whom permits will be obtained and their officers, officials, employees.agents servants and volunteers are hereby declared to be additional insureds under the terms of this policy. B. With respect to the insurance afforded to these additional insureds, the following additional exclusions apply: This insurance does not apply to: 1. "Bodily injury". "property damage" or 'personal and advertising injury' arising out of the rendering of, or the failure to render. any professional architectural, engineering or surveying services, including: a. The prepanng, approving, or failing to prepare or approve, maps, shop drawings, opinions, reports, surveys, field orders, change orders or drawings and specifications or b. Supervisory, inspection, architectural or engineering activities. 2. 'Bodily injury' or "property damage" occurring after. a. All work. including materials. parts or equipment furnished in connection with such work, on the project (other than service, maintenance or repairs) to be performed by or on behalf of the additional insured(s) at the location of the covered operations has been completed: or b. That portion of 'your work" out of which the injury or damage anses has been put to its intended use by any person or organization other than another contractor or subcontractor engaged in performing operations for a principal as a part of the same project. 3. "Bodily injury'. 'property damage" or 'personal and advertising injury" involving or related to or in connection with any additional insured or any location covered by a scheduled or blanket additional insured endorsement that is a part of the policy_ C. Primary and Non-contributory Insurance - We will consider this insurance to be primary and non contnbutory to other insurance issued directly to additional insured person(s) or organization(s) to which this endorsement applies if each such additional insured is a named insured in such other insurance and a written contract between you and such person(s) or organization(s) specifically requires that we consider this insurance to be pnmary and non-contnbutory D. Waiver of Subrogation — We waive any right of recovery we may have against the additional insured person(s) or organization(si to which this endorsement applies if each such additional insured is a named insured in such other insurance and a written contract between you and such person(s) or organization(s) specifically requires that we waive subrogation of payments we make for injury or damage arising out of "your work' done under a contract with such person(s) or organization(s) to which this endorsement applies.