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309673
<br /> ACC0R0® CERTIFICATE OF LIABILITY INSURANCE DATE IMM/DOPMY)
<br /> 07/28/20128/2015
<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 /> PRODUCER CONTACT Michelle Robinson
<br /> John O. Bronson Co. A Division of HUB International I #0757776 lac O No. EXn; 916-480-4158 FAX No): 916-993-7258
<br /> 3636 American River Drive Suite 200 E-MAIL
<br /> Sacramento, CA 95864 ADDRESS: Michelle.RObinson@ahubinternational,com
<br /> 916-974-7800 INSURER(S) AFFORDING COVERAGE NAIC It
<br /> INSURER A : United Specialty Ins Co (RT Specialty, San Francisco) 12537
<br /> INSURED Zakskom Construction Company dba ZCON Builders INSURER B : Navigators Ins Co (RT Specialty, San Francisco, CA) 42307
<br /> INSURER C : State Compensation Insurance Fund of California 35076
<br /> 780 West Grand Avenue INSURER D :
<br /> Oakland, CA 94612
<br /> INSURER E :
<br /> INSURER F :
<br /> COVERAGES CERTIFICATE NUMBER: 21590 REVISION NUMBER:
<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 /> INSR ADDL SUBR POLICY EFF POLICY EXP
<br /> LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER IMMIDDWYYY) IMMIDOTYYYY) LIMITS
<br /> GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
<br /> X COMMERCIAL GENERAL LIABILITY BT01547816 7/15/15 7/15/16 DAMAGE TO RENTED
<br /> PREMISES (Ea occurrence) $ 50,000
<br /> CLAIMS-MADE X OCCUR MED EXP (Any one person) $ Excluded
<br /> A X PERSONAL &ADV INJURY $ 1,000,000
<br /> GENERAL AGGREGATE $ 2,000,000
<br /> GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OPAGG $ 2,000,000
<br /> —I POLICY X JFCT LOC $
<br /> AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
<br /> (Ea accdent) $
<br /> ANY AUTO
<br /> BODILY INJURY (Per person) $
<br /> ALL OWNED SCHEDULED BODILY INJURY (Per ac ident) $ -
<br /> AUTOS NON-OWNED PROPERTY DAMAGE
<br /> HIRED AUTOS AUTOS (Per accident)
<br /> $
<br /> UMBRELLA LIAR X OCCUR EXC7876981V 7/15/15 7/15/16 EACH OCCURRENCE $ 10,000,000
<br /> B X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 10,000,000
<br /> DED RETENTION $
<br /> WORKERS COMPENSATION WC STATU- OTH-
<br /> AND EMPLOYERS' LIABILITY VIN 9082/8315 1/01/15 1/01/16 X TORY LIMITS FR
<br /> ANY PROPRIETOR/PARTNER/EXECUTIVE NIA E.L. EACH ACCIDENT $ 1,000,000
<br /> C OFFICER/MEMBER EXCLUDED?
<br /> (Mandatory In NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br /> If yes, describe under
<br /> DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br /> DESCRIPTION OF OPERATIONS/ LOCATIONS/VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br /> RE: Project: Offsite Work Only For Jefferson & Franklin Apartments 103 Wilson Street, Redwood City, CA ZCON #3042 Greystar/Off Site Utility Work - Wrap
<br /> Exclusion Applies -
<br /> Add'1 The City of Redwood City, its council members, officers, boards, commissions, employees and agents
<br /> Interests:
<br /> Forms: VEN02211 1007, CG2012 0509, CG2010 0413, CO2037-0704, VEN10402 1107
<br /> CERTIFICATE HOLDER CANCELLATION
<br /> SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
<br /> THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
<br /> City of Redwood City ACCORDANCE WITH THE POLICY PROVISIONS.
<br /> Engineering & Construction
<br /> P.O. Box 391 AUTHORIZED REPRESENTATIVE
<br /> N
<br /> Redwood City, CA 94064 ( a..-(� �' (
<br /> © 1988.2010 ACORD CORPORATION. All rights reserved.
<br /> ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
<br />
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