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HomeMy WebLinkAboutCOI - KB Home South Bay Inc. - Expires 2019-12-01�1 CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) I 08126/2019 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 rights to the certificate holder in lieu of such endorsement(s). PRODUCER Aon Risk Insurance Services west, Inc. Los Angeles CA office 707 Wilshire Boulevard Suite 2600 CONTACT PHONE FAX (A/C. No. Ext): C866) 283-7122 {Arc. No.: (800) 363-0105 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # LOS Angeles CA 90017-0460 USA INSURED INSURER A: old Republic Insurance Company 24147 KB Home South Bay Inc. 5000 Executive Parkway suite #12 5 INSURER B: Starr Indemnity & Liability Company 38318 INSURER C: INSURERD: San Ramon, CA 94583 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 570077969635 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER IMMIDDIYYYYI IMMIDDrYYYY)LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY EACH OCCURRENCE $1, 000 , 000 CLAIMS -MADE ❑X OCCUR PREMISES Ea occurrence)$ 500 , 000 MED EXP (Any one person) S5,000 PERSONAL & ADV INJURY $1, 000 , 000 GEN'LAGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $1, 000, 000 X POLICY �JERCOT- �LOC. PRODUCTS - COMP/OPAGG $1,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY ( Per person) ANY AUTO BODILY INJURY (Per accident) OWNED SCHEDULED AUTOS ONLY AUTOS HIRED AUTOS NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE DED RETENTION _R B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY N ANY PROPRIETOR / PARTNER / EXECUTIVE YIN 1000001836 08/31/2019 08/31/20120 X STATUTE OTH ER E.L. EACH ACCIDENT S1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) N 1 A E.L. DISEASE -EA EMPLOYEE $1, 000 , 000 If yyes, describe under DnCRIr 1 ION OF OPERATIONS below F I DISEASE-Pnl IrvIMI LT $) , 000 , 000 DESCRIPTION OF OPERATIONS / LOCATIONS 1 VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) RE: Project Description: Oak Place, Tract 10184. City of Gilroy is included as Additional Insured in accordance with the policy provisions of the General Liability policy. A waiver of Subrogation is granted in favor of City of Gilroy in accordance with the policy provisions of the General Liability and workers' Compensation policies. CERTIFICATE HOLDER t= s� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. City of Gilroy AUTHORIZED REPRESENTATIVE 7351 Rosanna St. za Gilroy CA 95020 USA J4'an %�es�e��tanca✓ �u><.uaxr,4 % �e�na ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD CANCELLATION