Loading...
HomeMy WebLinkAboutComcast (4)A'I"Rpr CERTIFICATE OF LIABILITY INSURANC INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS DATE(MM/DD/YYYY) l`® }f INSR LTR 11!27/2020 THIS ATE IS AS A R OF INFORMATION AND CONFERS NO RIGHTTIFICABY CDOES CERTIFICATE NOT AFFIRMATIVELY VELYEOR NEGATIVELY AMEND, EXTEND OR ALTER COVER�4 A -F O THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEi,J® HEt ISSUING INER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. Q W Qi /f .. A IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have ADDITIONAL INSU 0rbVrdIbWbr 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). 12101/2021 PRODUCER MARSH USA INC. 1717 Arch Street Philadelphia, PA 19103-2797 Attn: Comcast.Certs@marsh.com Fax: 212-948-0360 CONTACT NAME: AX A/�Nr o Ext):ICNo AUDRIEss: INSURER(S) AFFORDING COVERAGE NAIC # MED EXP (Any one person) $ 10,000 INSURER A: ACE American Insurance Company _ 22667 INSURED COMCAST OF CAL IFORNIAIOHIOIPENNSYLVANIAI INSURER B: Indemnity Ins Cc Of North America 43575 INSURER C : ACE Property And Casualty Ins Cc 20699 UTAHANASHINGTON, INC. 12647 ALCOSTA BLVD., SUITE 200 P.O. BOX 5147 INSURER D : ACE Fire Underwriters Ins. Co. 20702 INSURER E : SAN RAMON, CA 94583 INSURER F: PRODUCTS -COMP/OP AGG $ 15,000,000 $ COVERAGES CERTIFICATE NUMBER- Cl F-0054A3o6A-99 RF\/ICInAI All IMR1=0. 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 J= SUER WVD POLICY_NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR XSLG71447510 12/01/2020 12101/2021 EACH OCCURRENCE $ 14,900,000 DAMAGE TO RENTED PREMISES Ea occurrence $ 14,900,000 X SIR: $100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 14,900,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY F]PRO- ❑ JECT LOC GENERAL AGGREGATE $ 60,000,000 PRODUCTS -COMP/OP AGG $ 15,000,000 $ OTHER: A AUTOMOBILE LIABILITY ISAh125305590 12101/2020 12/01/2021 COMBINED SINGLE LIMIT $ 15,000,000 Ea accident X ANY AUTO BODILY INJURY (Per person) $ OWNEDSCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE ccident $ Per accident) X UMBRELLA LIAB X OCCUR XEU 627924840 006 12/0112020 1210112021 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS -MADE DED I I RETENTION $ $ B A D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? � (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WLR 067458928 (AOS) WLR 067458965 CA, MA ( )2,000,000 SCF 067459040 (WI) 1210112020 1210112020 12/01/2021 12101/2021 12101/2021 X PER OTH- STATUTE I ER E. L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 A Excess Workers Compensation WCU C67459003 (WA) 12101/2020 12101/2021 Ea Acc/Dis Employee/Dis Polic 2,000,000 SIR 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) CERTIFICATE HOLDER IS INCLUDED AS ADDITIONAL INSURED WITH RESPECT TO GENERAL LIABILITY POLICY AND AUTOMOBILE LIABILITY POLICY WHERE REQUIRED BY WRITTEN CONTRACT WITH THE NAMED INSURED. CFRTIFICATF_ HOLDF_R (ANCIPl I ATlntd TOWN OF LOS ALTOS HILLS, CALIFORNIA SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: CITY MANAGER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26379 FREEMONT ROAD ACCORDANCE WITH THE POLICY PROVISIONS. LOS ALTOS HILLS, CA 94022 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee U 1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD Dear Certificate Flcalder. As many companies have moved to a remote working environment, mailing Certificates of Insurance to a physical address can cause unnecessary delays in providing you proof of insurance, To streamline delivery and in an effort to support our firm's commitment to sustainability, going forward, We Would like to distribute your Certificates of insurance electronicaliyif passible,. We are kindly requesting Certificate Holders provide us an email address where we can deliver your COIin the future,. Please sear your response to: and provide the following informati on so that we can expedite your CCI delivery. • Certificate # (:Shown below insured Name — e.g.: ABC -123456789-01) • E -Mail for future delivery. For undeliverable email addre sses, our systema is configured to automatically redirect the Certificate for deliveryvia USPS, Lastly, if you no longer need this COI please respond to with the Certificate number and we will inactive the record in our system to avoid future automatic delivery. Thank you, US Operations, Marsh USA, Inc, 0000922 SP 0660 -C01 -P00922-1 TOWN OF LOS ALTOS HILLS, CALIFORNIA ATTN: CITY MANAGER 26379 FREEMONT ROAD LOS ALTOS HILLS, CA 94022 ACCW?aCERTIFICATE OF LIABILITY INSURA �' DATE IMM/DD/YYYY) 11/27/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS P-OWfI49 dtlRLT*WATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE CO GE �iQ�FFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN T CSSTJIhJ0@§URER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. POLICY NUMBER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must have AD11� �� �ts or be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an end�t' IVL A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). X PRODUCER MARSH USA INC. 1717 Arch Street Philadelphia, PA 19103-2797 Attn: Comcast.Certs@marsh.com Fax: 212-948-0360 CONTACT NAME: PHONEo Ex FAX No): L-mAILss: EACH OCCURRENCE INSURERS AFFORDING COVERAGE NAIC # INSURER A : ACE American Insurance Company 22667 INSURED COMCAST OF CALIFORNIA/OHIO/PENNSYLVANIA/ INSURER B : Indemni Ins Cc Of North America 43575 INSURER C : ACE Property And Casualty Ins Cc 20699 UTAHANASHINGTON, INC. 12647 ALCOSTA BLVD., SUITE 200 P.O. BOX 5147 INSURER D : ACE Fire Underwriters Ins. Co. 20702 INSURER E: PERSONAL & ADV INJURY SAN RAMON, CA 94583 INSURER F: COVERAGES CERTIFICATE NUMBER: CLE -005483718-24 REVISION Nt1MRFR- 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. NR IL_LICY TR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER M� DD YYYLICY Y EXP MM/DD Y YY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR XS G71447510 1210112020 12/01/2021 EACH OCCURRENCE $ 14,900,000 DAMAGE TO RENTED PREMISES (Ea occurrence) $ 14,900,000 X SIR: $100,000 MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 14,900,000 AGGREGATE LIMIT APPLIES PER: ❑ POLICY PRO- JECT ❑ LOC GENERAL AGGREGATE $ 60,000,000 GENT X PRODUCTS -COMP/OP AGG $ 15,000,000 $ OTHER: A AUTOMOBILE LIABILITY ISAH25305590 12101/2020 12101/2021 COMBINED SINGLE LIMIT Ea accident $ 15,000,000 X ANY AUTO BODILY INJURY (Per person) $ OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY Per accident ( ) $ HIRED NON -OWNED AUTOS ONLY AUTOS ONLY PROPERTY DAMAGE Per accident $ X UMBRELLA LIAB X OCCUR XEU G27924840 006 12/01/2020 12/01/2021 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 EXCESS LIAB CLAIMS MADE DED I I RETENTION $ $ B A D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNERIEXECUTIVE OFFICER/M EM BER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A WLR C67458928 (AOS) WLR 067458965 ( ) CA, MA SCF 067459040 (WI) 12101/2020 1210112020 12/01/2021 12101/2021 12/0112021 X I PER OTH- STATUTE ER E. L. EACH ACCIDENT $ 2,000,000 E. L. DISEASE - EA EMPLOYEE $ 2,000,000 E.L. DISEASE - POLICY LIMIT $ 2,000,000 A Excess Workers CompensationWCU 067459003 (WA) 12/01/2020 12/01/2021 Ea Acc/Dis Employee/Dis Polic 2,000,000 SIR 5,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) CERTIFICATE HOLDER CANCFI_t ATInN TOWN OF LOS ALTOS HILLS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ATTN: CITY MANAGER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 26379 FREEMONT ROAD ACCORDANCE WITH THE POLICY PROVISIONS. LOS ALTOS HILLS, CA 94022 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2016 ACORD CORPORATION. All rights reserved. ACORD 26 (2016/03) The ACORD name and logo are registered marks of ACORD Gear Certificate holder; As many companies have moved to a remote workin anviror meat, mailing Certificates of Insurance to a physical address can cause unnecessary delays in providing you proof of Insurance, To streamline delivery and in an effort to support our firm's commitment to sustainability, going forward, we would like to distribute your Certificates of Insurance electronically if possible, We are Kindly requesting Certificate Holders, provide us an email address where we can deliver your COI in the future. Please send your rasPonse to I _00 era: s.email �x`�rraarsi�,ccarri and provide thefollowing information so that we can expedite year COI delivery. • Certificate # (shown bolra insured Marne —e...: ABC -123456789-01) • E -Mail for future delivery;. car undeliverable entail addresses, our system is configured to automatically redirect the Certificate for d:eliveryvia USPS, Lastly, if you no longer need this Ctrl please respond to tl �� rations, retail ¢� rrt<�rsh,.� cant with the Certificate number and we will inactive the record in out, system to avoid future automatic delivery. Thank you, US Operations, rations, ie arsh USA, Inc:.. 0000931 SP 0660 -C01 -P00931.1 TOWN OF LOS ALTOS HILLS ATTN: CITY MANAGER 26379 FREEMONT ROAD LOS ALTOS HILLS, CA 94022 is.