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6.C. - Page 39 of 57
<br />309673
<br />CERTIFICATE OF LIABILITY INSURANCE07/282015
<br />DATE YYYY)
<br />07/28/2015
<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) most 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
<br />John O. Bronson Co. A Division of HUB International / 410757776
<br />3636 American River Drive Suite 200
<br />Sacramento, CA 95864
<br />O
<br />CNAMTACT
<br />E; Michelle Robinson
<br />PHONE FAX
<br />c 916-480-4158 Arc No): 916-993-7259
<br />E-MAIL
<br />ADDRESS: Michelle.Robinsan(ohubintemational,com
<br />INSURER(S) AFFORDING COVERAGE NAIC #
<br />916-974-7800
<br />INSURER A : United Specialty ins Co (RT Specialty, San Francisco) 12537
<br />INSURED Zakskom Construction Company dba ICON Builders
<br />INSURER 8: Navigators Ins Co RTSpecialty, San Francisca CA)_42307
<br />INSURER C : State Compensation Insurance Fund of Califomia 35076
<br />780 West Grand Avenue
<br />Oakland, CA 9€612
<br />INSURER D :
<br />INSURERE:
<br />INSURER F :
<br />7/15/15
<br />COVERAGES CERTIFICATE NUMBER:21.590 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
<br />LTR
<br />TYPE OF INSURANCE
<br />ADDL
<br />S
<br />SUBR
<br />WVD
<br />POLICY NUMBER
<br />POLICY EFF
<br />MMIDDNYYn,
<br />POLICY EXP
<br />(MMIDDIYYYYj
<br />LIMITS
<br />GENERAL LIABILITY
<br />EACH OCCURRENCE $ 1,000,000
<br />X COMMERCIAL GENERAL LIABILITY
<br />BT01547816
<br />7/15/15
<br />7/15/16
<br />DAMAGE TO RENTED 50,000
<br />PREMISES Era occurrence $
<br />MED EXP (Any one person) $ Excluded
<br />CLAIMS -MADE 111 OCCUR
<br />PERSONAL & ADV INJURY $ 1,000,000
<br />A
<br />X
<br />GENERAL AGGREGATE $ 2,000,000
<br />GEN'L AGGREGATE LIMIT APPLIES PER:
<br />PRODUCTS - COMPIOP AGG $ 2,000,000
<br />$
<br />POLICY X PR0. JECTLOC
<br />AUTOMOBILE
<br />LIABILITY
<br />COMBINED SINGLE T
<br />Ea acddent
<br />BODILY INJURY (Per person) $
<br />ANY AUTO
<br />BODILY INJURY (Per accident) $
<br />ALL OWNED SCHEDULED
<br />AUTOS NUTOS
<br />ON OWNED
<br />HIREDAUTOS AUTOS
<br />PROPERTY DAMAGE $
<br />Perawident
<br />UMBRELLA UAB}(
<br />OCCUR
<br />EXC7876981V
<br />7/15115
<br />7/15/16
<br />EACH OCCURRENCE $ 10,000,000
<br />AGGREGATE $ 10,000,000
<br />B
<br />X
<br />EXCESS LIAR
<br />CLAIMS -MADE
<br />DED I I RETENTION
<br />-$.
<br />WORKERS COMPENSATION
<br />AND EMPLOYERS'LIABILITY YIN
<br />ANY PROPRIETORIPARTNER/EXECUTIVE
<br />908218315
<br />1/Ot/15
<br />1/01/16
<br />X WCSTATU- OTH-
<br />1 FR
<br />E.L. EACH ACCIDENT $ 1,000,000
<br />C
<br />OFFICERIMEMBER EXCLUDED? ❑
<br />(Mandatory In NH)
<br />NIA
<br />E.L. DISEASE - EA EMPLOYEE $ 1,000,000
<br />E.L. DISEASE - POLICY LIMIT $ 1,000,000
<br />If yes, describe under
<br />DESCRIPTION OF OPERATIONS below
<br />DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
<br />RE, Projec(: Offsite Work Only For Jefferson & Franklin Apartments 103 Wilson Street, Redwood City, CA ICON #3042 GreystarlOff 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: VEN022 t 1 1007, CG2012 0509, CG2010 0413, CG2037-0704, VEN10402 1107
<br />City of Redwood City
<br />Engineering & Construction
<br />P.O. Box 391
<br />Redwood City, CA 94064
<br />C.filVlr�r.i-H I KAM
<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 />AUTHORIZED REPRESENTATIVE
<br />O 1988-2010 ACORD CORPORATION. All rights reserved.
<br />ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 65
<br />
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