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HomeMy WebLinkAboutCertificate of Insurance (2)GLADGOV-01 SGONZALEZ CERTIFICATE OF LIABILITY INSURANCE DATEiMM/DD/YYYY) 10/13/2020 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 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 License # 0757776 NAME: DT Jordan Bartleson HUB International Insurance Services Inc. 3390 University Avenue Suite 300 PHONE Ax (A/C, No, Ext): (951) 779-8575 (A/C, No):(951) 231-2572 Ar MAIL cal.cpu@hubinternational.com Riverside, CA 92501 INSURERS AFFORDING COVERAGE NAIC # INSURER A: Sentinel Insurance Company. Ltd. 11000 INSURED INSURER B: Hartford Accident and Indemnity Company 22357 INSURERC:United States Liability Insurance 25895 Gladwell Governmental Services, Inc. INSURER D: P.O. BOX 62 Lake Arrowhead, CA 92352 INSURER E INSURER F: 10/31GETORENTED COVERAGES CERTIFICATE NUMBER: 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. IL SR TYPE OF INSURANCE ?DDp WVDSUBR POLICY NUMBER POLICY EFF fYYYYl Exp POLICT 'Do' YY LIMITS A X COMMERCIAL GENERAL LIABILITY OCCURRENCE $ 1,000,000 CLAIMS -MADE X OCCUR XISES 72SBAlBB623 10/31/2020 10/31GETORENTED 1,000,000 Eaoccurrence $ EXP An one erson $ 10,000 ONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ 2,000,000 POLICYFX] JECT F LOC PRODUCTS -COMP/OP AGG $ 2,000,000 $ OTHER: B AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 Ea accident $ BODILY INJURY Per person)$ X ANY AUTO 72UECPT0490 10/31/2020 10/31/2021 BODILY INJURY Per accident $ OWNED SCHEDULED AUTOS ONLY AUTOS P�20PERTY DAMAGE er accident $ AUTOS ONLY AUTOS ONLY UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L, EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? ❑ (Mandatory m NH) N/A E.L. DISEASE - EA EMPLOYE $ If yes, describe under DESCRIPTION OF OPERATIONS below I E.L. DISEASE - POLICY LIMIT $ C Professional Liab SP 1020956J 10/31/2020 10/31/2021 Per Occurence 1,000,000 C Professional Liab SP 1020955J 10/31/2020 10/31/2021 Aggregate 2,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Town of Los Altos Hills is Additional Insured with regard to the General Liability policy when required by written contract per the attached endorsement form IH12001185T. CERTIFICATE HOLDER CANCELLATION ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of Los Altos Hills THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, Attn: Deborah Padovan, City Clerk 26379 Fremont Road AUTHORIZED REPRESENTATIVE Los Altos Hills, CA 94022 ACORD 25 (2016/03) ©1988-2015 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD POLICY NUMBER: 72 SBA IB5623 THIS ENDORSEMENT CHANGES THE POLICY. PLEASE READ IT CAREFULLY. ADDITIONAL INSURED - PERSON -ORGANIZATION CITY OF SAN MARCOS AND ITS ELECTED AND APPOINTED BOARDS, OFFICERS, AGENTS AND EMPLOYEES PRIMARY NON-CONTRIBUTORY BASIS CITY CLERK DEPARTMENT 1 CIVIC CENTER DRIVE SAN MARCOS, CA 92069-2918 RE: LOC 001 BLDG 001. CITY OF SANTA ROSA ATTENTION: CITY CLERK 100 SANTA ROSA AVE, ROOM 10 SANTA ROSA, CA 95404 CITY OF SAN GABRIEL 425 SOUTH MISSION DR. SAN GABRIEL, CA 91778 LOC 001 BLDG 001 CITY OF MERCED ATTENTION: INFORMATION TECHNOLOGY 678 18TH ST. MERCED, CA 95340 LOC 001 BLDG 001 CITY OF BEVERLY HILLS 455 N. REDFORD DR. BEVERLY HILLS, CA 92352-0062 TOWN OF LOS ALTOS HILLS 26379 FREMONT ROAD LOS ALTOS HILLS, CA 94022 CITY OF EL CAJON ATTN: KATHIE RUTLEDGE, CITY CL 200 CIVIC CENTER WAY EL CAJON, CA 92020-3916 Form IH 1200 11 85 T SEQ. NO. 005 Printed in U.S.A. Page 001 (CONTINUED ON NEXT PAGE) Process Date: 08/12/20 Expiration Date: 10/31/21