HomeMy WebLinkAboutCertificate of Insurance (2)AC4OR6r CERTIFICATE OF LIABILITY INSURANCE
FDATE(MM/DD/YYYY)
16.
3/28/2019
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(les) must 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 Moira Crosby
Hays Companies Inc.
133 Federal Street, 4th Floor
PHONE FAX
_(A/C. No, Ext): (A/C. IN
E-MAIL
DDRESS: Y Yatom mcrosb @ha anies.com
AP
INSURERS AFFORDING COVERAGE NAIC #
Boston MA 02110
INSURER A:Hartford Fire Insurance Company 19682
INSURED
INSURER B:HartfOrd Casualty Insurance Company 29424
Tyler Technologies, Inc.
5101 Tennyson Parkway
INSURERC:Lloyds of London Syndicates 048337 &
INSURER D: 048945
INSURER E :
MED EXP (Any one person)
Plano TX 75024
INSURER F:
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
TYPE OF INSURANCE
ADDL
SUBR
POLICY NUMBER
POLICY EFF
MM/DD/YYYY1
POLICY EXP
fMM/DD/YYYYJ
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
EACH OCCURRENCE
$ 1,000,000
DAMAGE TO RENTED
PREMISES (Ea occurrence)
$ 11000,000
MED EXP (Any one person)
$ 10,000
08URNAY8572
4/1/2019
4/1/2020
PERSONAL &ADV INJURY
$ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY PRO- ❑
JECT LOC
GENERAL AGGREGATE
$ 2,000,000
PRODUCTS - COMP/OPAGG
$ 2,000,000
$
OTHER:
AUTOMOBILE
LIABILITY
CO BINEtDSINGLE LIMIT
$ 11000,000
A
X
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
08UENAY8572
4 1/2019
/
4/1/2020
BODILY INJURY (Per person)
$
BODILY INJURY Per accident
( )
$
HIRED AUTOS X NON -OWNED
AUTOS
X
PROPERTY DAMAGE
Per accident
$
X
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE
$ 25, 000, 000
B
EXCESS LIAB
CLAIMS -MADE
AGGREGATE
$ 25, 000, 000
DED I RETENTION$
$
OBXHUAZ8392
4/1/2019
4/1/2020
B
WORKERS COMPENSATIONX
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
N/A
OGWEEL5271
4/1/2019
4/1/2020
PER OTH-
STATUTE ER
E.L. EACH ACCIDENT
$ 1,000,000
E.L. DISEASE - EA EMPLOYE
$ 1,000,000
E.L. DISEASE - POLICY LIMIT
$ 11000,000
DESCRIPTION OF OPERATIONS below
C
Cyber/Privacy Prof Liab
B0621PTYLE000218
12/17/2018
12/17/2019
Occurence Limit $20,000,000
C
Cyber/Privacy Prof Liab
B0621PTYLE000318
12/17/2018
12/18/2019
Aggregate Limit $20,000,000
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required)
Certificate holder its officers officials employees and volunteers are included as additional insureds
on a primary and non-contributory basis under the general and automobile liability policies when required
by written contract. Waiver of subrogation applied under the workers' compensation policy in favor of the
additional insureds.
Town of Los Altos Hills, CA
Nick Pegueros
26379 Fremont Road
Los Altos Hills, CA 94022
yM114VGLLFI 1 Rill
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
S Hays/MCROSB
'J 1asu-YU94 ACORU CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD