18-057 Alvarnaz Construction, Concrete Foundation for Ark - Creekside Park―
COVERAGES CERT:F:CATE NUMBER:REVIS10N NUMBER:
ハCORが CERT:F:CATE OF LIABILITY INSURANCE DATE(MM′DD―)04ノ 16ノ 18
THIS CERT!FiCATE IS iSSUED AS A MATTER OF INFORMAT:ON ONLY AND CONFERS NO R:GHTS UPON THE CERT!F!CATE HOLDER.TH:S
CERT!FiCATE DOES NOT AFF:RMAT!VELY OR NEGAT!VELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POL!CiES
BELOW. THiS CERTIFiCATE OF!NSURANCE DOES NOT CONST!TUTE A CONTRACT BETWEEN THE iSSuiNG:NSURER(S),AUTHOR!ZED
REPRESENTAT:VE OR PRODuCER,AND THE CERTlFiCATE HOLDER.
lMPORTANT: if the certificate ho!deris an ADD:T:ONAL INSU RED,the policy(ies)must have ADDIT:ONAL:NSURED provisions or be endorsed.
lf SUBROGATiON IS WA:VED,subieCt tO the terms and conditions of the po!icy,certain policies may require an endorsement, A statement on
this certricate does not confer面 ghts to the certricate hO:derin lieu of such endorsem9116)・
PRODuCER
BELL PLAZA INSURANCE
991 W Hedding St Ste 108
San」ose,CA 95126
0891409
CONTACTNAME:
閣Ptt Fn:“0助 288‐8400 1離 .蹴
“
08124←7205
:メ H彗 卜ss insurance@bel:plaza.com
INSuRER(S)AFFORDINC COVERAGE NAIC#
lNsuRER A. Prefered cohtractoE lhaurance company 12497
:NSuRED
Alvernaz Construction
Michael Alvernaz
12120 Central Ave
San Martin, CA 95046
TNSURER B , PCIA
tNsuRER c : PCIA
INSURERO: StAtEFUNd
INSURER E:
THlS IS TO CERTIFY THAT THE POLIC!ES OFINS∪RANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POL:CY PER10D
INDICATED NOTυ VITHSTANDlNG ANY REQUlREMENT,TERM OR COND:T10N OF ANY CONTRACT OR OTHER DOCUMENT W TH RESPECT TO llVHICH THIS
CERTIFICATE MAY BE:SSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLiCIES DESCRIBED HEREIN IS SUB」ECT TO ALL THE TERMS,
EXCLUS10NS AND COND!T10NS OF SUCH POLICIES LIMITS SHOVVN MAY HAVE BEEN REDUCED BY PAID CLAIMS
lNSR TYPE OFINSuRANCE POLICY NuMBER POLICY EFF
`MM′
DD―lPOL:CY EXP
(MM′DDハ～γ｀イ)L:M:TSAX
ヨ c□MttMADE図 OCCUR
B:Ded Sl,000YY
PCA5026‐PC259524 01′25′18 01725′19
EACH OCCURRENCE 2,000,000
DAMAGE TO RENTED
PREMISES(Ea occurence)$× MEO EXP (Anv one Derson)$5,000
×PD Ded Sl1000 PERSONAL&ADVIN」URY $ 1,000,000
1'L ACGREGATE LIMIT APPLIES PER:
PttCY□鵬□ЮC GENERAL AGGREGATE$4,000,000
PRODUCTS―COMP′OP AGG$2,000,000
Hired Auto PD ACVSB
OM08:LE LIAB:Liマ γ
ANY AUTO
螂叩i鼈YY PCA5026‐PC259524 01′25′18 01′25′19
COMBINED SINGLE LIMI
`Ea accident)
S l,000,000
BOOILY INJURY (Per person)$80DlLY IN」URY(Per aCCidOnt)$PROPERTY DAMAGE$Hired Auto PDSC
×UMBRELLA L:AB
EXCESS L:AB 刊:li∥:_MADE PCA5026‐PC259524 01′25′18 01′25′19
EACH OCCURRENCE$AGGREGATE $ 5,000,000
o=o lXl ^.t.*r,o*s 1o,ooo$DWORKERS COMPENSAT10N
AND EMPLOYERS'L!AB!LITY Y′NANY PROPRIETORIPARTNERIEXECUTIVE l __ |N′A1721281 12′01717 12′01′18
× :早 肝UTEI I頷 H‐
E L EACH ACCIDENT $ 1,000,000
∬鼎:辮 編YttEXCLUDED? Ш
じと詭 貫肝 鵬
『
るPERAT10NS bdow
E L DISEASE―EA EMPLOYE[$1,000,000
E L DiSEASE‐POL CY LIMIT s l,000,000
DESCRTPTTONOFOPERATIONS/LOCATIONS/VEHICLES (ACORD'l0l,AdditionalRemarksSchedule,maybeattachedlfmorespaceisrequired)
City of Cupertino, boards and commissions, officers, officials, agents, employees, consultants and volunteers.
Commercial Umbrella Policy extends coverage on CSL Automobile Liability underlying Policy.
ERTIFiCATE HOLDER CANCELLATION
City of Cupertino - Public Works
10300 Torre Avenue
Cupertino, CA 950'14
Attn: Brian Gathers
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORETHE EXP!RAT!ON DATE THEREOF, NOT!CE WILL BE DELiVERED IN
ACCORDANCE WITH THE POLICY PROV:S10NS
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