Loading...
HomeMy WebLinkAboutCOI - KB Home South Bay Inc. - Expires 2021-03-01Ac o® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 12/26/2019 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 CONTACT NAME: Nanette Valle Los Angeles-Alliant Insurance Services, Inc. PHONE FAX 333 S Hope St Ste 3750 (Arc No, Extl�__ �(A/C, No):E-M Los Angeles CA 90071 ADDRESS: nvalle@alliant.com INSURERJS) AFFORDING COVERAGE NAIC # - _ License#: OC36861 INSURER A: Starr Indemnity & Liability Co 38318 INSURED KBHOMEO-01 INSURER B : Old Republic Insurance COm any 24147 KB Home South Bay Inc. 5000 Executive Pkwy Ste. 125 INSURER C : San Ramon, CA 94583 INSURER D : _ INSURER E : INSURER F : COVERAGES CERTIFICATE NUMRFR* 117R17RQA RFVISION NIIMRFR- 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. POLICY EFF POLICY EXP NSR f TYPE OF INSURANCE INSD $UBR� POLICY NUMBER MMI DfYY LT LTR YY MMl DIYYYY LIMITS B X COMMERCIAL GENERAL LIABILITY MWZY 311986-19 12/31/2019 1 3/1/2021 1 EACH OCCURRENCE $ 1,000,000 CLAIMS -MADE x OCCUR DAMAGE TO RENTED PREMISES (Ea occurrencM_ S 500,000 MED EXP (Any one person) $ 5,000 — PERSONAL & ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER AGGREGATE $ 1,000,000 X — JECT POLICY PRO LOC _GENERAL PRODUCTS - COMP/OP AGG $ 1,000,000 — - OTHER: $ AUTOMOBILE LIABILITY __(Ea COMBINED SINGLE LIMIT S accident) ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY (Per accident) S HIRED NON -OWNED PROPERTY DAMAGE $ _ AUTOS ONLY ^' AUTOS ONLY (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ _ EXCESS LIAB CLAIMS -MADE AGGREGATE $ DED RETENTION $ $ A WORKERS COMPENSATION 1000001836 8/31/2019 8/31/2020 X STATUTE ERH AND EMPLOYERS' LIABILITY YIN -- ANYPROPRIETOR/PARTNER/EXECUTIVE N E.L. EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? I NIA I (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under - DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / 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 CANCELLATION 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 7351 Rosanna St. AUTHORIZED REPRESENTATIVE Gilroy CA 95020 ` ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016103) The ACORD name and logo are registered marks of ACORD