HomeMy WebLinkAboutCOI - KB Home South Bay Inc. - Expires 2023-03-01a� �® CERTIFICATE OF LIABILITY INSURANCE
(MIWDD
DATE
3/1/ 02P Y)
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 endomement(s).
PRODUCER
Los Angeles-Alllant Insurance S
333 S Hope St Ste 3750
Angeles CA 90071
CONTACT
Nanette Valle
FNAMNE FAX
AIC No :
E MA LLos
DDREss: nvalie aliiant.com
AFFORDING COVERAGE
NAICL
FG1L=ROYCITYCLERKS
INSURER A: Star' Indemnl & Liabili CO
38318
�oA�INSURERS
INSURED KSHOMEO-01
KB Home South Bay Inc. OFFICE
5000 Executive Pkwy Ste. 125
INSURER B: Old Re ubiic Insurance Com an
24147
INSURERC:
INSURERD:
San Ramon, CA 94583
INSURER E :
INSURER F:
COVERAGES CERTIFICATE NUMBER: 1981668802 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.
INSR
LTR
OF INSURANCE
ADDLTYPE
INSD
SUER
POUCYNUMBER
MMIDDNYYPOLICYEF
MOWODOOYEXP
LIMITS
B
X
COMMERCIALGENERALLIABILITY
MWZY311986-22
3/1/2022
3/1/2023
EACH OCCURRENCE
$1.000.000
CLAIMS -MADE � OCCUR
GE TO RED
PREMISES Me occaNTEmnance)$500.000
MED EXP (Any one non)
$ 5,000
PERSONAL& ADV INJURY
$1,000,000
BERL
AGGREGATE LIMIT APPLIES PER:
GENERAL AGGREGATE
$2,000.000
X
PRO -
POLICY JEC- ❑ LOC
PRODUCTS -COMP/OPAGG
$2,000,000
$
OTHER:
,
AUTOMOSILELULBILITY
COMBINED SINGLE LIMIT
Es accident
$
BODILY INJURY (Per person)
$
ANY AUTO
OWNED SCHEDULED
AUTOS ONLY AUTOS
BODILY INJURY (Per accident)
$
PROPERTYDAMAGE
Per accident
$
HIRED NON -OWNED
AUTOS ONLY AUTOS ONLY
$
UMBRELLALIAB
OCCUR
EACH OCCURRENCE
$
AGGREGATE
$
EXCESS LIAR
CLAIMS -MADE
DED I I RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYERS'UASILITY YI
ANYPROPRIETORIPARTNERIEXECUTNE ❑NN
OFFICERIMEMBEREXCLUDED?
NIA
1000001836
8/31/2021
8/31/2022
X STATUTE ER
E.L. EACH ACCIDENT
$1,000,000
(Mandatory In NH)
E.L. DISEASE -EA EMPLOYEE
$1,000,000
Ir yes, aasaibe anaer
DESCRIPTION OF OPERATIONS below
E.L. DISEASE -PODGY LIMIT
$1,000.000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may 1,e attached it 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.
Gilroy CA 95020
AUTHORREDREPRESENTATIVE
Y� / /`
h mot-`
ACORD 25 (2016103)
01988-2015 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD